|
INSERT INDWELLING TUN CATH W C
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
761P1197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.77 |
| Max. Negotiated Rate |
$956.72 |
| Rate for Payer: Aetna Commercial |
$387.12
|
| Rate for Payer: Ambetter Exchange |
$190.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.77
|
| Rate for Payer: Anthem Medicaid |
$580.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.88
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$356.09
|
| Rate for Payer: Healthspan PPO |
$956.72
|
| Rate for Payer: Humana Medicaid |
$580.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$307.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.96
|
| Rate for Payer: Molina Healthcare Passport |
$580.35
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.95
|
| Rate for Payer: UHCCP Medicaid |
$166.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$586.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.73
|
|
|
INSERT INDWELLING TUN CATH W C
|
Facility
|
IP
|
$6,810.00
|
|
|
Service Code
|
HCPCS 32550
|
| Hospital Charge Code |
76101197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$6,537.60 |
| Rate for Payer: Aetna Commercial |
$5,243.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.80
|
| Rate for Payer: Cash Price |
$3,405.00
|
| Rate for Payer: Cigna Commercial |
$5,652.30
|
| Rate for Payer: First Health Commercial |
$6,469.50
|
| Rate for Payer: Humana Commercial |
$5,788.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,584.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,107.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,924.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,698.90
|
| Rate for Payer: PHCS Commercial |
$6,537.60
|
| Rate for Payer: United Healthcare All Payer |
$5,992.80
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$955.20 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem Medicaid |
$342.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Humana KY Medicaid |
$342.18
|
| Rate for Payer: Kentucky WC Medicaid |
$345.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$349.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
INSERTION CATHETER ARTERY
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$955.20 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
INSERTION CATHETER ARTERY
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
76101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Aetna Commercial |
$80.47
|
| Rate for Payer: Ambetter Exchange |
$41.21
|
| Rate for Payer: Anthem Medicaid |
$54.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.45
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$76.91
|
| Rate for Payer: Healthspan PPO |
$64.35
|
| Rate for Payer: Humana Medicaid |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Molina Healthcare Passport |
$54.85
|
| Rate for Payer: Multiplan PHCS |
$597.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.57
|
| Rate for Payer: UHCCP Medicaid |
$348.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.21
|
|
|
INSERTION CATHETER ARTERY(P
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761P1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$80.47 |
| Rate for Payer: Aetna Commercial |
$80.47
|
| Rate for Payer: Ambetter Exchange |
$41.21
|
| Rate for Payer: Anthem Medicaid |
$54.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.45
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$76.91
|
| Rate for Payer: Healthspan PPO |
$64.35
|
| Rate for Payer: Humana Medicaid |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Molina Healthcare Passport |
$54.85
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.57
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.21
|
|
|
INSERTION CATHETER ARTERY(T
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761T1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.79
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
INSERTION CATHETER ARTERY(T
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
761T1500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem Medicaid |
$306.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Humana KY Medicaid |
$306.41
|
| Rate for Payer: Kentucky WC Medicaid |
$309.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.79
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,943.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
76101472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,012.10 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,266.11
|
| Rate for Payer: Anthem Medicaid |
$1,012.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,295.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cigna Commercial |
$2,442.69
|
| Rate for Payer: First Health Commercial |
$2,795.85
|
| Rate for Payer: Humana Commercial |
$2,501.55
|
| Rate for Payer: Humana KY Medicaid |
$1,012.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,589.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.67
|
| Rate for Payer: PHCS Commercial |
$2,825.28
|
| Rate for Payer: United Healthcare All Payer |
$2,589.84
|
|
|
INSERTION CENTRAL LINE
|
Professional
|
Both
|
$2,943.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
76101472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$1,765.80 |
| Rate for Payer: Aetna Commercial |
$191.04
|
| Rate for Payer: Ambetter Exchange |
$79.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$98.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.14
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Healthspan PPO |
$278.14
|
| Rate for Payer: Humana Medicaid |
$98.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.70
|
| Rate for Payer: Molina Healthcare Passport |
$98.73
|
| Rate for Payer: Multiplan PHCS |
$1,765.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.06
|
| Rate for Payer: UHCCP Medicaid |
$51.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.28
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,943.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
76101472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$882.90 |
| Max. Negotiated Rate |
$2,825.28 |
| Rate for Payer: Aetna Commercial |
$2,266.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,295.54
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cigna Commercial |
$2,442.69
|
| Rate for Payer: First Health Commercial |
$2,795.85
|
| Rate for Payer: Humana Commercial |
$2,501.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,589.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.67
|
| Rate for Payer: PHCS Commercial |
$2,825.28
|
| Rate for Payer: United Healthcare All Payer |
$2,589.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$755.40 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,014.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,190.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.42
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
48100030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$865.94 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cash Price |
$1,259.00
|
| Rate for Payer: Cigna Commercial |
$2,089.94
|
| Rate for Payer: First Health Commercial |
$2,392.10
|
| Rate for Payer: Humana Commercial |
$2,140.30
|
| Rate for Payer: Humana KY Medicaid |
$865.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$874.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,858.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$883.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,014.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,190.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.42
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
45000236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CENTRAL LINE
|
Facility
|
IP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
45000236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CENTRAL LINE (P
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761P1472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$278.14 |
| Rate for Payer: Aetna Commercial |
$191.04
|
| Rate for Payer: Ambetter Exchange |
$79.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$98.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.14
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$182.21
|
| Rate for Payer: Healthspan PPO |
$278.14
|
| Rate for Payer: Humana Medicaid |
$98.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.70
|
| Rate for Payer: Molina Healthcare Passport |
$98.73
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.06
|
| Rate for Payer: UHCCP Medicaid |
$51.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.28
|
|
|
INSERTION CENTRAL LINE (T
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761T1472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CENTRAL LINE (T
|
Facility
|
IP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
761T1472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSERTION CHEST TUBE
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
45000223
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$778.20 |
| Max. Negotiated Rate |
$2,490.24 |
| Rate for Payer: Aetna Commercial |
$1,997.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,023.32
|
| Rate for Payer: Cash Price |
$1,297.00
|
| Rate for Payer: Cigna Commercial |
$2,153.02
|
| Rate for Payer: First Health Commercial |
$2,464.30
|
| Rate for Payer: Humana Commercial |
$2,204.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,127.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,914.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,282.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,945.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,075.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,256.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,789.86
|
| Rate for Payer: PHCS Commercial |
$2,490.24
|
| Rate for Payer: United Healthcare All Payer |
$2,282.72
|
|
|
INSERTION CHEST TUBE
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
45000223
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$892.08 |
| Max. Negotiated Rate |
$2,490.24 |
| Rate for Payer: Aetna Commercial |
$1,997.38
|
| Rate for Payer: Anthem Medicaid |
$892.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,023.32
|
| 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 |
$1,297.00
|
| Rate for Payer: Cash Price |
$1,297.00
|
| Rate for Payer: Cigna Commercial |
$2,153.02
|
| Rate for Payer: First Health Commercial |
$2,464.30
|
| Rate for Payer: Humana Commercial |
$2,204.90
|
| Rate for Payer: Humana KY Medicaid |
$892.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$901.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,127.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,914.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$909.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,282.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,945.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,075.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,256.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,789.86
|
| Rate for Payer: PHCS Commercial |
$2,490.24
|
| Rate for Payer: United Healthcare All Payer |
$2,282.72
|
|
|
INSERTION CHEST TUBE
|
Facility
|
IP
|
$2,849.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.70 |
| Max. Negotiated Rate |
$2,735.04 |
| Rate for Payer: Aetna Commercial |
$2,193.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,222.22
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cigna Commercial |
$2,364.67
|
| Rate for Payer: First Health Commercial |
$2,706.55
|
| Rate for Payer: Humana Commercial |
$2,421.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,336.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,102.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$854.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,507.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,136.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,478.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,965.81
|
| Rate for Payer: PHCS Commercial |
$2,735.04
|
| Rate for Payer: United Healthcare All Payer |
$2,507.12
|
|
|
INSERTION CHEST TUBE
|
Professional
|
Both
|
$2,849.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.15 |
| Max. Negotiated Rate |
$1,709.40 |
| Rate for Payer: Aetna Commercial |
$303.54
|
| Rate for Payer: Ambetter Exchange |
$146.69
|
| Rate for Payer: Anthem Medicaid |
$139.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.03
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cigna Commercial |
$282.14
|
| Rate for Payer: Healthspan PPO |
$236.99
|
| Rate for Payer: Humana Medicaid |
$139.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$233.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.93
|
| Rate for Payer: Molina Healthcare Passport |
$139.15
|
| Rate for Payer: Multiplan PHCS |
$1,709.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.70
|
| Rate for Payer: UHCCP Medicaid |
$997.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.69
|
|
|
INSERTION CHEST TUBE
|
Facility
|
OP
|
$2,849.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
76101198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$979.77 |
| Max. Negotiated Rate |
$2,735.04 |
| Rate for Payer: Aetna Commercial |
$2,193.73
|
| Rate for Payer: Anthem Medicaid |
$979.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,222.22
|
| 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 |
$1,424.50
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cigna Commercial |
$2,364.67
|
| Rate for Payer: First Health Commercial |
$2,706.55
|
| Rate for Payer: Humana Commercial |
$2,421.65
|
| Rate for Payer: Humana KY Medicaid |
$979.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$989.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,336.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,102.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,507.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,136.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,478.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,965.81
|
| Rate for Payer: PHCS Commercial |
$2,735.04
|
| Rate for Payer: United Healthcare All Payer |
$2,507.12
|
|
