|
INSERT IABP PERCUTANEOUS
|
Facility
|
OP
|
$3,336.00
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
48100003
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$433.68 |
| Max. Negotiated Rate |
$3,202.56 |
| Rate for Payer: Aetna Commercial |
$2,568.72
|
| Rate for Payer: Anthem Medicaid |
$1,147.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,602.08
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cigna Commercial |
$2,768.88
|
| Rate for Payer: First Health Commercial |
$3,169.20
|
| Rate for Payer: Humana Commercial |
$2,835.60
|
| Rate for Payer: Humana KY Medicaid |
$1,147.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,158.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,735.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,461.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,935.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,502.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.16
|
| Rate for Payer: PHCS Commercial |
$3,202.56
|
| Rate for Payer: United Healthcare All Payer |
$2,935.68
|
|
|
INSERT IABP PERCUTANEOUS
|
Facility
|
OP
|
$3,720.10
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
76101324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.61 |
| Max. Negotiated Rate |
$3,571.30 |
| Rate for Payer: Aetna Commercial |
$2,864.48
|
| Rate for Payer: Anthem Medicaid |
$1,279.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,901.68
|
| Rate for Payer: Cash Price |
$1,860.05
|
| Rate for Payer: Cigna Commercial |
$3,087.68
|
| Rate for Payer: First Health Commercial |
$3,534.10
|
| Rate for Payer: Humana Commercial |
$3,162.08
|
| Rate for Payer: Humana KY Medicaid |
$1,279.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,050.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,745.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,273.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.23
|
| Rate for Payer: PHCS Commercial |
$3,571.30
|
| Rate for Payer: United Healthcare All Payer |
$3,273.69
|
|
|
INSERT IABP PERCUTANEOUS
|
Professional
|
Both
|
$3,720.10
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
76101324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.92 |
| Max. Negotiated Rate |
$3,720.10 |
| Rate for Payer: Aetna Commercial |
$462.26
|
| Rate for Payer: Anthem Medicaid |
$196.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,720.10
|
| Rate for Payer: Cash Price |
$1,860.05
|
| Rate for Payer: Cash Price |
$1,860.05
|
| Rate for Payer: Cigna Commercial |
$420.59
|
| Rate for Payer: Healthspan PPO |
$454.50
|
| Rate for Payer: Humana Medicaid |
$196.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.86
|
| Rate for Payer: Molina Healthcare Passport |
$196.92
|
| Rate for Payer: Multiplan PHCS |
$2,232.06
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,604.07
|
| Rate for Payer: UHCCP Medicaid |
$1,302.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.89
|
|
|
INSERT IABP PERCUTANEOUS
|
Facility
|
IP
|
$3,720.10
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
76101324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.61 |
| Max. Negotiated Rate |
$3,571.30 |
| Rate for Payer: Aetna Commercial |
$2,864.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,901.68
|
| Rate for Payer: Cash Price |
$1,860.05
|
| Rate for Payer: Cigna Commercial |
$3,087.68
|
| Rate for Payer: First Health Commercial |
$3,534.10
|
| Rate for Payer: Humana Commercial |
$3,162.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,050.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,745.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,273.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.23
|
| Rate for Payer: PHCS Commercial |
$3,571.30
|
| Rate for Payer: United Healthcare All Payer |
$3,273.69
|
|
|
INSERT IABP PERCUTANEOUS(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
761P1324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$462.26 |
| Rate for Payer: Aetna Commercial |
$462.26
|
| Rate for Payer: Anthem Medicaid |
$196.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$420.59
|
| Rate for Payer: Healthspan PPO |
$454.50
|
| Rate for Payer: Humana Medicaid |
$196.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.86
|
| Rate for Payer: Molina Healthcare Passport |
$196.92
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.89
|
|
|
INSERT IABP PERCUTANEOUS(T
|
Facility
|
IP
|
$3,320.10
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
761T1324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.61 |
| Max. Negotiated Rate |
$3,187.30 |
| Rate for Payer: Aetna Commercial |
$2,556.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.68
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cigna Commercial |
$2,755.68
|
| Rate for Payer: First Health Commercial |
$3,154.10
|
| Rate for Payer: Humana Commercial |
$2,822.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.23
|
| Rate for Payer: PHCS Commercial |
$3,187.30
|
| Rate for Payer: United Healthcare All Payer |
$2,921.69
|
|
|
INSERT IABP PERCUTANEOUS(T
|
Facility
|
OP
|
$3,320.10
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
761T1324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.61 |
| Max. Negotiated Rate |
$3,187.30 |
| Rate for Payer: Aetna Commercial |
$2,556.48
|
| Rate for Payer: Anthem Medicaid |
$1,141.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.68
|
| Rate for Payer: Cash Price |
$1,660.05
|
| Rate for Payer: Cigna Commercial |
$2,755.68
|
| Rate for Payer: First Health Commercial |
$3,154.10
|
| Rate for Payer: Humana Commercial |
$2,822.08
|
| Rate for Payer: Humana KY Medicaid |
$1,141.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.23
|
| Rate for Payer: PHCS Commercial |
$3,187.30
|
| Rate for Payer: United Healthcare All Payer |
$2,921.69
|
|
|
INSERT INDWELLING TUN CATH W C
|
Facility
|
OP
|
$6,455.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
76101197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$839.15 |
| Max. Negotiated Rate |
$6,196.80 |
| Rate for Payer: Aetna Commercial |
$4,970.35
|
| Rate for Payer: Anthem Medicaid |
$2,219.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,034.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$3,227.50
|
| Rate for Payer: Cash Price |
$3,227.50
|
| Rate for Payer: Cigna Commercial |
$5,357.65
|
| Rate for Payer: First Health Commercial |
$6,132.25
|
| Rate for Payer: Humana Commercial |
$5,486.75
|
| Rate for Payer: Humana KY Medicaid |
$2,219.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,242.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,293.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,763.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,264.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,680.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,841.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.05
|
| Rate for Payer: PHCS Commercial |
$6,196.80
|
| Rate for Payer: United Healthcare All Payer |
$5,680.40
|
|
|
INSERT INDWELLING TUN CATH W C
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
761T1197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
INSERT INDWELLING TUN CATH W C
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
761P1197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.77 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$387.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.77
|
| Rate for Payer: Anthem Medicaid |
$180.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$356.09
|
| Rate for Payer: Healthspan PPO |
$956.72
|
| Rate for Payer: Humana Medicaid |
$180.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$307.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Molina Healthcare Passport |
$180.99
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$166.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.80
|
|
|
INSERT INDWELLING TUN CATH W C
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
76101197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.77 |
| Max. Negotiated Rate |
$6,455.00 |
| Rate for Payer: Aetna Commercial |
$387.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.77
|
| Rate for Payer: Anthem Medicaid |
$180.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,455.00
|
| Rate for Payer: Cash Price |
$3,227.50
|
| Rate for Payer: Cash Price |
$3,227.50
|
| Rate for Payer: Cigna Commercial |
$356.09
|
| Rate for Payer: Healthspan PPO |
$956.72
|
| Rate for Payer: Humana Medicaid |
$180.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$307.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Molina Healthcare Passport |
$180.99
|
| Rate for Payer: Multiplan PHCS |
$3,873.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,518.50
|
| Rate for Payer: UHCCP Medicaid |
$166.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.80
|
|
|
INSERT INDWELLING TUN CATH W C
|
Facility
|
IP
|
$6,455.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
76101197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$839.15 |
| Max. Negotiated Rate |
$6,196.80 |
| Rate for Payer: Aetna Commercial |
$4,970.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,034.90
|
| Rate for Payer: Cash Price |
$3,227.50
|
| Rate for Payer: Cigna Commercial |
$5,357.65
|
| Rate for Payer: First Health Commercial |
$6,132.25
|
| Rate for Payer: Humana Commercial |
$5,486.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,293.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,763.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,936.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,680.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,841.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.05
|
| Rate for Payer: PHCS Commercial |
$6,196.80
|
| Rate for Payer: United Healthcare All Payer |
$5,680.40
|
|
|
INSERT INDWELLING TUN CATH W C
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
761T1197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
INSERTION CATHETER ARTERY
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.85 |
| Max. Negotiated Rate |
$941.00 |
| Rate for Payer: Aetna Commercial |
$80.47
|
| Rate for Payer: Anthem Medicaid |
$54.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$941.00
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$76.91
|
| Rate for Payer: Healthspan PPO |
$64.35
|
| Rate for Payer: Humana Medicaid |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Molina Healthcare Passport |
$54.85
|
| Rate for Payer: Multiplan PHCS |
$564.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.70
|
| Rate for Payer: UHCCP Medicaid |
$329.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.40
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.33 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.71
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.33 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem Medicaid |
$323.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Humana KY Medicaid |
$323.61
|
| Rate for Payer: Kentucky WC Medicaid |
$326.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.71
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
INSERTION CATHETER ARTERY(P
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761P1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$80.47
|
| Rate for Payer: Anthem Medicaid |
$54.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$76.91
|
| Rate for Payer: Healthspan PPO |
$64.35
|
| Rate for Payer: Humana Medicaid |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Molina Healthcare Passport |
$54.85
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.40
|
|
|
INSERTION CATHETER ARTERY(T
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761T1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$644.49
|
| Rate for Payer: Anthem Medicaid |
$287.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.86
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$694.71
|
| Rate for Payer: First Health Commercial |
$795.15
|
| Rate for Payer: Humana Commercial |
$711.45
|
| Rate for Payer: Humana KY Medicaid |
$287.84
|
| Rate for Payer: Kentucky WC Medicaid |
$290.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.56
|
| Rate for Payer: Ohio Health Group HMO |
$627.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.47
|
| Rate for Payer: PHCS Commercial |
$803.52
|
| Rate for Payer: United Healthcare All Payer |
$736.56
|
|
|
INSERTION CATHETER ARTERY(T
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761T1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$644.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.86
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$694.71
|
| Rate for Payer: First Health Commercial |
$795.15
|
| Rate for Payer: Humana Commercial |
$711.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.56
|
| Rate for Payer: Ohio Health Group HMO |
$627.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.47
|
| Rate for Payer: PHCS Commercial |
$803.52
|
| Rate for Payer: United Healthcare All Payer |
$736.56
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
76101472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem Medicaid |
$955.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Humana KY Medicaid |
$955.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$965.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$974.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
45000236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Humana KY Medicaid |
$865.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$874.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$883.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
76101472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.27 |
| Max. Negotiated Rate |
$2,667.84 |
| Rate for Payer: Aetna Commercial |
$2,139.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,167.62
|
| Rate for Payer: Cash Price |
$1,389.50
|
| Rate for Payer: Cigna Commercial |
$2,306.57
|
| Rate for Payer: First Health Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial |
$2,362.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,278.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$833.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,445.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,084.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.49
|
| Rate for Payer: PHCS Commercial |
$2,667.84
|
| Rate for Payer: United Healthcare All Payer |
$2,445.52
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Humana KY Medicaid |
$865.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$874.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$883.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
