|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
IP
|
$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 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 TMP INDWL CATH SIM
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
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 TMP INDWL CATH SIM
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
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 BUCK W/DISP 18.5MM
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT BUCK W/DISP 18.5MM
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT BUCK W/DISP 25MM
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT BUCK W/DISP 25MM
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT BUCK W/DISP 30MM
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT BUCK W/DISP 30MM
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761T1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$7,620.48 |
| Rate for Payer: Aetna Commercial |
$6,112.26
|
| Rate for Payer: Anthem Medicaid |
$2,729.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,191.64
|
| 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 |
$3,969.00
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cigna Commercial |
$6,588.54
|
| Rate for Payer: First Health Commercial |
$7,541.10
|
| Rate for Payer: Humana Commercial |
$6,747.30
|
| Rate for Payer: Humana KY Medicaid |
$2,729.88
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,985.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.78
|
| Rate for Payer: PHCS Commercial |
$7,620.48
|
| Rate for Payer: United Healthcare All Payer |
$6,985.44
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Professional
|
Both
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.65 |
| Max. Negotiated Rate |
$8,388.00 |
| Rate for Payer: Aetna Commercial |
$244.78
|
| Rate for Payer: Anthem Medicaid |
$137.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,388.00
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cigna Commercial |
$239.42
|
| Rate for Payer: Healthspan PPO |
$195.72
|
| Rate for Payer: Humana Medicaid |
$137.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.40
|
| Rate for Payer: Molina Healthcare Passport |
$137.65
|
| Rate for Payer: Multiplan PHCS |
$5,032.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,871.60
|
| Rate for Payer: UHCCP Medicaid |
$2,935.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.03
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761P1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.65 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$244.78
|
| Rate for Payer: Anthem Medicaid |
$137.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$239.42
|
| Rate for Payer: Healthspan PPO |
$195.72
|
| Rate for Payer: Humana Medicaid |
$137.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.40
|
| Rate for Payer: Molina Healthcare Passport |
$137.65
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.03
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761T1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$7,620.48 |
| Rate for Payer: Aetna Commercial |
$6,112.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,191.64
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cigna Commercial |
$6,588.54
|
| Rate for Payer: First Health Commercial |
$7,541.10
|
| Rate for Payer: Humana Commercial |
$6,747.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,985.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.78
|
| Rate for Payer: PHCS Commercial |
$7,620.48
|
| Rate for Payer: United Healthcare All Payer |
$6,985.44
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,090.44 |
| Max. Negotiated Rate |
$8,052.48 |
| Rate for Payer: Aetna Commercial |
$6,458.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,542.64
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cigna Commercial |
$6,962.04
|
| Rate for Payer: First Health Commercial |
$7,968.60
|
| Rate for Payer: Humana Commercial |
$7,129.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,878.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,190.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,516.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,381.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,090.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,600.28
|
| Rate for Payer: PHCS Commercial |
$8,052.48
|
| Rate for Payer: United Healthcare All Payer |
$7,381.44
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,090.44 |
| Max. Negotiated Rate |
$8,052.48 |
| Rate for Payer: Aetna Commercial |
$6,458.76
|
| Rate for Payer: Anthem Medicaid |
$2,884.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,542.64
|
| 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 |
$4,194.00
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cigna Commercial |
$6,962.04
|
| Rate for Payer: First Health Commercial |
$7,968.60
|
| Rate for Payer: Humana Commercial |
$7,129.80
|
| Rate for Payer: Humana KY Medicaid |
$2,884.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,878.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,190.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,942.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,381.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,090.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,600.28
|
| Rate for Payer: PHCS Commercial |
$8,052.48
|
| Rate for Payer: United Healthcare All Payer |
$7,381.44
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$3,451.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.63 |
| Max. Negotiated Rate |
$3,312.96 |
| Rate for Payer: Aetna Commercial |
$2,657.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.78
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$2,864.33
|
| Rate for Payer: First Health Commercial |
$3,278.45
|
| Rate for Payer: Humana Commercial |
$2,933.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.81
|
| Rate for Payer: PHCS Commercial |
$3,312.96
|
| Rate for Payer: United Healthcare All Payer |
$3,036.88
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem Medicaid |
$837.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Humana KY Medicaid |
$837.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$846.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$854.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Professional
|
Both
|
$3,451.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$3,451.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.61
|
| Rate for Payer: Anthem Medicaid |
$132.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,451.00
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$308.80
|
| Rate for Payer: Healthspan PPO |
$1,037.54
|
| Rate for Payer: Humana Medicaid |
$132.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.59
|
| Rate for Payer: Molina Healthcare Passport |
$132.93
|
| Rate for Payer: Multiplan PHCS |
$2,070.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,415.70
|
| Rate for Payer: UHCCP Medicaid |
$102.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.26
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem Medicaid |
$837.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Humana KY Medicaid |
$837.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$846.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$854.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$3,451.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.63 |
| Max. Negotiated Rate |
$3,312.96 |
| Rate for Payer: Aetna Commercial |
$2,657.27
|
| Rate for Payer: Anthem Medicaid |
$1,186.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: Cigna Commercial |
$2,864.33
|
| Rate for Payer: First Health Commercial |
$3,278.45
|
| Rate for Payer: Humana Commercial |
$2,933.35
|
| Rate for Payer: Humana KY Medicaid |
$1,186.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,198.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,210.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.81
|
| Rate for Payer: PHCS Commercial |
$3,312.96
|
| Rate for Payer: United Healthcare All Payer |
$3,036.88
|
|
|
INSERT CATH PLEURA W/ IMAGE(P
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761P1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.61
|
| Rate for Payer: Anthem Medicaid |
$132.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$308.80
|
| Rate for Payer: Healthspan PPO |
$1,037.54
|
| Rate for Payer: Humana Medicaid |
$132.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.59
|
| Rate for Payer: Molina Healthcare Passport |
$132.93
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$102.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.26
|
|
|
INSERT CATH PLEURA W/ IMAGE(T
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761T1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$2,242.56 |
| Rate for Payer: Aetna Commercial |
$1,798.72
|
| Rate for Payer: Anthem Medicaid |
$803.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,822.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,938.88
|
| Rate for Payer: First Health Commercial |
$2,219.20
|
| Rate for Payer: Humana Commercial |
$1,985.60
|
| Rate for Payer: Humana KY Medicaid |
$803.35
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$811.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,915.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$819.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,055.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,752.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.16
|
| Rate for Payer: PHCS Commercial |
$2,242.56
|
| Rate for Payer: United Healthcare All Payer |
$2,055.68
|
|
|
INSERT CATH PLEURA W/ IMAGE(T
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761T1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$2,242.56 |
| Rate for Payer: Aetna Commercial |
$1,798.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,822.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,938.88
|
| Rate for Payer: First Health Commercial |
$2,219.20
|
| Rate for Payer: Humana Commercial |
$1,985.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,915.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,055.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,752.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.16
|
| Rate for Payer: PHCS Commercial |
$2,242.56
|
| Rate for Payer: United Healthcare All Payer |
$2,055.68
|
|
