|
CPS AIM SL CATH 27*59CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL CATH 27*59CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL CATH 28*59CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL CATH 28*59CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL CATH 29*65CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL CATH 29*65CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL SUB-ACU 135A 65CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS AIM SL SUB-ACU 135A 65CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CPS COURIER GUIDEWIRE MEDIUM
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CPS COURIER GUIDEWIRE MEDIUM
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CPS DIRECT SL II CATH 115/47CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 115/47CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 135/47CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 135/47CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 135/54CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 135/54CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 7F**47CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS DIRECT SL II CATH 7F**47CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CPS SAFESHEATH ADAPTOR 410195
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
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
|
|
|
CPS SAFESHEATH ADAPTOR 410195
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
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
|
|
|
CPSULRRPHY GLNHUML JT MULTIDIR
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 23466
|
| Hospital Charge Code |
76100464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CPSULRRPHY GLNHUML JT MULTIDIR
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 23466
|
| Hospital Charge Code |
76100464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,781.38 |
| Rate for Payer: Aetna Commercial |
$1,644.03
|
| Rate for Payer: Ambetter Exchange |
$1,063.02
|
| Rate for Payer: Anthem Medicaid |
$908.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,063.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,063.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,275.62
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,781.38
|
| Rate for Payer: Healthspan PPO |
$1,489.14
|
| Rate for Payer: Humana Medicaid |
$908.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,393.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,063.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$926.96
|
| Rate for Payer: Molina Healthcare Passport |
$908.78
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,381.93
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$917.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,063.02
|
|
|
CPSULRRPHY GLNHUML JT MULTIDIR
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 23466
|
| Hospital Charge Code |
761P0464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,781.38 |
| Rate for Payer: Aetna Commercial |
$1,644.03
|
| Rate for Payer: Ambetter Exchange |
$1,063.02
|
| Rate for Payer: Anthem Medicaid |
$908.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,063.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,063.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,275.62
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,781.38
|
| Rate for Payer: Healthspan PPO |
$1,489.14
|
| Rate for Payer: Humana Medicaid |
$908.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,393.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,063.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$926.96
|
| Rate for Payer: Molina Healthcare Passport |
$908.78
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,381.93
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$917.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,063.02
|
|
|
CPSULRRPHY GLNHUML JT MULTIDIR
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 23466
|
| Hospital Charge Code |
76100464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CPT TOTAL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
30001827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$6.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.51
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$6.51
|
| Rate for Payer: Humana Medicare Advantage |
$6.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
