|
INSERT PACEMKR PULSE GEN ONLY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$650.00
|
| 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: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| 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 |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| 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
|
|
|
INSERT PACEMKR PULSE GEN ONLY
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
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 PACING ELECTRODE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$791.63 |
| Rate for Payer: Aetna Commercial |
$791.63
|
| Rate for Payer: Anthem Medicaid |
$329.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$722.37
|
| Rate for Payer: Healthspan PPO |
$778.33
|
| Rate for Payer: Humana Medicaid |
$329.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.89
|
| Rate for Payer: Molina Healthcare Passport |
$329.30
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.59
|
|
|
INSERT PACING ELECTRODE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT PACING ELECTRODE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT PACING ELECTRODE(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
761P1257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$791.63 |
| Rate for Payer: Aetna Commercial |
$791.63
|
| Rate for Payer: Anthem Medicaid |
$329.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$722.37
|
| Rate for Payer: Healthspan PPO |
$778.33
|
| Rate for Payer: Humana Medicaid |
$329.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.89
|
| Rate for Payer: Molina Healthcare Passport |
$329.30
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.59
|
|
|
INSERT PACING LEAD & CONNEC(P
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
761P1256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$878.67
|
| Rate for Payer: Anthem Medicaid |
$370.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$886.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$811.53
|
| Rate for Payer: Healthspan PPO |
$863.91
|
| Rate for Payer: Humana Medicaid |
$370.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.96
|
| Rate for Payer: Molina Healthcare Passport |
$370.55
|
| Rate for Payer: Multiplan PHCS |
$531.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.20
|
| Rate for Payer: UHCCP Medicaid |
$310.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$374.26
|
|
|
INSERT PACING LEAD & CONNECT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$878.67
|
| Rate for Payer: Anthem Medicaid |
$370.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$886.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$811.53
|
| Rate for Payer: Healthspan PPO |
$863.91
|
| Rate for Payer: Humana Medicaid |
$370.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.96
|
| Rate for Payer: Molina Healthcare Passport |
$370.55
|
| Rate for Payer: Multiplan PHCS |
$531.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.20
|
| Rate for Payer: UHCCP Medicaid |
$310.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$374.26
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem Medicaid |
$304.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Humana KY Medicaid |
$304.70
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$307.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.66
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.18 |
| Max. Negotiated Rate |
$850.56 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.66
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
INSERT PERITONEAL SHUNT
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERITONEAL SHUNT
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERITONEAL SHUNT
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,107.46
|
| Rate for Payer: Anthem Medicaid |
$570.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,035.23
|
| Rate for Payer: Healthspan PPO |
$933.94
|
| Rate for Payer: Humana Medicaid |
$570.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$971.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.00
|
| Rate for Payer: Molina Healthcare Passport |
$570.59
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.30
|
|
|
INSERT PERITONEAL SHUNT(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
761P2002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,107.46
|
| Rate for Payer: Anthem Medicaid |
$570.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,035.23
|
| Rate for Payer: Healthspan PPO |
$933.94
|
| Rate for Payer: Humana Medicaid |
$570.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$971.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.00
|
| Rate for Payer: Molina Healthcare Passport |
$570.59
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.30
|
|
|
INSERT PERM PACEMAKER
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.85 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$903.03
|
| Rate for Payer: Anthem Medicaid |
$505.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$799.67
|
| Rate for Payer: Healthspan PPO |
$887.86
|
| Rate for Payer: Humana Medicaid |
$505.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.97
|
| Rate for Payer: Molina Healthcare Passport |
$505.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.91
|
|
|
INSERT PERM PACEMAKER
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERM PACEMAKER
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERM PACEMAKER(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
761P1244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.85 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$903.03
|
| Rate for Payer: Anthem Medicaid |
$505.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$799.67
|
| Rate for Payer: Healthspan PPO |
$887.86
|
| Rate for Payer: Humana Medicaid |
$505.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.97
|
| Rate for Payer: Molina Healthcare Passport |
$505.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.91
|
|
|
INSERT PICVAD CATH <5 Y/O
|
Facility
|
OP
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.32 |
| Max. Negotiated Rate |
$5,437.44 |
| Rate for Payer: Aetna Commercial |
$4,361.28
|
| Rate for Payer: Anthem Medicaid |
$1,947.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,417.92
|
| 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 |
$2,832.00
|
| Rate for Payer: Cash Price |
$2,832.00
|
| Rate for Payer: Cigna Commercial |
$4,701.12
|
| Rate for Payer: First Health Commercial |
$5,380.80
|
| Rate for Payer: Humana Commercial |
$4,814.40
|
| Rate for Payer: Humana KY Medicaid |
$1,947.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,644.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,986.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,984.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,755.84
|
| Rate for Payer: PHCS Commercial |
$5,437.44
|
| Rate for Payer: United Healthcare All Payer |
$4,984.32
|
|
|
INSERT PICVAD CATH <5 Y/O
|
Professional
|
Both
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$5,664.00 |
| 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 |
$5,664.00
|
| Rate for Payer: Cash Price |
$2,832.00
|
| Rate for Payer: Cash Price |
$2,832.00
|
| 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 |
$3,398.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,964.80
|
| Rate for Payer: UHCCP Medicaid |
$237.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.27
|
|
|
INSERT PICVAD CATH <5 Y/O
|
Facility
|
IP
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.32 |
| Max. Negotiated Rate |
$5,437.44 |
| Rate for Payer: Aetna Commercial |
$4,361.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,417.92
|
| Rate for Payer: Cash Price |
$2,832.00
|
| Rate for Payer: Cigna Commercial |
$4,701.12
|
| Rate for Payer: First Health Commercial |
$5,380.80
|
| Rate for Payer: Humana Commercial |
$4,814.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,644.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,984.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,755.84
|
| Rate for Payer: PHCS Commercial |
$5,437.44
|
| Rate for Payer: United Healthcare All Payer |
$4,984.32
|
|
|
INSERT PICVAD CATH <5 Y/O (P
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761P2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$1,364.62 |
| 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 |
$540.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| 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 |
$324.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$378.00
|
| Rate for Payer: UHCCP Medicaid |
$237.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.27
|
|
|
INSERT PICVAD CATH <5 Y/O (T
|
Facility
|
IP
|
$5,124.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761T2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$4,919.04 |
| Rate for Payer: Aetna Commercial |
$3,945.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.72
|
| Rate for Payer: Cash Price |
$2,562.00
|
| Rate for Payer: Cigna Commercial |
$4,252.92
|
| Rate for Payer: First Health Commercial |
$4,867.80
|
| Rate for Payer: Humana Commercial |
$4,355.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,509.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,588.44
|
| Rate for Payer: PHCS Commercial |
$4,919.04
|
| Rate for Payer: United Healthcare All Payer |
$4,509.12
|
|
|
INSERT PICVAD CATH <5 Y/O (T
|
Facility
|
OP
|
$5,124.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761T2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$4,919.04 |
| Rate for Payer: Aetna Commercial |
$3,945.48
|
| Rate for Payer: Anthem Medicaid |
$1,762.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.72
|
| 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 |
$2,562.00
|
| Rate for Payer: Cash Price |
$2,562.00
|
| Rate for Payer: Cigna Commercial |
$4,252.92
|
| Rate for Payer: First Health Commercial |
$4,867.80
|
| Rate for Payer: Humana Commercial |
$4,355.40
|
| Rate for Payer: Humana KY Medicaid |
$1,762.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,797.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,509.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,588.44
|
| Rate for Payer: PHCS Commercial |
$4,919.04
|
| Rate for Payer: United Healthcare All Payer |
$4,509.12
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
IP
|
$9,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,283.23 |
| Max. Negotiated Rate |
$9,476.16 |
| Rate for Payer: Aetna Commercial |
$7,600.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,699.38
|
| Rate for Payer: Cash Price |
$4,935.50
|
| Rate for Payer: Cigna Commercial |
$8,192.93
|
| Rate for Payer: First Health Commercial |
$9,377.45
|
| Rate for Payer: Humana Commercial |
$8,390.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,094.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,284.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,961.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,686.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,403.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,060.01
|
| Rate for Payer: PHCS Commercial |
$9,476.16
|
| Rate for Payer: United Healthcare All Payer |
$8,686.48
|
|
