|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
761T1503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,729.88 |
| Max. Negotiated Rate |
$7,620.48 |
| Rate for Payer: Aetna Commercial |
$6,112.26
|
| Rate for Payer: Anthem Medicaid |
$2,729.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,191.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,969.00
|
| 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: Humana KY Medicaid |
$2,729.88
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.66
|
| 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 |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.65
|
| 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
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.01 |
| Max. Negotiated Rate |
$5,032.80 |
| 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 |
$4,194.00
|
| Rate for Payer: Cash Price |
$4,194.00
|
| 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 |
$5,032.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.91
|
| Rate for Payer: UHCCP Medicaid |
$2,935.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.01
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,884.63 |
| Max. Negotiated Rate |
$8,052.48 |
| Rate for Payer: Aetna Commercial |
$6,458.76
|
| Rate for Payer: Anthem Medicaid |
$2,884.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,542.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cigna Commercial |
$6,962.04
|
| Rate for Payer: First Health Commercial |
$7,968.60
|
| Rate for Payer: Humana Commercial |
$7,129.80
|
| Rate for Payer: Humana KY Medicaid |
$2,884.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,878.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,190.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,942.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,381.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,297.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,787.72
|
| Rate for Payer: PHCS Commercial |
$8,052.48
|
| Rate for Payer: United Healthcare All Payer |
$7,381.44
|
|
|
INSERT CANNULA FOR HEMODIALYSI
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
76101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,516.40 |
| Max. Negotiated Rate |
$8,052.48 |
| Rate for Payer: Aetna Commercial |
$6,458.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,542.64
|
| Rate for Payer: Cash Price |
$4,194.00
|
| Rate for Payer: Cigna Commercial |
$6,962.04
|
| Rate for Payer: First Health Commercial |
$7,968.60
|
| Rate for Payer: Humana Commercial |
$7,129.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,878.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,190.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,516.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,381.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,297.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,787.72
|
| Rate for Payer: PHCS Commercial |
$8,052.48
|
| Rate for Payer: United Healthcare All Payer |
$7,381.44
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem Medicaid |
$831.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Humana KY Medicaid |
$831.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$840.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$848.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$3,533.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$3,391.68 |
| Rate for Payer: Aetna Commercial |
$2,720.41
|
| Rate for Payer: Anthem Medicaid |
$1,215.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,755.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$2,932.39
|
| Rate for Payer: First Health Commercial |
$3,356.35
|
| Rate for Payer: Humana Commercial |
$3,003.05
|
| Rate for Payer: Humana KY Medicaid |
$1,215.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,227.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,897.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,607.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,239.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,109.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,649.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,073.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,437.77
|
| Rate for Payer: PHCS Commercial |
$3,391.68
|
| Rate for Payer: United Healthcare All Payer |
$3,109.04
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$3,533.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,059.90 |
| Max. Negotiated Rate |
$3,391.68 |
| Rate for Payer: Aetna Commercial |
$2,720.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,755.74
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$2,932.39
|
| Rate for Payer: First Health Commercial |
$3,356.35
|
| Rate for Payer: Humana Commercial |
$3,003.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,897.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,607.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,109.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,649.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,073.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,437.77
|
| Rate for Payer: PHCS Commercial |
$3,391.68
|
| Rate for Payer: United Healthcare All Payer |
$3,109.04
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Professional
|
Both
|
$3,533.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
76101203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$2,119.80 |
| Rate for Payer: Ambetter Exchange |
$139.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.61
|
| Rate for Payer: Anthem Medicaid |
$851.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.03
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$308.80
|
| Rate for Payer: Healthspan PPO |
$1,037.54
|
| Rate for Payer: Humana Medicaid |
$851.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.64
|
| Rate for Payer: Molina Healthcare Passport |
$851.61
|
| Rate for Payer: Multiplan PHCS |
$2,119.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.95
|
| Rate for Payer: UHCCP Medicaid |
$102.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.19
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem Medicaid |
$831.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Humana KY Medicaid |
$831.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$840.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$848.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
45000228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/ IMAGE(P
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761P1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$1,037.54 |
| Rate for Payer: Ambetter Exchange |
$139.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.61
|
| Rate for Payer: Anthem Medicaid |
$851.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.03
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$308.80
|
| Rate for Payer: Healthspan PPO |
$1,037.54
|
| Rate for Payer: Humana Medicaid |
$851.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$222.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.64
|
| Rate for Payer: Molina Healthcare Passport |
$851.61
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.95
|
| Rate for Payer: UHCCP Medicaid |
$102.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.19
|
|
|
INSERT CATH PLEURA W/ IMAGE(T
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761T1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/ IMAGE(T
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
761T1203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$831.55 |
| Max. Negotiated Rate |
$2,321.28 |
| Rate for Payer: Aetna Commercial |
$1,861.86
|
| Rate for Payer: Anthem Medicaid |
$831.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,886.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cash Price |
$1,209.00
|
| Rate for Payer: Cigna Commercial |
$2,006.94
|
| Rate for Payer: First Health Commercial |
$2,297.10
|
| Rate for Payer: Humana Commercial |
$2,055.30
|
| Rate for Payer: Humana KY Medicaid |
$831.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$840.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,982.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,784.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$848.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,127.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,813.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.42
|
| Rate for Payer: PHCS Commercial |
$2,321.28
|
| Rate for Payer: United Healthcare All Payer |
$2,127.84
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
IP
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.30 |
| Max. Negotiated Rate |
$2,967.36 |
| Rate for Payer: Aetna Commercial |
$2,380.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,410.98
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$2,565.53
|
| Rate for Payer: First Health Commercial |
$2,936.45
|
| Rate for Payer: Humana Commercial |
$2,627.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,132.79
|
| Rate for Payer: PHCS Commercial |
$2,967.36
|
| Rate for Payer: United Healthcare All Payer |
$2,720.08
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
OP
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,062.99 |
| Max. Negotiated Rate |
$2,967.36 |
| Rate for Payer: Aetna Commercial |
$2,380.07
|
| Rate for Payer: Anthem Medicaid |
$1,062.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,410.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$2,565.53
|
| Rate for Payer: First Health Commercial |
$2,936.45
|
| Rate for Payer: Humana Commercial |
$2,627.35
|
| Rate for Payer: Humana KY Medicaid |
$1,062.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,073.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,084.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,132.79
|
| Rate for Payer: PHCS Commercial |
$2,967.36
|
| Rate for Payer: United Healthcare All Payer |
$2,720.08
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$1,854.60 |
| Rate for Payer: Ambetter Exchange |
$117.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.05
|
| Rate for Payer: Anthem Medicaid |
$466.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.92
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$1,069.62
|
| Rate for Payer: Healthspan PPO |
$565.85
|
| Rate for Payer: Humana Medicaid |
$466.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$476.13
|
| Rate for Payer: Molina Healthcare Passport |
$466.79
|
| Rate for Payer: Multiplan PHCS |
$1,854.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.66
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$471.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.43
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
45000226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$767.24 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
45000226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CATH PLEURA W/O IMAG(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761P1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$1,069.62 |
| Rate for Payer: Ambetter Exchange |
$117.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.05
|
| Rate for Payer: Anthem Medicaid |
$466.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$140.92
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,069.62
|
| Rate for Payer: Healthspan PPO |
$565.85
|
| Rate for Payer: Humana Medicaid |
$466.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$476.13
|
| Rate for Payer: Molina Healthcare Passport |
$466.79
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.66
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$471.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.43
|
|
|
INSERT CATH PLEURA W/O IMAG(T
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761T1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$767.24 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CATH PLEURA W/O IMAG(T
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761T1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
INSERT CERVICAL DILATOR
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$76.13
|
| Rate for Payer: Ambetter Exchange |
$64.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.67
|
| Rate for Payer: Anthem Medicaid |
$40.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.23
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Healthspan PPO |
$85.85
|
| Rate for Payer: Humana Medicaid |
$40.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.15
|
| Rate for Payer: Molina Healthcare Passport |
$40.34
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.67
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.36
|
|
