|
CATH SBCLVN OR INNOMIN UNIL(T
|
Facility
|
OP
|
$8,004.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761T1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,752.82 |
| Max. Negotiated Rate |
$7,684.51 |
| Rate for Payer: Aetna Commercial |
$6,163.62
|
| Rate for Payer: Anthem Medicaid |
$2,752.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,243.67
|
| 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 |
$4,002.35
|
| Rate for Payer: Cash Price |
$4,002.35
|
| Rate for Payer: Cigna Commercial |
$6,643.90
|
| Rate for Payer: First Health Commercial |
$7,604.47
|
| Rate for Payer: Humana Commercial |
$6,803.99
|
| Rate for Payer: Humana KY Medicaid |
$2,752.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,780.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,563.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,403.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.24
|
| Rate for Payer: PHCS Commercial |
$7,684.51
|
| Rate for Payer: United Healthcare All Payer |
$7,044.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL(T
|
Facility
|
IP
|
$8,004.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761T1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,401.41 |
| Max. Negotiated Rate |
$7,684.51 |
| Rate for Payer: Aetna Commercial |
$6,163.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,243.67
|
| Rate for Payer: Cash Price |
$4,002.35
|
| Rate for Payer: Cigna Commercial |
$6,643.90
|
| Rate for Payer: First Health Commercial |
$7,604.47
|
| Rate for Payer: Humana Commercial |
$6,803.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,563.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,403.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.24
|
| Rate for Payer: PHCS Commercial |
$7,684.51
|
| Rate for Payer: United Healthcare All Payer |
$7,044.14
|
|
|
CATH SPYGLASS DISCOVER IMAGER
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
CATH SPYGLASS DISCOVER IMAGER
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
CATH SPYGLASS DISCOVER T/A
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
CATH SPYGLASS DISCOVER T/A
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
CATH STR 4F 65CM
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
CATH STR 4F 65CM
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
CATH STRAIGHT TENCKHOFF 47CM
|
Facility
|
IP
|
$1,682.13
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.64 |
| Max. Negotiated Rate |
$1,614.84 |
| Rate for Payer: Aetna Commercial |
$1,295.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,312.06
|
| Rate for Payer: Cash Price |
$841.06
|
| Rate for Payer: Cigna Commercial |
$1,396.17
|
| Rate for Payer: First Health Commercial |
$1,598.02
|
| Rate for Payer: Humana Commercial |
$1,429.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.67
|
| Rate for Payer: PHCS Commercial |
$1,614.84
|
| Rate for Payer: United Healthcare All Payer |
$1,480.27
|
|
|
CATH STRAIGHT TENCKHOFF 47CM
|
Facility
|
OP
|
$1,682.13
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.64 |
| Max. Negotiated Rate |
$1,614.84 |
| Rate for Payer: Aetna Commercial |
$1,295.24
|
| Rate for Payer: Anthem Medicaid |
$578.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,312.06
|
| Rate for Payer: Cash Price |
$841.06
|
| Rate for Payer: Cigna Commercial |
$1,396.17
|
| Rate for Payer: First Health Commercial |
$1,598.02
|
| Rate for Payer: Humana Commercial |
$1,429.81
|
| Rate for Payer: Humana KY Medicaid |
$578.48
|
| Rate for Payer: Kentucky WC Medicaid |
$584.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.67
|
| Rate for Payer: PHCS Commercial |
$1,614.84
|
| Rate for Payer: United Healthcare All Payer |
$1,480.27
|
|
|
CATH SUPRAPUBIC INTRODUCER KIT
|
Facility
|
OP
|
$1,531.25
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27000289
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$459.38 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$1,179.06
|
| Rate for Payer: Anthem Medicaid |
$526.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.38
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cigna Commercial |
$1,270.94
|
| Rate for Payer: First Health Commercial |
$1,454.69
|
| Rate for Payer: Humana Commercial |
$1,301.56
|
| Rate for Payer: Humana KY Medicaid |
$526.60
|
| Rate for Payer: Kentucky WC Medicaid |
$531.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,255.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,347.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.56
|
| Rate for Payer: PHCS Commercial |
$1,470.00
|
| Rate for Payer: United Healthcare All Payer |
$1,347.50
|
|
|
CATH SUPRAPUBIC INTRODUCER KIT
|
Facility
|
IP
|
$1,531.25
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27000289
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$459.38 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$1,179.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.38
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cigna Commercial |
$1,270.94
|
| Rate for Payer: First Health Commercial |
$1,454.69
|
| Rate for Payer: Humana Commercial |
$1,301.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,255.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,347.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.56
|
| Rate for Payer: PHCS Commercial |
$1,470.00
|
| Rate for Payer: United Healthcare All Payer |
$1,347.50
|
|
|
CATH SWAN NECK COILED L 62.5CM
|
Facility
|
IP
|
$3,037.70
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$911.31 |
| Max. Negotiated Rate |
$2,916.19 |
| Rate for Payer: Aetna Commercial |
$2,339.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.41
|
| Rate for Payer: Cash Price |
$1,518.85
|
| Rate for Payer: Cigna Commercial |
$2,521.29
|
| Rate for Payer: First Health Commercial |
$2,885.82
|
| Rate for Payer: Humana Commercial |
$2,582.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.01
|
| Rate for Payer: PHCS Commercial |
$2,916.19
|
| Rate for Payer: United Healthcare All Payer |
$2,673.18
|
|
|
CATH SWAN NECK COILED L 62.5CM
|
Facility
|
OP
|
$3,037.70
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$911.31 |
| Max. Negotiated Rate |
$2,916.19 |
| Rate for Payer: Aetna Commercial |
$2,339.03
|
| Rate for Payer: Anthem Medicaid |
$1,044.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.41
|
| Rate for Payer: Cash Price |
$1,518.85
|
| Rate for Payer: Cigna Commercial |
$2,521.29
|
| Rate for Payer: First Health Commercial |
$2,885.82
|
| Rate for Payer: Humana Commercial |
$2,582.05
|
| Rate for Payer: Humana KY Medicaid |
$1,044.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.01
|
| Rate for Payer: PHCS Commercial |
$2,916.19
|
| Rate for Payer: United Healthcare All Payer |
$2,673.18
|
|
|
CATH THORACIC 20FR RT ANGLE
|
Facility
|
IP
|
$445.33
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$427.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.36
|
| Rate for Payer: Cash Price |
$222.67
|
| Rate for Payer: Cigna Commercial |
$369.62
|
| Rate for Payer: First Health Commercial |
$423.06
|
| Rate for Payer: Humana Commercial |
$378.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.89
|
| Rate for Payer: Ohio Health Group HMO |
$334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.28
|
| Rate for Payer: PHCS Commercial |
$427.52
|
| Rate for Payer: United Healthcare All Payer |
$391.89
|
|
|
CATH THORACIC 20FR RT ANGLE
|
Facility
|
OP
|
$445.33
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$427.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Anthem Medicaid |
$153.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.36
|
| Rate for Payer: Cash Price |
$222.67
|
| Rate for Payer: Cigna Commercial |
$369.62
|
| Rate for Payer: First Health Commercial |
$423.06
|
| Rate for Payer: Humana Commercial |
$378.53
|
| Rate for Payer: Humana KY Medicaid |
$153.15
|
| Rate for Payer: Kentucky WC Medicaid |
$154.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.89
|
| Rate for Payer: Ohio Health Group HMO |
$334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.28
|
| Rate for Payer: PHCS Commercial |
$427.52
|
| Rate for Payer: United Healthcare All Payer |
$391.89
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,567.15 |
| Max. Negotiated Rate |
$4,374.72 |
| Rate for Payer: Aetna Commercial |
$3,508.89
|
| Rate for Payer: Anthem Medicaid |
$1,567.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,554.46
|
| 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 |
$2,278.50
|
| Rate for Payer: Cash Price |
$2,278.50
|
| Rate for Payer: Cigna Commercial |
$3,782.31
|
| Rate for Payer: First Health Commercial |
$4,329.15
|
| Rate for Payer: Humana Commercial |
$3,873.45
|
| Rate for Payer: Humana KY Medicaid |
$1,567.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,583.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,736.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,363.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,598.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,010.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,417.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,964.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,144.33
|
| Rate for Payer: PHCS Commercial |
$4,374.72
|
| Rate for Payer: United Healthcare All Payer |
$4,010.16
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Professional
|
Both
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$5,307.65 |
| Rate for Payer: Ambetter Exchange |
$187.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.47
|
| Rate for Payer: Anthem Medicaid |
$888.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.23
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$404.58
|
| Rate for Payer: Healthspan PPO |
$1,363.98
|
| Rate for Payer: Humana Medicaid |
$888.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$906.38
|
| Rate for Payer: Molina Healthcare Passport |
$888.61
|
| Rate for Payer: Multiplan PHCS |
$5,307.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.00
|
| Rate for Payer: UHCCP Medicaid |
$133.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$897.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.69
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
OP
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$8,492.24 |
| Rate for Payer: Aetna Commercial |
$6,811.48
|
| Rate for Payer: Anthem Medicaid |
$3,042.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,899.94
|
| 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 |
$4,423.04
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$7,342.25
|
| Rate for Payer: First Health Commercial |
$8,403.78
|
| Rate for Payer: Humana Commercial |
$7,519.17
|
| Rate for Payer: Humana KY Medicaid |
$3,042.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.80
|
| Rate for Payer: PHCS Commercial |
$8,492.24
|
| Rate for Payer: United Healthcare All Payer |
$7,784.55
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$4,374.72 |
| Rate for Payer: Aetna Commercial |
$3,508.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,554.46
|
| Rate for Payer: Cash Price |
$2,278.50
|
| Rate for Payer: Cigna Commercial |
$3,782.31
|
| Rate for Payer: First Health Commercial |
$4,329.15
|
| Rate for Payer: Humana Commercial |
$3,873.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,736.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,363.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,010.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,417.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,964.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,144.33
|
| Rate for Payer: PHCS Commercial |
$4,374.72
|
| Rate for Payer: United Healthcare All Payer |
$4,010.16
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
IP
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,653.82 |
| Max. Negotiated Rate |
$8,492.24 |
| Rate for Payer: Aetna Commercial |
$6,811.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,899.94
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$7,342.25
|
| Rate for Payer: First Health Commercial |
$8,403.78
|
| Rate for Payer: Humana Commercial |
$7,519.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.80
|
| Rate for Payer: PHCS Commercial |
$8,492.24
|
| Rate for Payer: United Healthcare All Payer |
$7,784.55
|
|
|
CATH THOR AORTA/INTRACRAN VS(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761P1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$1,363.98 |
| Rate for Payer: Ambetter Exchange |
$187.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.47
|
| Rate for Payer: Anthem Medicaid |
$888.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.23
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$404.58
|
| Rate for Payer: Healthspan PPO |
$1,363.98
|
| Rate for Payer: Humana Medicaid |
$888.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$906.38
|
| Rate for Payer: Molina Healthcare Passport |
$888.61
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.00
|
| Rate for Payer: UHCCP Medicaid |
$133.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$897.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.69
|
|
|
CATH THOR AORTA/INTRACRAN VS(T
|
Facility
|
OP
|
$7,246.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761T1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,491.93 |
| Max. Negotiated Rate |
$6,956.24 |
| Rate for Payer: Aetna Commercial |
$5,579.48
|
| Rate for Payer: Anthem Medicaid |
$2,491.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.94
|
| 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 |
$3,623.04
|
| Rate for Payer: Cash Price |
$3,623.04
|
| Rate for Payer: Cigna Commercial |
$6,014.25
|
| Rate for Payer: First Health Commercial |
$6,883.78
|
| Rate for Payer: Humana Commercial |
$6,159.17
|
| Rate for Payer: Humana KY Medicaid |
$2,491.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,517.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,941.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,347.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,541.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,376.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,434.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,796.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,304.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.80
|
| Rate for Payer: PHCS Commercial |
$6,956.24
|
| Rate for Payer: United Healthcare All Payer |
$6,376.55
|
|
|
CATH THOR AORTA/INTRACRAN VS(T
|
Facility
|
IP
|
$7,246.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761T1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,173.82 |
| Max. Negotiated Rate |
$6,956.24 |
| Rate for Payer: Aetna Commercial |
$5,579.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.94
|
| Rate for Payer: Cash Price |
$3,623.04
|
| Rate for Payer: Cigna Commercial |
$6,014.25
|
| Rate for Payer: First Health Commercial |
$6,883.78
|
| Rate for Payer: Humana Commercial |
$6,159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,941.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,347.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,376.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,434.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,796.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,304.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.80
|
| Rate for Payer: PHCS Commercial |
$6,956.24
|
| Rate for Payer: United Healthcare All Payer |
$6,376.55
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
OP
|
$14,444.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,967.29 |
| Max. Negotiated Rate |
$13,866.24 |
| Rate for Payer: Aetna Commercial |
$11,121.88
|
| Rate for Payer: Anthem Medicaid |
$4,967.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,266.32
|
| 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 |
$7,222.00
|
| Rate for Payer: Cash Price |
$7,222.00
|
| Rate for Payer: Cigna Commercial |
$11,988.52
|
| Rate for Payer: First Health Commercial |
$13,721.80
|
| Rate for Payer: Humana Commercial |
$12,277.40
|
| Rate for Payer: Humana KY Medicaid |
$4,967.29
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$5,017.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,844.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,659.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,066.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,710.72
|
| Rate for Payer: Ohio Health Group HMO |
$10,833.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,566.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,966.36
|
| Rate for Payer: PHCS Commercial |
$13,866.24
|
| Rate for Payer: United Healthcare All Payer |
$12,710.72
|
|
