|
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
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| 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 |
45000236
|
|
Hospital Revenue Code
|
450
|
| 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 (P
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761P1472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$278.14 |
| Rate for Payer: Aetna Commercial |
$191.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$98.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Healthspan PPO |
$278.14
|
| Rate for Payer: Humana Medicaid |
$98.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.70
|
| Rate for Payer: Molina Healthcare Passport |
$98.73
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$51.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.72
|
|
|
INSERTION CENTRAL LINE (T
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761T1472
|
|
Hospital Revenue Code
|
761
|
| 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 (T
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761T1472
|
|
Hospital Revenue Code
|
761
|
| 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 CHEST TUBE
|
Professional
|
Both
|
$2,691.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.15 |
| Max. Negotiated Rate |
$2,691.00 |
| Rate for Payer: Aetna Commercial |
$303.54
|
| Rate for Payer: Anthem Medicaid |
$139.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,691.00
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cigna Commercial |
$282.14
|
| Rate for Payer: Healthspan PPO |
$236.99
|
| Rate for Payer: Humana Medicaid |
$139.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$233.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.93
|
| Rate for Payer: Molina Healthcare Passport |
$139.15
|
| Rate for Payer: Multiplan PHCS |
$1,614.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,883.70
|
| Rate for Payer: UHCCP Medicaid |
$941.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.54
|
|
|
INSERTION CHEST TUBE
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.83 |
| Max. Negotiated Rate |
$2,583.36 |
| Rate for Payer: Aetna Commercial |
$2,072.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.98
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cigna Commercial |
$2,233.53
|
| Rate for Payer: First Health Commercial |
$2,556.45
|
| Rate for Payer: Humana Commercial |
$2,287.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,206.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,368.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,018.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.21
|
| Rate for Payer: PHCS Commercial |
$2,583.36
|
| Rate for Payer: United Healthcare All Payer |
$2,368.08
|
|
|
INSERTION CHEST TUBE
|
Facility
|
OP
|
$2,630.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
45000223
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$2,524.80 |
| Rate for Payer: Aetna Commercial |
$2,025.10
|
| Rate for Payer: Anthem Medicaid |
$904.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,051.40
|
| 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 |
$1,315.00
|
| Rate for Payer: Cash Price |
$1,315.00
|
| Rate for Payer: Cigna Commercial |
$2,182.90
|
| Rate for Payer: First Health Commercial |
$2,498.50
|
| Rate for Payer: Humana Commercial |
$2,235.50
|
| Rate for Payer: Humana KY Medicaid |
$904.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$913.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,156.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,940.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$922.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,314.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,972.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$526.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.30
|
| Rate for Payer: PHCS Commercial |
$2,524.80
|
| Rate for Payer: United Healthcare All Payer |
$2,314.40
|
|
|
INSERTION CHEST TUBE
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.83 |
| Max. Negotiated Rate |
$2,583.36 |
| Rate for Payer: Aetna Commercial |
$2,072.07
|
| Rate for Payer: Anthem Medicaid |
$925.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.98
|
| 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 |
$1,345.50
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cigna Commercial |
$2,233.53
|
| Rate for Payer: First Health Commercial |
$2,556.45
|
| Rate for Payer: Humana Commercial |
$2,287.35
|
| Rate for Payer: Humana KY Medicaid |
$925.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$934.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,206.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$944.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,368.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,018.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.21
|
| Rate for Payer: PHCS Commercial |
$2,583.36
|
| Rate for Payer: United Healthcare All Payer |
$2,368.08
|
|
|
INSERTION CHEST TUBE
|
Facility
|
IP
|
$2,630.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
45000223
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.90 |
| Max. Negotiated Rate |
$2,524.80 |
| Rate for Payer: Aetna Commercial |
$2,025.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,051.40
|
| Rate for Payer: Cash Price |
$1,315.00
|
| Rate for Payer: Cigna Commercial |
$2,182.90
|
| Rate for Payer: First Health Commercial |
$2,498.50
|
| Rate for Payer: Humana Commercial |
$2,235.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,156.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,940.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$789.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,314.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,972.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$526.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.30
|
| Rate for Payer: PHCS Commercial |
$2,524.80
|
| Rate for Payer: United Healthcare All Payer |
$2,314.40
|
|
|
INSERTION CHEST TUBE(P
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761P1198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: Aetna Commercial |
$303.54
|
| Rate for Payer: Anthem Medicaid |
$139.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$282.14
|
| Rate for Payer: Healthspan PPO |
$236.99
|
| Rate for Payer: Humana Medicaid |
$139.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$233.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.93
|
| Rate for Payer: Molina Healthcare Passport |
$139.15
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.54
|
|
|
INSERTION CHEST TUBE(T
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761T1198
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
INSERTION CHEST TUBE(T
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761T1198
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
INSERTION INTRAUTERINE IUD
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.18
|
| Rate for Payer: Anthem Medicaid |
$47.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,030.00
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cigna Commercial |
$131.13
|
| Rate for Payer: Healthspan PPO |
$105.15
|
| Rate for Payer: Humana Medicaid |
$47.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.00
|
| Rate for Payer: Molina Healthcare Passport |
$47.06
|
| Rate for Payer: Multiplan PHCS |
$1,218.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,421.00
|
| Rate for Payer: UHCCP Medicaid |
$39.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.53
|
|
|
INSERTION INTRAUTERINE IUD
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$1,948.80 |
| Rate for Payer: Aetna Commercial |
$1,563.10
|
| Rate for Payer: Anthem Medicaid |
$698.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cigna Commercial |
$1,684.90
|
| Rate for Payer: First Health Commercial |
$1,928.50
|
| Rate for Payer: Humana Commercial |
$1,725.50
|
| Rate for Payer: Humana KY Medicaid |
$698.12
|
| Rate for Payer: Kentucky WC Medicaid |
$705.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.30
|
| Rate for Payer: PHCS Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare All Payer |
$1,786.40
|
|
|
INSERTION INTRAUTERINE IUD
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$1,948.80 |
| Rate for Payer: Aetna Commercial |
$1,563.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cigna Commercial |
$1,684.90
|
| Rate for Payer: First Health Commercial |
$1,928.50
|
| Rate for Payer: Humana Commercial |
$1,725.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.30
|
| Rate for Payer: PHCS Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare All Payer |
$1,786.40
|
|
|
INSERTION INTRAUTERINE IUD(P
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761P2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.18
|
| Rate for Payer: Anthem Medicaid |
$47.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$131.13
|
| Rate for Payer: Healthspan PPO |
$105.15
|
| Rate for Payer: Humana Medicaid |
$47.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.00
|
| Rate for Payer: Molina Healthcare Passport |
$47.06
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$39.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.53
|
|
|
INSERTION INTRAUTERINE IUD(T
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761T2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
INSERTION INTRAUTERINE IUD(T
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761T2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
|
Facility
|
OP
|
$10,285.34
|
|
|
Service Code
|
CPT 33216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,346.67 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$7,894.80
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,639.14 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL
|
Facility
|
OP
|
$12,927.70
|
|
|
Service Code
|
CPT 33206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,234.07 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR
|
Facility
|
OP
|
$12,927.70
|
|
|
Service Code
|
CPT 33208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,234.07 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR
|
Facility
|
OP
|
$12,927.70
|
|
|
Service Code
|
CPT 33207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,234.07 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
|
