|
INSERT MULTI-COMP PENIS PROS
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
76102865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$1,322.82 |
| Rate for Payer: Aetna Commercial |
$1,322.82
|
| Rate for Payer: Anthem Medicaid |
$855.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$815.00
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$1,176.79
|
| Rate for Payer: Healthspan PPO |
$1,280.83
|
| Rate for Payer: Humana Medicaid |
$855.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,104.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$872.46
|
| Rate for Payer: Molina Healthcare Passport |
$855.35
|
| Rate for Payer: Multiplan PHCS |
$489.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$570.50
|
| Rate for Payer: UHCCP Medicaid |
$285.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$863.90
|
|
|
INSERT MULTI-COMP PENIS PROS
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
76102865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.95 |
| Max. Negotiated Rate |
$24,421.07 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,443.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,421.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,548.89
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$17,443.62
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,932.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.65
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
INSERT MULTI-COMP PENIS PROS
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 54405
|
| Hospital Charge Code |
76102865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.95 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.65
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
76101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
45000239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
76101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
INSERT NEEDLE BONE CAVITY
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
45000239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
INSERT NON-TUNNEL CV CATH <5
|
Facility
|
OP
|
$2,190.76
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761T2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.80 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,686.89
|
| Rate for Payer: Anthem Medicaid |
$753.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.79
|
| 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 |
$1,095.38
|
| Rate for Payer: Cash Price |
$1,095.38
|
| Rate for Payer: Cigna Commercial |
$1,818.33
|
| Rate for Payer: First Health Commercial |
$2,081.22
|
| Rate for Payer: Humana Commercial |
$1,862.15
|
| Rate for Payer: Humana KY Medicaid |
$753.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$761.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,796.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,643.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.14
|
| Rate for Payer: PHCS Commercial |
$2,103.13
|
| Rate for Payer: United Healthcare All Payer |
$1,927.87
|
|
|
INSERT NON-TUNNEL CV CATH <5
|
Facility
|
IP
|
$2,190.76
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761T2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.80 |
| Max. Negotiated Rate |
$2,103.13 |
| Rate for Payer: Aetna Commercial |
$1,686.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.79
|
| Rate for Payer: Cash Price |
$1,095.38
|
| Rate for Payer: Cigna Commercial |
$1,818.33
|
| Rate for Payer: First Health Commercial |
$2,081.22
|
| Rate for Payer: Humana Commercial |
$1,862.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,796.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,643.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.14
|
| Rate for Payer: PHCS Commercial |
$2,103.13
|
| Rate for Payer: United Healthcare All Payer |
$1,927.87
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Facility
|
IP
|
$2,804.76
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.62 |
| Max. Negotiated Rate |
$2,692.57 |
| Rate for Payer: Aetna Commercial |
$2,159.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.71
|
| Rate for Payer: Cash Price |
$1,402.38
|
| Rate for Payer: Cigna Commercial |
$2,327.95
|
| Rate for Payer: First Health Commercial |
$2,664.52
|
| Rate for Payer: Humana Commercial |
$2,384.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,299.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,069.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.48
|
| Rate for Payer: PHCS Commercial |
$2,692.57
|
| Rate for Payer: United Healthcare All Payer |
$2,468.19
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Facility
|
OP
|
$2,804.76
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.62 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,159.67
|
| Rate for Payer: Anthem Medicaid |
$964.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.71
|
| 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 |
$1,402.38
|
| Rate for Payer: Cash Price |
$1,402.38
|
| Rate for Payer: Cigna Commercial |
$2,327.95
|
| Rate for Payer: First Health Commercial |
$2,664.52
|
| Rate for Payer: Humana Commercial |
$2,384.05
|
| Rate for Payer: Humana KY Medicaid |
$964.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$974.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,299.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,069.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$983.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.48
|
| Rate for Payer: PHCS Commercial |
$2,692.57
|
| Rate for Payer: United Healthcare All Payer |
$2,468.19
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Professional
|
Both
|
$2,804.76
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$2,804.76 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$226.66
|
| Rate for Payer: Anthem Medicaid |
$235.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,804.76
|
| Rate for Payer: Cash Price |
$1,402.38
|
| Rate for Payer: Cash Price |
$1,402.38
|
| Rate for Payer: Cigna Commercial |
$459.04
|
| Rate for Payer: Healthspan PPO |
$1,364.62
|
| Rate for Payer: Humana Medicaid |
$235.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$383.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$240.63
|
| Rate for Payer: Molina Healthcare Passport |
$235.91
|
| Rate for Payer: Multiplan PHCS |
$1,682.86
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,963.33
|
| Rate for Payer: UHCCP Medicaid |
$237.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.27
|
|
|
INSERT NON-TUNNEL CV CATH <5(P
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761P2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Aetna Commercial |
$198.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.42
|
| Rate for Payer: Anthem Medicaid |
$102.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$190.41
|
| Rate for Payer: Healthspan PPO |
$322.12
|
| Rate for Payer: Humana Medicaid |
$102.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.88
|
| Rate for Payer: Molina Healthcare Passport |
$102.82
|
| Rate for Payer: Multiplan PHCS |
$368.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.80
|
| Rate for Payer: UHCCP Medicaid |
$45.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.85
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761T1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.43 |
| Max. Negotiated Rate |
$5,482.56 |
| Rate for Payer: Aetna Commercial |
$4,397.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,454.58
|
| Rate for Payer: Cash Price |
$2,855.50
|
| Rate for Payer: Cigna Commercial |
$4,740.13
|
| Rate for Payer: First Health Commercial |
$5,425.45
|
| Rate for Payer: Humana Commercial |
$4,854.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,683.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,214.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,713.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,025.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,770.41
|
| Rate for Payer: PHCS Commercial |
$5,482.56
|
| Rate for Payer: United Healthcare All Payer |
$5,025.68
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761P1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.71 |
| Max. Negotiated Rate |
$1,657.00 |
| Rate for Payer: Aetna Commercial |
$485.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.71
|
| Rate for Payer: Anthem Medicaid |
$235.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,657.00
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cigna Commercial |
$458.98
|
| Rate for Payer: Healthspan PPO |
$1,414.20
|
| Rate for Payer: Humana Medicaid |
$235.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.78
|
| Rate for Payer: Molina Healthcare Passport |
$235.08
|
| Rate for Payer: Multiplan PHCS |
$994.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,159.90
|
| Rate for Payer: UHCCP Medicaid |
$228.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.43
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
OP
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.84 |
| Max. Negotiated Rate |
$7,073.28 |
| Rate for Payer: Aetna Commercial |
$5,673.36
|
| Rate for Payer: Anthem Medicaid |
$2,533.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,747.04
|
| 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 |
$3,684.00
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$6,115.44
|
| Rate for Payer: First Health Commercial |
$6,999.60
|
| Rate for Payer: Humana Commercial |
$6,262.80
|
| Rate for Payer: Humana KY Medicaid |
$2,533.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,559.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,041.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,437.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,584.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,483.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,526.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,284.08
|
| Rate for Payer: PHCS Commercial |
$7,073.28
|
| Rate for Payer: United Healthcare All Payer |
$6,483.84
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Professional
|
Both
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.71 |
| Max. Negotiated Rate |
$7,368.00 |
| Rate for Payer: Aetna Commercial |
$485.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.71
|
| Rate for Payer: Anthem Medicaid |
$235.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,368.00
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$458.98
|
| Rate for Payer: Healthspan PPO |
$1,414.20
|
| Rate for Payer: Humana Medicaid |
$235.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.78
|
| Rate for Payer: Molina Healthcare Passport |
$235.08
|
| Rate for Payer: Multiplan PHCS |
$4,420.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,157.60
|
| Rate for Payer: UHCCP Medicaid |
$228.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.43
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761T1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.43 |
| Max. Negotiated Rate |
$5,482.56 |
| Rate for Payer: Aetna Commercial |
$4,397.47
|
| Rate for Payer: Anthem Medicaid |
$1,964.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,454.58
|
| 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 |
$2,855.50
|
| Rate for Payer: Cash Price |
$2,855.50
|
| Rate for Payer: Cigna Commercial |
$4,740.13
|
| Rate for Payer: First Health Commercial |
$5,425.45
|
| Rate for Payer: Humana Commercial |
$4,854.35
|
| Rate for Payer: Humana KY Medicaid |
$1,964.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,984.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,683.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,214.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,003.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,025.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,770.41
|
| Rate for Payer: PHCS Commercial |
$5,482.56
|
| Rate for Payer: United Healthcare All Payer |
$5,025.68
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
IP
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.84 |
| Max. Negotiated Rate |
$7,073.28 |
| Rate for Payer: Aetna Commercial |
$5,673.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,747.04
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$6,115.44
|
| Rate for Payer: First Health Commercial |
$6,999.60
|
| Rate for Payer: Humana Commercial |
$6,262.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,041.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,437.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,210.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,483.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,526.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,284.08
|
| Rate for Payer: PHCS Commercial |
$7,073.28
|
| Rate for Payer: United Healthcare All Payer |
$6,483.84
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$587.07
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$552.18
|
| Rate for Payer: Healthspan PPO |
$577.20
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
761P1246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Aetna Commercial |
$587.07
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$552.18
|
| Rate for Payer: Healthspan PPO |
$577.20
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
|
|
INSERT PACEMKR PULSE GEN ONL(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
761P1247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.15 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$668.78
|
| Rate for Payer: Anthem Medicaid |
$346.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$626.76
|
| Rate for Payer: Healthspan PPO |
$657.54
|
| Rate for Payer: Humana Medicaid |
$346.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.07
|
| Rate for Payer: Molina Healthcare Passport |
$346.15
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.61
|
|
|
INSERT PACEMKR PULSE GEN ONLY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
