|
CATH MAHURKAR TRIPLE 12*20
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CATH OPTI-FLOW PRECURVED 45CM
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$949.20 |
| Max. Negotiated Rate |
$3,037.44 |
| Rate for Payer: Aetna Commercial |
$2,436.28
|
| Rate for Payer: Anthem Medicaid |
$1,088.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,467.92
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: Cigna Commercial |
$2,626.12
|
| Rate for Payer: First Health Commercial |
$3,005.80
|
| Rate for Payer: Humana Commercial |
$2,689.40
|
| Rate for Payer: Humana KY Medicaid |
$1,088.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,594.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,784.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.16
|
| Rate for Payer: PHCS Commercial |
$3,037.44
|
| Rate for Payer: United Healthcare All Payer |
$2,784.32
|
|
|
CATH OPTI-FLOW PRECURVED 45CM
|
Facility
|
IP
|
$3,164.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$949.20 |
| Max. Negotiated Rate |
$3,037.44 |
| Rate for Payer: Aetna Commercial |
$2,436.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,467.92
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: Cigna Commercial |
$2,626.12
|
| Rate for Payer: First Health Commercial |
$3,005.80
|
| Rate for Payer: Humana Commercial |
$2,689.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,594.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,784.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.16
|
| Rate for Payer: PHCS Commercial |
$3,037.44
|
| Rate for Payer: United Healthcare All Payer |
$2,784.32
|
|
|
CATH PALINDROME 19CM STR
|
Facility
|
IP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
CATH PALINDROME 19CM STR
|
Facility
|
OP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem Medicaid |
$1,042.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Humana KY Medicaid |
$1,042.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
CATH PALINDROME 23CM STR
|
Facility
|
IP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
CATH PALINDROME 23CM STR
|
Facility
|
OP
|
$3,031.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.38 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Aetna Commercial |
$2,334.06
|
| Rate for Payer: Anthem Medicaid |
$1,042.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.38
|
| Rate for Payer: Cash Price |
$1,515.62
|
| Rate for Payer: Cigna Commercial |
$2,515.94
|
| Rate for Payer: First Health Commercial |
$2,879.69
|
| Rate for Payer: Humana Commercial |
$2,576.56
|
| Rate for Payer: Humana KY Medicaid |
$1,042.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,237.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,091.56
|
| Rate for Payer: PHCS Commercial |
$2,910.00
|
| Rate for Payer: United Healthcare All Payer |
$2,667.50
|
|
|
CATH PALINDROME SILVER ION 44C
|
Facility
|
IP
|
$4,332.17
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,299.65 |
| Max. Negotiated Rate |
$4,158.88 |
| Rate for Payer: Aetna Commercial |
$3,335.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,379.09
|
| Rate for Payer: Cash Price |
$2,166.08
|
| Rate for Payer: Cigna Commercial |
$3,595.70
|
| Rate for Payer: First Health Commercial |
$4,115.56
|
| Rate for Payer: Humana Commercial |
$3,682.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,552.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,197.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,812.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,249.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,465.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,768.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.20
|
| Rate for Payer: PHCS Commercial |
$4,158.88
|
| Rate for Payer: United Healthcare All Payer |
$3,812.31
|
|
|
CATH PALINDROME SILVER ION 44C
|
Facility
|
OP
|
$4,332.17
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,299.65 |
| Max. Negotiated Rate |
$4,158.88 |
| Rate for Payer: Aetna Commercial |
$3,335.77
|
| Rate for Payer: Anthem Medicaid |
$1,489.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,379.09
|
| Rate for Payer: Cash Price |
$2,166.08
|
| Rate for Payer: Cigna Commercial |
$3,595.70
|
| Rate for Payer: First Health Commercial |
$4,115.56
|
| Rate for Payer: Humana Commercial |
$3,682.34
|
| Rate for Payer: Humana KY Medicaid |
$1,489.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,552.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,197.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,519.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,812.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,249.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,465.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,768.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.20
|
| Rate for Payer: PHCS Commercial |
$4,158.88
|
| Rate for Payer: United Healthcare All Payer |
$3,812.31
|
|
|
CATH PATENCY
|
Facility
|
OP
|
$1,097.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$1,053.12 |
| Rate for Payer: Aetna Commercial |
$844.69
|
| Rate for Payer: Anthem Medicaid |
$377.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$910.51
|
| Rate for Payer: First Health Commercial |
$1,042.15
|
| Rate for Payer: Humana Commercial |
$932.45
|
| Rate for Payer: Humana KY Medicaid |
$377.26
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$381.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.36
|
| Rate for Payer: Ohio Health Group HMO |
$822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.93
|
| Rate for Payer: PHCS Commercial |
$1,053.12
|
| Rate for Payer: United Healthcare All Payer |
$965.36
|
|
|
CATH PATENCY
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.10 |
| Max. Negotiated Rate |
$1,053.12 |
| Rate for Payer: Aetna Commercial |
$844.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.66
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$910.51
|
| Rate for Payer: First Health Commercial |
$1,042.15
|
| Rate for Payer: Humana Commercial |
$932.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.36
|
| Rate for Payer: Ohio Health Group HMO |
$822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.93
|
| Rate for Payer: PHCS Commercial |
$1,053.12
|
| Rate for Payer: United Healthcare All Payer |
$965.36
|
|
|
CATH PATENCY
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$658.20 |
| Rate for Payer: Aetna Commercial |
$93.38
|
| Rate for Payer: Ambetter Exchange |
$33.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.85
|
| Rate for Payer: Anthem Medicaid |
$90.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.61
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$154.88
|
| Rate for Payer: Healthspan PPO |
$135.00
|
| Rate for Payer: Humana Medicaid |
$90.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.79
|
| Rate for Payer: Molina Healthcare Passport |
$90.97
|
| Rate for Payer: Multiplan PHCS |
$658.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.91
|
| Rate for Payer: UHCCP Medicaid |
$29.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.01
|
|
|
CATH PATENCY (P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320P1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Aetna Commercial |
$93.38
|
| Rate for Payer: Ambetter Exchange |
$33.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.85
|
| Rate for Payer: Anthem Medicaid |
$90.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.61
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$154.88
|
| Rate for Payer: Healthspan PPO |
$135.00
|
| Rate for Payer: Humana Medicaid |
$90.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.79
|
| Rate for Payer: Molina Healthcare Passport |
$90.97
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.91
|
| Rate for Payer: UHCCP Medicaid |
$29.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.01
|
|
|
CATH PATENCY (T
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320T1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.78
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
CATH PATENCY (T
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320T1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.60 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.78
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
CATH PRUITT OCCLUSION 4FR
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
CATH PRUITT OCCLUSION 4FR
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
CATH PVC SOFT 24FR STR
|
Facility
|
IP
|
$1,190.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,142.78 |
| Rate for Payer: Aetna Commercial |
$916.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.51
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$988.03
|
| Rate for Payer: First Health Commercial |
$1,130.88
|
| Rate for Payer: Humana Commercial |
$1,011.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.55
|
| Rate for Payer: Ohio Health Group HMO |
$892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.38
|
| Rate for Payer: PHCS Commercial |
$1,142.78
|
| Rate for Payer: United Healthcare All Payer |
$1,047.55
|
|
|
CATH PVC SOFT 24FR STR
|
Facility
|
OP
|
$1,190.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$1,142.78 |
| Rate for Payer: Aetna Commercial |
$916.61
|
| Rate for Payer: Anthem Medicaid |
$409.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.51
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$988.03
|
| Rate for Payer: First Health Commercial |
$1,130.88
|
| Rate for Payer: Humana Commercial |
$1,011.84
|
| Rate for Payer: Humana KY Medicaid |
$409.38
|
| Rate for Payer: Kentucky WC Medicaid |
$413.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.55
|
| Rate for Payer: Ohio Health Group HMO |
$892.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.38
|
| Rate for Payer: PHCS Commercial |
$1,142.78
|
| Rate for Payer: United Healthcare All Payer |
$1,047.55
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
48100019
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,908.23 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 SBCLVN OR INNOMIN UNIL
|
Facility
|
IP
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,383.91 |
| Max. Negotiated Rate |
$10,828.51 |
| Rate for Payer: Aetna Commercial |
$8,685.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,798.17
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$9,362.15
|
| Rate for Payer: First Health Commercial |
$10,715.72
|
| Rate for Payer: Humana Commercial |
$9,587.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,249.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,324.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,383.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,926.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,459.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,023.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,813.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,782.99
|
| Rate for Payer: PHCS Commercial |
$10,828.51
|
| Rate for Payer: United Healthcare All Payer |
$9,926.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Professional
|
Both
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$6,767.82 |
| Rate for Payer: Ambetter Exchange |
$311.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.45
|
| Rate for Payer: Anthem Medicaid |
$1,204.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$311.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$311.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$373.25
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$588.27
|
| Rate for Payer: Healthspan PPO |
$1,846.39
|
| Rate for Payer: Humana Medicaid |
$1,204.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$311.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,228.23
|
| Rate for Payer: Molina Healthcare Passport |
$1,204.15
|
| Rate for Payer: Multiplan PHCS |
$6,767.82
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$404.35
|
| Rate for Payer: UHCCP Medicaid |
$193.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,216.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$311.04
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
OP
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$10,828.51 |
| Rate for Payer: Aetna Commercial |
$8,685.37
|
| Rate for Payer: Anthem Medicaid |
$3,879.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,798.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$9,362.15
|
| Rate for Payer: First Health Commercial |
$10,715.72
|
| Rate for Payer: Humana Commercial |
$9,587.75
|
| Rate for Payer: Humana KY Medicaid |
$3,879.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,249.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,324.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,956.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,926.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,459.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,023.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,813.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,782.99
|
| Rate for Payer: PHCS Commercial |
$10,828.51
|
| Rate for Payer: United Healthcare All Payer |
$9,926.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
48100019
|
|
Hospital Revenue Code
|
481
|
| 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 SBCLVN OR INNOMIN UNIL(P
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761P1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Ambetter Exchange |
$311.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.45
|
| Rate for Payer: Anthem Medicaid |
$1,204.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$311.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$311.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$373.25
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$588.27
|
| Rate for Payer: Healthspan PPO |
$1,846.39
|
| Rate for Payer: Humana Medicaid |
$1,204.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$311.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,228.23
|
| Rate for Payer: Molina Healthcare Passport |
$1,204.15
|
| Rate for Payer: Multiplan PHCS |
$1,965.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$404.35
|
| Rate for Payer: UHCCP Medicaid |
$193.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,216.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$311.04
|
|
