|
INSERT TS TIBIAL #9/24MM 11T
|
Facility
|
IP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TS TIBIAL #9/24MM 11T
|
Facility
|
OP
|
$7,028.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.66 |
| Max. Negotiated Rate |
$6,747.03 |
| Rate for Payer: Aetna Commercial |
$5,411.68
|
| Rate for Payer: Anthem Medicaid |
$2,416.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.96
|
| Rate for Payer: Cash Price |
$3,514.08
|
| Rate for Payer: Cigna Commercial |
$5,833.37
|
| Rate for Payer: First Health Commercial |
$6,676.75
|
| Rate for Payer: Humana Commercial |
$5,973.94
|
| Rate for Payer: Humana KY Medicaid |
$2,416.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.73
|
| Rate for Payer: PHCS Commercial |
$6,747.03
|
| Rate for Payer: United Healthcare All Payer |
$6,184.78
|
|
|
INSERT TUN IP CATH PERC
|
Professional
|
Both
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.45 |
| Max. Negotiated Rate |
$8,603.41 |
| Rate for Payer: Aetna Commercial |
$379.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.45
|
| Rate for Payer: Anthem Medicaid |
$205.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,603.41
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$2,482.81
|
| Rate for Payer: Healthspan PPO |
$1,496.16
|
| Rate for Payer: Humana Medicaid |
$205.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$209.12
|
| Rate for Payer: Molina Healthcare Passport |
$205.02
|
| Rate for Payer: Multiplan PHCS |
$5,162.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,022.39
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.07
|
|
|
INSERT TUN IP CATH PERC
|
Facility
|
IP
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,118.44 |
| Max. Negotiated Rate |
$8,259.27 |
| Rate for Payer: Aetna Commercial |
$6,624.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.66
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$7,140.83
|
| Rate for Payer: First Health Commercial |
$8,173.24
|
| Rate for Payer: Humana Commercial |
$7,312.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,667.06
|
| Rate for Payer: PHCS Commercial |
$8,259.27
|
| Rate for Payer: United Healthcare All Payer |
$7,571.00
|
|
|
INSERT TUN IP CATH PERC
|
Facility
|
OP
|
$8,603.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
76101999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,118.44 |
| Max. Negotiated Rate |
$8,259.27 |
| Rate for Payer: Aetna Commercial |
$6,624.63
|
| Rate for Payer: Anthem Medicaid |
$2,958.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cash Price |
$4,301.70
|
| Rate for Payer: Cigna Commercial |
$7,140.83
|
| Rate for Payer: First Health Commercial |
$8,173.24
|
| Rate for Payer: Humana Commercial |
$7,312.90
|
| Rate for Payer: Humana KY Medicaid |
$2,958.71
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,667.06
|
| Rate for Payer: PHCS Commercial |
$8,259.27
|
| Rate for Payer: United Healthcare All Payer |
$7,571.00
|
|
|
INSERT TUN IP CATH PERC(P
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
761P1999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.45 |
| Max. Negotiated Rate |
$2,482.81 |
| Rate for Payer: Aetna Commercial |
$379.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.45
|
| Rate for Payer: Anthem Medicaid |
$205.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,180.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cigna Commercial |
$2,482.81
|
| Rate for Payer: Healthspan PPO |
$1,496.16
|
| Rate for Payer: Humana Medicaid |
$205.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$209.12
|
| Rate for Payer: Molina Healthcare Passport |
$205.02
|
| Rate for Payer: Multiplan PHCS |
$1,308.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,526.00
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.07
|
|
|
INSERT TUN IP CATH PERC(T
|
Facility
|
OP
|
$6,423.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
761T1999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.04 |
| Max. Negotiated Rate |
$6,166.47 |
| Rate for Payer: Aetna Commercial |
$4,946.03
|
| Rate for Payer: Anthem Medicaid |
$2,209.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,010.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$3,211.70
|
| Rate for Payer: Cash Price |
$3,211.70
|
| Rate for Payer: Cigna Commercial |
$5,331.43
|
| Rate for Payer: First Health Commercial |
$6,102.24
|
| Rate for Payer: Humana Commercial |
$5,459.90
|
| Rate for Payer: Humana KY Medicaid |
$2,209.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,231.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,267.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,253.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,652.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,817.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,284.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.26
|
| Rate for Payer: PHCS Commercial |
$6,166.47
|
| Rate for Payer: United Healthcare All Payer |
$5,652.60
|
|
|
INSERT TUN IP CATH PERC(T
|
Facility
|
IP
|
$6,423.41
|
|
|
Service Code
|
HCPCS 49418
|
| Hospital Charge Code |
761T1999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.04 |
| Max. Negotiated Rate |
$6,166.47 |
| Rate for Payer: Aetna Commercial |
$4,946.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,010.26
|
| Rate for Payer: Cash Price |
$3,211.70
|
| Rate for Payer: Cigna Commercial |
$5,331.43
|
| Rate for Payer: First Health Commercial |
$6,102.24
|
| Rate for Payer: Humana Commercial |
$5,459.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,267.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,927.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,652.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,817.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,284.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.26
|
| Rate for Payer: PHCS Commercial |
$6,166.47
|
| Rate for Payer: United Healthcare All Payer |
$5,652.60
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Professional
|
Both
|
$9,097.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
76101475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.01 |
| Max. Negotiated Rate |
$9,097.00 |
| Rate for Payer: Aetna Commercial |
$556.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$250.01
|
| Rate for Payer: Anthem Medicaid |
$270.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,097.00
|
| Rate for Payer: Cash Price |
$4,548.50
|
| Rate for Payer: Cash Price |
$4,548.50
|
| Rate for Payer: Cigna Commercial |
$524.61
|
| Rate for Payer: Healthspan PPO |
$1,345.50
|
| Rate for Payer: Humana Medicaid |
$270.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.02
|
| Rate for Payer: Molina Healthcare Passport |
$270.61
|
| Rate for Payer: Multiplan PHCS |
$5,458.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,367.90
|
| Rate for Payer: UHCCP Medicaid |
$262.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.32
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Facility
|
OP
|
$7,097.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
761T1475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem Medicaid |
$2,440.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Humana KY Medicaid |
$2,440.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
761P1475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.01 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$556.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$250.01
|
| Rate for Payer: Anthem Medicaid |
$270.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$524.61
|
| Rate for Payer: Healthspan PPO |
$1,345.50
|
| Rate for Payer: Humana Medicaid |
$270.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.02
|
| Rate for Payer: Molina Healthcare Passport |
$270.61
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$262.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.32
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Facility
|
OP
|
$9,097.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
76101475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,182.61 |
| Max. Negotiated Rate |
$8,733.12 |
| Rate for Payer: Aetna Commercial |
$7,004.69
|
| Rate for Payer: Anthem Medicaid |
$3,128.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,095.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,548.50
|
| Rate for Payer: Cash Price |
$4,548.50
|
| Rate for Payer: Cigna Commercial |
$7,550.51
|
| Rate for Payer: First Health Commercial |
$8,642.15
|
| Rate for Payer: Humana Commercial |
$7,732.45
|
| Rate for Payer: Humana KY Medicaid |
$3,128.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,160.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,459.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,713.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,191.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,005.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.07
|
| Rate for Payer: PHCS Commercial |
$8,733.12
|
| Rate for Payer: United Healthcare All Payer |
$8,005.36
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Facility
|
IP
|
$7,097.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
761T1475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,129.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
INSERT TUNNELED CENTRAL ACCESS
|
Facility
|
IP
|
$9,097.00
|
|
|
Service Code
|
HCPCS 36560
|
| Hospital Charge Code |
76101475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,182.61 |
| Max. Negotiated Rate |
$8,733.12 |
| Rate for Payer: Aetna Commercial |
$7,004.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,095.66
|
| Rate for Payer: Cash Price |
$4,548.50
|
| Rate for Payer: Cigna Commercial |
$7,550.51
|
| Rate for Payer: First Health Commercial |
$8,642.15
|
| Rate for Payer: Humana Commercial |
$7,732.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,459.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,713.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,729.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,005.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.07
|
| Rate for Payer: PHCS Commercial |
$8,733.12
|
| Rate for Payer: United Healthcare All Payer |
$8,005.36
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$4,275.00
|
|
|
Service Code
|
HCPCS 36566
|
| Hospital Charge Code |
76102770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$3,291.75
|
| Rate for Payer: Anthem Medicaid |
$1,470.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna Commercial |
$3,548.25
|
| Rate for Payer: First Health Commercial |
$4,061.25
|
| Rate for Payer: Humana Commercial |
$3,633.75
|
| Rate for Payer: Humana KY Medicaid |
$1,470.17
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,762.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.25
|
| Rate for Payer: PHCS Commercial |
$4,104.00
|
| Rate for Payer: United Healthcare All Payer |
$3,762.00
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$8,464.00
|
|
|
Service Code
|
HCPCS 36563
|
| Hospital Charge Code |
76101477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,100.32 |
| Max. Negotiated Rate |
$8,125.44 |
| Rate for Payer: Aetna Commercial |
$6,517.28
|
| Rate for Payer: Anthem Medicaid |
$2,910.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,601.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,232.00
|
| Rate for Payer: Cash Price |
$4,232.00
|
| Rate for Payer: Cigna Commercial |
$7,025.12
|
| Rate for Payer: First Health Commercial |
$8,040.80
|
| Rate for Payer: Humana Commercial |
$7,194.40
|
| Rate for Payer: Humana KY Medicaid |
$2,910.77
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,940.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,940.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,246.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,969.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,448.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,348.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,623.84
|
| Rate for Payer: PHCS Commercial |
$8,125.44
|
| Rate for Payer: United Healthcare All Payer |
$7,448.32
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$7,103.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
76101473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$6,818.88 |
| Rate for Payer: Aetna Commercial |
$5,469.31
|
| Rate for Payer: Anthem Medicaid |
$2,442.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,540.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$3,551.50
|
| Rate for Payer: Cash Price |
$3,551.50
|
| Rate for Payer: Cigna Commercial |
$5,895.49
|
| Rate for Payer: First Health Commercial |
$6,747.85
|
| Rate for Payer: Humana Commercial |
$6,037.55
|
| Rate for Payer: Humana KY Medicaid |
$2,442.72
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,824.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,491.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,250.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.93
|
| Rate for Payer: PHCS Commercial |
$6,818.88
|
| Rate for Payer: United Healthcare All Payer |
$6,250.64
|
|
|
INSERT TUNNELED CV CATH
|
Professional
|
Both
|
$7,103.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
76101473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$7,103.00 |
| Rate for Payer: Aetna Commercial |
$472.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$213.16
|
| Rate for Payer: Anthem Medicaid |
$227.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,103.00
|
| Rate for Payer: Cash Price |
$3,551.50
|
| Rate for Payer: Cash Price |
$3,551.50
|
| Rate for Payer: Cigna Commercial |
$444.51
|
| Rate for Payer: Healthspan PPO |
$986.00
|
| Rate for Payer: Humana Medicaid |
$227.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$411.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.34
|
| Rate for Payer: Molina Healthcare Passport |
$227.78
|
| Rate for Payer: Multiplan PHCS |
$4,261.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,972.10
|
| Rate for Payer: UHCCP Medicaid |
$223.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.06
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$8,464.00
|
|
|
Service Code
|
HCPCS 36563
|
| Hospital Charge Code |
76101477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,100.32 |
| Max. Negotiated Rate |
$8,125.44 |
| Rate for Payer: Aetna Commercial |
$6,517.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,601.92
|
| Rate for Payer: Cash Price |
$4,232.00
|
| Rate for Payer: Cigna Commercial |
$7,025.12
|
| Rate for Payer: First Health Commercial |
$8,040.80
|
| Rate for Payer: Humana Commercial |
$7,194.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,940.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,246.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,539.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,448.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,348.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,623.84
|
| Rate for Payer: PHCS Commercial |
$8,125.44
|
| Rate for Payer: United Healthcare All Payer |
$7,448.32
|
|
|
INSERT TUNNELED CV CATH
|
Professional
|
Both
|
$4,275.00
|
|
|
Service Code
|
HCPCS 36566
|
| Hospital Charge Code |
76102770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.58 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.58
|
| Rate for Payer: Anthem Medicaid |
$279.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,275.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna Commercial |
$543.16
|
| Rate for Payer: Healthspan PPO |
$4,127.18
|
| Rate for Payer: Humana Medicaid |
$279.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.46
|
| Rate for Payer: Molina Healthcare Passport |
$279.86
|
| Rate for Payer: Multiplan PHCS |
$2,565.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,992.50
|
| Rate for Payer: UHCCP Medicaid |
$264.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.66
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$4,275.00
|
|
|
Service Code
|
HCPCS 36566
|
| Hospital Charge Code |
76102770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.75 |
| Max. Negotiated Rate |
$4,104.00 |
| Rate for Payer: Aetna Commercial |
$3,291.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna Commercial |
$3,548.25
|
| Rate for Payer: First Health Commercial |
$4,061.25
|
| Rate for Payer: Humana Commercial |
$3,633.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,762.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.25
|
| Rate for Payer: PHCS Commercial |
$4,104.00
|
| Rate for Payer: United Healthcare All Payer |
$3,762.00
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$7,103.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
76101473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$6,818.88 |
| Rate for Payer: Aetna Commercial |
$5,469.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,540.34
|
| Rate for Payer: Cash Price |
$3,551.50
|
| Rate for Payer: Cigna Commercial |
$5,895.49
|
| Rate for Payer: First Health Commercial |
$6,747.85
|
| Rate for Payer: Humana Commercial |
$6,037.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,824.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,130.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,250.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.93
|
| Rate for Payer: PHCS Commercial |
$6,818.88
|
| Rate for Payer: United Healthcare All Payer |
$6,250.64
|
|
|
INSERT TUNNELED CV CATH
|
Professional
|
Both
|
$8,464.00
|
|
|
Service Code
|
HCPCS 36563
|
| Hospital Charge Code |
76101477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.03 |
| Max. Negotiated Rate |
$8,464.00 |
| Rate for Payer: Aetna Commercial |
$567.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.03
|
| Rate for Payer: Anthem Medicaid |
$271.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,464.00
|
| Rate for Payer: Cash Price |
$4,232.00
|
| Rate for Payer: Cash Price |
$4,232.00
|
| Rate for Payer: Cigna Commercial |
$537.01
|
| Rate for Payer: Healthspan PPO |
$1,353.42
|
| Rate for Payer: Humana Medicaid |
$271.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$481.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.93
|
| Rate for Payer: Molina Healthcare Passport |
$271.50
|
| Rate for Payer: Multiplan PHCS |
$5,078.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,924.80
|
| Rate for Payer: UHCCP Medicaid |
$265.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.22
|
|
|
INSERT TUNNELED CV CATH (P
|
Professional
|
Both
|
$4,275.00
|
|
|
Service Code
|
HCPCS 36566
|
| Hospital Charge Code |
761P2770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.58 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.58
|
| Rate for Payer: Anthem Medicaid |
$279.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,275.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna Commercial |
$543.16
|
| Rate for Payer: Healthspan PPO |
$4,127.18
|
| Rate for Payer: Humana Medicaid |
$279.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.46
|
| Rate for Payer: Molina Healthcare Passport |
$279.86
|
| Rate for Payer: Multiplan PHCS |
$2,565.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,992.50
|
| Rate for Payer: UHCCP Medicaid |
$264.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.66
|
|
|
INSERT TUNNELED CV CATH(P
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
761P1473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Aetna Commercial |
$472.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$213.16
|
| Rate for Payer: Anthem Medicaid |
$227.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$444.51
|
| Rate for Payer: Healthspan PPO |
$986.00
|
| Rate for Payer: Humana Medicaid |
$227.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$411.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.34
|
| Rate for Payer: Molina Healthcare Passport |
$227.78
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$223.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.06
|
|
