|
DEST ANY METHOD 1ST LESION
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$256.80 |
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Ambetter Exchange |
$50.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$43.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.04
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$99.70
|
| Rate for Payer: Healthspan PPO |
$85.53
|
| Rate for Payer: Humana Medicaid |
$43.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.41
|
| Rate for Payer: Molina Healthcare Passport |
$43.54
|
| Rate for Payer: Multiplan PHCS |
$256.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.13
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.87
|
|
|
DEST ANY METHOD 1ST LESION(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761P0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Ambetter Exchange |
$50.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$43.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.04
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$99.70
|
| Rate for Payer: Healthspan PPO |
$85.53
|
| Rate for Payer: Humana Medicaid |
$43.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.41
|
| Rate for Payer: Molina Healthcare Passport |
$43.54
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.13
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.87
|
|
|
DEST ANY METHOD 1ST LESION(T
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761T0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
DEST ANY METHOD 1ST LESION(T
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761T0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.51 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
DESTINATION 5FR 45CM STR CCV
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 5FR 45CM STR CCV
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 6FR. 45CM STR CCV
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 6FR. 45CM STR CCV
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 6FR 90CM RSC05
|
Facility
|
OP
|
$1,902.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.69 |
| Max. Negotiated Rate |
$1,826.21 |
| Rate for Payer: Aetna Commercial |
$1,464.77
|
| Rate for Payer: Anthem Medicaid |
$654.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.79
|
| Rate for Payer: Cash Price |
$951.15
|
| Rate for Payer: Cigna Commercial |
$1,578.91
|
| Rate for Payer: First Health Commercial |
$1,807.18
|
| Rate for Payer: Humana Commercial |
$1,616.95
|
| Rate for Payer: Humana KY Medicaid |
$654.20
|
| Rate for Payer: Kentucky WC Medicaid |
$660.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.59
|
| Rate for Payer: PHCS Commercial |
$1,826.21
|
| Rate for Payer: United Healthcare All Payer |
$1,674.02
|
|
|
DESTINATION 6FR 90CM RSC05
|
Facility
|
IP
|
$1,902.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.69 |
| Max. Negotiated Rate |
$1,826.21 |
| Rate for Payer: Aetna Commercial |
$1,464.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.79
|
| Rate for Payer: Cash Price |
$951.15
|
| Rate for Payer: Cigna Commercial |
$1,578.91
|
| Rate for Payer: First Health Commercial |
$1,807.18
|
| Rate for Payer: Humana Commercial |
$1,616.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.59
|
| Rate for Payer: PHCS Commercial |
$1,826.21
|
| Rate for Payer: United Healthcare All Payer |
$1,674.02
|
|
|
DESTINATION 7FR 45CM STR CCV
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 7FR 45CM STR CCV
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
DESTINATION 7FR ST 90CM RSC06
|
Facility
|
OP
|
$1,549.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.88 |
| Max. Negotiated Rate |
$1,487.62 |
| Rate for Payer: Aetna Commercial |
$1,193.19
|
| Rate for Payer: Anthem Medicaid |
$532.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.69
|
| Rate for Payer: Cash Price |
$774.80
|
| Rate for Payer: Cigna Commercial |
$1,286.17
|
| Rate for Payer: First Health Commercial |
$1,472.12
|
| Rate for Payer: Humana Commercial |
$1,317.16
|
| Rate for Payer: Humana KY Medicaid |
$532.91
|
| Rate for Payer: Kentucky WC Medicaid |
$538.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.22
|
| Rate for Payer: PHCS Commercial |
$1,487.62
|
| Rate for Payer: United Healthcare All Payer |
$1,363.65
|
|
|
DESTINATION 7FR ST 90CM RSC06
|
Facility
|
IP
|
$1,549.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.88 |
| Max. Negotiated Rate |
$1,487.62 |
| Rate for Payer: Aetna Commercial |
$1,193.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.69
|
| Rate for Payer: Cash Price |
$774.80
|
| Rate for Payer: Cigna Commercial |
$1,286.17
|
| Rate for Payer: First Health Commercial |
$1,472.12
|
| Rate for Payer: Humana Commercial |
$1,317.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.22
|
| Rate for Payer: PHCS Commercial |
$1,487.62
|
| Rate for Payer: United Healthcare All Payer |
$1,363.65
|
|
|
DESTINATION 8FR 45CM STR CCV
|
Facility
|
IP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
DESTINATION 8FR 45CM STR CCV
|
Facility
|
OP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem Medicaid |
$519.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Humana KY Medicaid |
$519.84
|
| Rate for Payer: Kentucky WC Medicaid |
$525.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
DESTINO TWIST SHEATH 7F
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
DESTINO TWIST SHEATH 7F
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Ambetter Exchange |
$82.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.12
|
| Rate for Payer: Anthem Medicaid |
$80.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.53
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$165.26
|
| Rate for Payer: Healthspan PPO |
$150.22
|
| Rate for Payer: Humana Medicaid |
$80.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.39
|
| Rate for Payer: Molina Healthcare Passport |
$80.77
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.74
|
| Rate for Payer: UHCCP Medicaid |
$61.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.11
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
