|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
IP
|
$14,444.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,333.20 |
| Max. Negotiated Rate |
$13,866.24 |
| Rate for Payer: Aetna Commercial |
$11,121.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,266.32
|
| 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: 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 |
$4,333.20
|
| 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
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
OP
|
$12,975.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,462.10 |
| Max. Negotiated Rate |
$12,456.00 |
| Rate for Payer: Aetna Commercial |
$9,990.75
|
| Rate for Payer: Anthem Medicaid |
$4,462.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,120.50
|
| 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 |
$6,487.50
|
| Rate for Payer: Cash Price |
$6,487.50
|
| Rate for Payer: Cigna Commercial |
$10,769.25
|
| Rate for Payer: First Health Commercial |
$12,326.25
|
| Rate for Payer: Humana Commercial |
$11,028.75
|
| Rate for Payer: Humana KY Medicaid |
$4,462.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,507.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,639.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,575.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,551.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,418.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,288.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,952.75
|
| Rate for Payer: PHCS Commercial |
$12,456.00
|
| Rate for Payer: United Healthcare All Payer |
$11,418.00
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
IP
|
$12,975.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,892.50 |
| Max. Negotiated Rate |
$12,456.00 |
| Rate for Payer: Aetna Commercial |
$9,990.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,120.50
|
| Rate for Payer: Cash Price |
$6,487.50
|
| Rate for Payer: Cigna Commercial |
$10,769.25
|
| Rate for Payer: First Health Commercial |
$12,326.25
|
| Rate for Payer: Humana Commercial |
$11,028.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,639.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,575.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,418.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,288.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,952.75
|
| Rate for Payer: PHCS Commercial |
$12,456.00
|
| Rate for Payer: United Healthcare All Payer |
$11,418.00
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Professional
|
Both
|
$14,444.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$8,666.40 |
| Rate for Payer: Ambetter Exchange |
$348.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.68
|
| Rate for Payer: Anthem Medicaid |
$1,345.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.15
|
| Rate for Payer: Cash Price |
$7,222.00
|
| Rate for Payer: Cash Price |
$7,222.00
|
| Rate for Payer: Cigna Commercial |
$644.17
|
| Rate for Payer: Healthspan PPO |
$2,061.32
|
| Rate for Payer: Humana Medicaid |
$1,345.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$348.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,371.90
|
| Rate for Payer: Molina Healthcare Passport |
$1,345.00
|
| Rate for Payer: Multiplan PHCS |
$8,666.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.00
|
| Rate for Payer: UHCCP Medicaid |
$211.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,358.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.46
|
|
|
CATH VERTIBRAL ART UNILATERA(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761P1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$2,061.32 |
| Rate for Payer: Ambetter Exchange |
$348.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.68
|
| Rate for Payer: Anthem Medicaid |
$1,345.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.15
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$644.17
|
| Rate for Payer: Healthspan PPO |
$2,061.32
|
| Rate for Payer: Humana Medicaid |
$1,345.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$348.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,371.90
|
| Rate for Payer: Molina Healthcare Passport |
$1,345.00
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.00
|
| Rate for Payer: UHCCP Medicaid |
$211.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,358.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.46
|
|
|
CATH VERTIBRAL ART UNILATERA(T
|
Facility
|
OP
|
$11,944.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761T1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,107.54 |
| Max. Negotiated Rate |
$11,466.24 |
| Rate for Payer: Aetna Commercial |
$9,196.88
|
| Rate for Payer: Anthem Medicaid |
$4,107.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,316.32
|
| 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 |
$5,972.00
|
| Rate for Payer: Cash Price |
$5,972.00
|
| Rate for Payer: Cigna Commercial |
$9,913.52
|
| Rate for Payer: First Health Commercial |
$11,346.80
|
| Rate for Payer: Humana Commercial |
$10,152.40
|
| Rate for Payer: Humana KY Medicaid |
$4,107.54
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,149.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,794.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,814.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,189.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,510.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,391.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,241.36
|
| Rate for Payer: PHCS Commercial |
$11,466.24
|
| Rate for Payer: United Healthcare All Payer |
$10,510.72
|
|
|
CATH VERTIBRAL ART UNILATERA(T
|
Facility
|
IP
|
$11,944.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761T1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,583.20 |
| Max. Negotiated Rate |
$11,466.24 |
| Rate for Payer: Aetna Commercial |
$9,196.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,316.32
|
| Rate for Payer: Cash Price |
$5,972.00
|
| Rate for Payer: Cigna Commercial |
$9,913.52
|
| Rate for Payer: First Health Commercial |
$11,346.80
|
| Rate for Payer: Humana Commercial |
$10,152.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,794.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,814.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,583.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,510.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,391.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,241.36
|
| Rate for Payer: PHCS Commercial |
$11,466.24
|
| Rate for Payer: United Healthcare All Payer |
$10,510.72
|
|
|
CATH XPEEDIOR 4FR*135CM
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
CATH XPEEDIOR 4FR*135CM
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
CATH XPEEDIOR 6FR*100CM
|
Facility
|
IP
|
$6,850.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,055.22 |
| Max. Negotiated Rate |
$6,576.72 |
| Rate for Payer: Aetna Commercial |
$5,275.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,343.59
|
| Rate for Payer: Cash Price |
$3,425.38
|
| Rate for Payer: Cigna Commercial |
$5,686.12
|
| Rate for Payer: First Health Commercial |
$6,508.21
|
| Rate for Payer: Humana Commercial |
$5,823.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,617.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,055.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,028.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,138.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,480.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,960.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.02
|
| Rate for Payer: PHCS Commercial |
$6,576.72
|
| Rate for Payer: United Healthcare All Payer |
$6,028.66
|
|
|
CATH XPEEDIOR 6FR*100CM
|
Facility
|
OP
|
$6,850.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,055.22 |
| Max. Negotiated Rate |
$6,576.72 |
| Rate for Payer: Aetna Commercial |
$5,275.08
|
| Rate for Payer: Anthem Medicaid |
$2,355.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,343.59
|
| Rate for Payer: Cash Price |
$3,425.38
|
| Rate for Payer: Cigna Commercial |
$5,686.12
|
| Rate for Payer: First Health Commercial |
$6,508.21
|
| Rate for Payer: Humana Commercial |
$5,823.14
|
| Rate for Payer: Humana KY Medicaid |
$2,355.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,379.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,617.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,055.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,403.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,028.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,138.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,480.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,960.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.02
|
| Rate for Payer: PHCS Commercial |
$6,576.72
|
| Rate for Payer: United Healthcare All Payer |
$6,028.66
|
|
|
[C]ATIVAN (LORAZEPAM .5MG/1TAB
|
Facility
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
25000089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$46.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.86
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.08
|
| Rate for Payer: Humana Commercial |
$51.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.87
|
| Rate for Payer: Ohio Health Group HMO |
$45.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| Rate for Payer: PHCS Commercial |
$57.68
|
| Rate for Payer: United Healthcare All Payer |
$52.87
|
|
|
[C]ATIVAN (LORAZEPAM .5MG/1TAB
|
Facility
|
OP
|
$60.08
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
25000089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$46.26
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.86
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.08
|
| Rate for Payer: Humana Commercial |
$51.07
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.87
|
| Rate for Payer: Ohio Health Group HMO |
$45.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| Rate for Payer: PHCS Commercial |
$57.68
|
| Rate for Payer: United Healthcare All Payer |
$52.87
|
|
|
CATS 120 RESERVOIR BIO TRONIC
|
Facility
|
IP
|
$3,650.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
CATS 120 RESERVOIR BIO TRONIC
|
Facility
|
OP
|
$3,650.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Humana KY Medicaid |
$1,255.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Ambetter Exchange |
$120.34
|
| Rate for Payer: Anthem Medicaid |
$136.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$120.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.41
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$283.88
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$120.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.69
|
| Rate for Payer: Molina Healthcare Passport |
$136.95
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$156.44
|
| Rate for Payer: UHCCP Medicaid |
$425.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.34
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem Medicaid |
$417.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Humana KY Medicaid |
$417.84
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$422.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
CAT SCAN FOLLOW-UP STUDY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350P0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$283.88 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Ambetter Exchange |
$120.34
|
| Rate for Payer: Anthem Medicaid |
$136.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$120.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.41
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$283.88
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$120.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.69
|
| Rate for Payer: Molina Healthcare Passport |
$136.95
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$156.44
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.34
|
|
|
CAT SCAN FOLLOW-UP STUDY(T
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350T0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CAT SCAN FOLLOW-UP STUDY(T
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350T0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CAUTERY & ABLATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CAUTERY & ABLATION
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$297.80 |
| Rate for Payer: Aetna Commercial |
$181.82
|
| Rate for Payer: Ambetter Exchange |
$136.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.77
|
| Rate for Payer: Anthem Medicaid |
$43.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.17
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$297.80
|
| Rate for Payer: Healthspan PPO |
$251.28
|
| Rate for Payer: Humana Medicaid |
$43.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.62
|
| Rate for Payer: Molina Healthcare Passport |
$43.75
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.85
|
| Rate for Payer: UHCCP Medicaid |
$83.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.81
|
|
|
CAUTERY & ABLATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CAUTERY/ABLATION
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.99 |
| Max. Negotiated Rate |
$328.32 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Ambetter Exchange |
$185.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.72
|
| Rate for Payer: Anthem Medicaid |
$85.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.14
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$253.74
|
| Rate for Payer: Healthspan PPO |
$328.32
|
| Rate for Payer: Humana Medicaid |
$85.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.71
|
| Rate for Payer: Molina Healthcare Passport |
$85.99
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.66
|
| Rate for Payer: UHCCP Medicaid |
$111.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.12
|
|
