|
INS ART C/R GII SZ 7-8 9MM
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
INS BLAD TMPINDWL CATHSIMPL
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INS BLAD TMPINDWL CATHSIMPL
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$284.13
|
| Rate for Payer: Anthem Medicaid |
$126.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$306.27
|
| Rate for Payer: First Health Commercial |
$350.55
|
| Rate for Payer: Humana Commercial |
$313.65
|
| Rate for Payer: Humana KY Medicaid |
$126.90
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$128.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$272.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.72
|
| Rate for Payer: Ohio Health Group HMO |
$276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.39
|
| Rate for Payer: PHCS Commercial |
$354.24
|
| Rate for Payer: United Healthcare All Payer |
$324.72
|
|
|
INS BLAD TMPINDWL CATHSIMPL
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INS BLAD TMPINDWL CATHSIMPL
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$48.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.92
|
| Rate for Payer: Anthem Medicaid |
$22.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$135.82
|
| Rate for Payer: Healthspan PPO |
$96.40
|
| Rate for Payer: Humana Medicaid |
$22.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.55
|
| Rate for Payer: Molina Healthcare Passport |
$22.11
|
| Rate for Payer: Multiplan PHCS |
$221.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$258.30
|
| Rate for Payer: UHCCP Medicaid |
$25.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.33
|
|
|
INS BLAD TMPINDWL CATHSIMPL
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$284.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$306.27
|
| Rate for Payer: First Health Commercial |
$350.55
|
| Rate for Payer: Humana Commercial |
$313.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$272.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.72
|
| Rate for Payer: Ohio Health Group HMO |
$276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.39
|
| Rate for Payer: PHCS Commercial |
$354.24
|
| Rate for Payer: United Healthcare All Payer |
$324.72
|
|
|
INS BLAD TMPINDWL CATHSIMPL(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
761P2066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$48.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.92
|
| Rate for Payer: Anthem Medicaid |
$22.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$135.82
|
| Rate for Payer: Healthspan PPO |
$96.40
|
| Rate for Payer: Humana Medicaid |
$22.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.55
|
| Rate for Payer: Molina Healthcare Passport |
$22.11
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$25.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.33
|
|
|
INS BLAD TMPINDWL CATHSIMPL(T
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
761T2066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INS BLAD TMPINDWL CATHSIMPL(T
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
761T2066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INS ENDOVAS VENA CAVA FILTR
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
76101530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
INS ENDOVAS VENA CAVA FILTR
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
76101530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
INS ENDOVAS VENA CAVA FILTR
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
76101530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.87
|
| Rate for Payer: Anthem Medicaid |
$194.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$447.14
|
| Rate for Payer: Healthspan PPO |
$2,315.67
|
| Rate for Payer: Humana Medicaid |
$194.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.14
|
| Rate for Payer: Molina Healthcare Passport |
$194.25
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$203.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.19
|
|
|
INS ENDOVAS VENA CAVA FILTR(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
761P1530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.87
|
| Rate for Payer: Anthem Medicaid |
$194.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$447.14
|
| Rate for Payer: Healthspan PPO |
$2,315.67
|
| Rate for Payer: Humana Medicaid |
$194.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.14
|
| Rate for Payer: Molina Healthcare Passport |
$194.25
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$203.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.19
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$284.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$306.27
|
| Rate for Payer: First Health Commercial |
$350.55
|
| Rate for Payer: Humana Commercial |
$313.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$272.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.72
|
| Rate for Payer: Ohio Health Group HMO |
$276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.39
|
| Rate for Payer: PHCS Commercial |
$354.24
|
| Rate for Payer: United Healthcare All Payer |
$324.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
45000279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$284.13
|
| Rate for Payer: Anthem Medicaid |
$126.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$306.27
|
| Rate for Payer: First Health Commercial |
$350.55
|
| Rate for Payer: Humana Commercial |
$313.65
|
| Rate for Payer: Humana KY Medicaid |
$126.90
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$128.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$272.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.72
|
| Rate for Payer: Ohio Health Group HMO |
$276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.39
|
| Rate for Payer: PHCS Commercial |
$354.24
|
| Rate for Payer: United Healthcare All Payer |
$324.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
45000279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD STRAIGHT CATH
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.57
|
| Rate for Payer: Anthem Medicaid |
$20.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: Healthspan PPO |
$75.43
|
| Rate for Payer: Humana Medicaid |
$20.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.72
|
| Rate for Payer: Molina Healthcare Passport |
$20.31
|
| Rate for Payer: Multiplan PHCS |
$221.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$258.30
|
| Rate for Payer: UHCCP Medicaid |
$20.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.51
|
|
|
INSERT BLAD STRAIGHT CATH(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761P2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.57
|
| Rate for Payer: Anthem Medicaid |
$20.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: Healthspan PPO |
$75.43
|
| Rate for Payer: Humana Medicaid |
$20.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.72
|
| Rate for Payer: Molina Healthcare Passport |
$20.31
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$20.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.51
|
|
|
INSERT BLAD STRAIGHT CATH(T
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761T2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD STRAIGHT CATH(T
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761T2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
45000280
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$48.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.92
|
| Rate for Payer: Anthem Medicaid |
$22.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$169.00
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$135.82
|
| Rate for Payer: Healthspan PPO |
$96.40
|
| Rate for Payer: Humana Medicaid |
$22.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.55
|
| Rate for Payer: Molina Healthcare Passport |
$22.11
|
| Rate for Payer: Multiplan PHCS |
$101.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.30
|
| Rate for Payer: UHCCP Medicaid |
$25.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.33
|
|
