|
INS ENDOVAS VENA CAVA FILTR
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
76101530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$2,315.67 |
| Rate for Payer: Ambetter Exchange |
$205.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.87
|
| Rate for Payer: Anthem Medicaid |
$2,040.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.83
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$447.14
|
| Rate for Payer: Healthspan PPO |
$2,315.67
|
| Rate for Payer: Humana Medicaid |
$2,040.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,081.25
|
| Rate for Payer: Molina Healthcare Passport |
$2,040.44
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$203.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,060.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.69
|
|
|
INS ENDOVAS VENA CAVA FILTR(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
761P1530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$2,315.67 |
| Rate for Payer: Ambetter Exchange |
$205.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.87
|
| Rate for Payer: Anthem Medicaid |
$2,040.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$246.83
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$447.14
|
| Rate for Payer: Healthspan PPO |
$2,315.67
|
| Rate for Payer: Humana Medicaid |
$2,040.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,081.25
|
| Rate for Payer: Molina Healthcare Passport |
$2,040.44
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$203.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,060.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.69
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
45000279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
45000279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
INSERT BLAD STRAIGHT CATH
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
INSERT BLAD STRAIGHT CATH
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
76102065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Ambetter Exchange |
$23.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.57
|
| Rate for Payer: Anthem Medicaid |
$42.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.54
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: Healthspan PPO |
$75.43
|
| Rate for Payer: Humana Medicaid |
$42.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.26
|
| Rate for Payer: Molina Healthcare Passport |
$42.41
|
| Rate for Payer: Multiplan PHCS |
$228.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.91
|
| Rate for Payer: UHCCP Medicaid |
$20.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.78
|
|
|
INSERT BLAD STRAIGHT CATH(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761P2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Ambetter Exchange |
$23.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.57
|
| Rate for Payer: Anthem Medicaid |
$42.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.54
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: Healthspan PPO |
$75.43
|
| Rate for Payer: Humana Medicaid |
$42.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.26
|
| Rate for Payer: Molina Healthcare Passport |
$42.41
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.91
|
| Rate for Payer: UHCCP Medicaid |
$20.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.78
|
|
|
INSERT BLAD STRAIGHT CATH(T
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761T2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BLAD STRAIGHT CATH(T
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
761T2065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
45000280
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$135.82 |
| Rate for Payer: Aetna Commercial |
$48.84
|
| Rate for Payer: Ambetter Exchange |
$23.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.92
|
| Rate for Payer: Anthem Medicaid |
$65.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.13
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$135.82
|
| Rate for Payer: Healthspan PPO |
$96.40
|
| Rate for Payer: Humana Medicaid |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.11
|
| Rate for Payer: Molina Healthcare Passport |
$65.79
|
| Rate for Payer: Multiplan PHCS |
$101.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.47
|
| Rate for Payer: UHCCP Medicaid |
$25.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.44
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76102575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
INSERT BLAD TMP INDWL CATH SIM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
45000280
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
INSERT BUCK W/DISP 18.5MM
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT BUCK W/DISP 18.5MM
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT BUCK W/DISP 25MM
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT BUCK W/DISP 25MM
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT BUCK W/DISP 30MM
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT BUCK W/DISP 30MM
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761T1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,381.40 |
| Max. Negotiated Rate |
$7,620.48 |
| Rate for Payer: Aetna Commercial |
$6,112.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,191.64
|
| Rate for Payer: Cash Price |
$3,969.00
|
| Rate for Payer: Cigna Commercial |
$6,588.54
|
| Rate for Payer: First Health Commercial |
$7,541.10
|
| Rate for Payer: Humana Commercial |
$6,747.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,985.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,906.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,477.22
|
| Rate for Payer: PHCS Commercial |
$7,620.48
|
| Rate for Payer: United Healthcare All Payer |
$6,985.44
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761P1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.01 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$244.78
|
| Rate for Payer: Ambetter Exchange |
$113.01
|
| Rate for Payer: Anthem Medicaid |
$137.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.61
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$239.42
|
| Rate for Payer: Healthspan PPO |
$195.72
|
| Rate for Payer: Humana Medicaid |
$137.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.40
|
| Rate for Payer: Molina Healthcare Passport |
$137.65
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.91
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.01
|
|
