|
INSERTION CHEST TUBE(P
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761P1198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$303.54 |
| 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 |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| 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 |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.70
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.69
|
|
|
INSERTION CHEST TUBE(T
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761T1198
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
761T1198
|
|
Hospital Revenue Code
|
761
|
| 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 INTRAUTERINE IUD
|
Facility
|
IP
|
$2,144.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.20 |
| Max. Negotiated Rate |
$2,058.24 |
| Rate for Payer: Aetna Commercial |
$1,650.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.32
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cigna Commercial |
$1,779.52
|
| Rate for Payer: First Health Commercial |
$2,036.80
|
| Rate for Payer: Humana Commercial |
$1,822.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,865.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.36
|
| Rate for Payer: PHCS Commercial |
$2,058.24
|
| Rate for Payer: United Healthcare All Payer |
$1,886.72
|
|
|
INSERTION INTRAUTERINE IUD
|
Professional
|
Both
|
$2,144.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,500.80 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.18
|
| Rate for Payer: Anthem Medicaid |
$59.25
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cigna Commercial |
$131.13
|
| Rate for Payer: Healthspan PPO |
$105.15
|
| Rate for Payer: Humana Medicaid |
$59.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.44
|
| Rate for Payer: Molina Healthcare Passport |
$59.25
|
| Rate for Payer: Multiplan PHCS |
$1,286.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,500.80
|
| Rate for Payer: UHCCP Medicaid |
$39.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.84
|
|
|
INSERTION INTRAUTERINE IUD
|
Facility
|
OP
|
$2,144.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
76102220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.20 |
| Max. Negotiated Rate |
$2,058.24 |
| Rate for Payer: Aetna Commercial |
$1,650.88
|
| Rate for Payer: Anthem Medicaid |
$737.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.32
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cigna Commercial |
$1,779.52
|
| Rate for Payer: First Health Commercial |
$2,036.80
|
| Rate for Payer: Humana Commercial |
$1,822.40
|
| Rate for Payer: Humana KY Medicaid |
$737.32
|
| Rate for Payer: Kentucky WC Medicaid |
$744.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,865.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.36
|
| Rate for Payer: PHCS Commercial |
$2,058.24
|
| Rate for Payer: United Healthcare All Payer |
$1,886.72
|
|
|
INSERTION INTRAUTERINE IUD(P
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761P2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$85.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.18
|
| Rate for Payer: Anthem Medicaid |
$59.25
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$131.13
|
| Rate for Payer: Healthspan PPO |
$105.15
|
| Rate for Payer: Humana Medicaid |
$59.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.44
|
| Rate for Payer: Molina Healthcare Passport |
$59.25
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$39.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.84
|
|
|
INSERTION INTRAUTERINE IUD(T
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761T2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$1,789.44 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem Medicaid |
$641.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Humana KY Medicaid |
$641.03
|
| Rate for Payer: Kentucky WC Medicaid |
$647.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.16
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
INSERTION INTRAUTERINE IUD(T
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
761T2220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$1,789.44 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.16
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
|
Facility
|
OP
|
$10,705.58
|
|
|
Service Code
|
CPT 33216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$10,705.58 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$8,435.98
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,025.70 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
|
|
INSERTION OF CATHETER VEIN
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna Commercial |
$90.38
|
| Rate for Payer: Ambetter Exchange |
$49.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.87
|
| Rate for Payer: Anthem Medicaid |
$41.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$93.30
|
| Rate for Payer: Healthspan PPO |
$130.05
|
| Rate for Payer: Humana Medicaid |
$41.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.42
|
| Rate for Payer: Molina Healthcare Passport |
$41.59
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.82
|
| Rate for Payer: UHCCP Medicaid |
$29.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.09
|
|
|
INSERTION OF CATHETER VEIN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
INSERTION OF CATHETER VEIN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL
|
Facility
|
OP
|
$13,537.66
|
|
|
Service Code
|
CPT 33206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,669.76 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR
|
Facility
|
OP
|
$13,537.66
|
|
|
Service Code
|
CPT 33208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,669.76 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
|
|
INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR
|
Facility
|
OP
|
$13,537.66
|
|
|
Service Code
|
CPT 33207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,669.76 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
|
|
INSERTION OF PESSARY
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
76102177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$74.02
|
| Rate for Payer: Ambetter Exchange |
$43.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.66
|
| Rate for Payer: Anthem Medicaid |
$34.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.58
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$111.99
|
| Rate for Payer: Healthspan PPO |
$110.53
|
| Rate for Payer: Humana Medicaid |
$34.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.72
|
| Rate for Payer: Molina Healthcare Passport |
$34.04
|
| Rate for Payer: Multiplan PHCS |
$230.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.97
|
| Rate for Payer: UHCCP Medicaid |
$33.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.82
|
|
|
INSERTION OF PESSARY
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
76102177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$368.64 |
| Rate for Payer: Aetna Commercial |
$295.68
|
| Rate for Payer: Anthem Medicaid |
$132.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$299.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$318.72
|
| Rate for Payer: First Health Commercial |
$364.80
|
| Rate for Payer: Humana Commercial |
$326.40
|
| Rate for Payer: Humana KY Medicaid |
$132.06
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$133.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$283.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.92
|
| Rate for Payer: Ohio Health Group HMO |
$288.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.96
|
| Rate for Payer: PHCS Commercial |
$368.64
|
| Rate for Payer: United Healthcare All Payer |
$337.92
|
|
|
INSERTION OF PESSARY
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
76102177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$368.64 |
| Rate for Payer: Aetna Commercial |
$295.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$299.52
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$318.72
|
| Rate for Payer: First Health Commercial |
$364.80
|
| Rate for Payer: Humana Commercial |
$326.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$283.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.92
|
| Rate for Payer: Ohio Health Group HMO |
$288.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.96
|
| Rate for Payer: PHCS Commercial |
$368.64
|
| Rate for Payer: United Healthcare All Payer |
$337.92
|
|
|
INSERTION OF PESSARY(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
761P2177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$111.99 |
| Rate for Payer: Aetna Commercial |
$74.02
|
| Rate for Payer: Ambetter Exchange |
$43.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.66
|
| Rate for Payer: Anthem Medicaid |
$34.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.58
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$111.99
|
| Rate for Payer: Healthspan PPO |
$110.53
|
| Rate for Payer: Humana Medicaid |
$34.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.72
|
| Rate for Payer: Molina Healthcare Passport |
$34.04
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.97
|
| Rate for Payer: UHCCP Medicaid |
$33.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.82
|
|
|
INSERTION OF PESSARY(T
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
761T2177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$260.23 |
| Rate for Payer: Aetna Commercial |
$203.28
|
| Rate for Payer: Anthem Medicaid |
$90.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$219.12
|
| Rate for Payer: First Health Commercial |
$250.80
|
| Rate for Payer: Humana Commercial |
$224.40
|
| Rate for Payer: Humana KY Medicaid |
$90.79
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$91.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.32
|
| Rate for Payer: Ohio Health Group HMO |
$198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.16
|
| Rate for Payer: PHCS Commercial |
$253.44
|
| Rate for Payer: United Healthcare All Payer |
$232.32
|
|
|
INSERTION OF PESSARY(T
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
761T2177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: Aetna Commercial |
$203.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.92
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$219.12
|
| Rate for Payer: First Health Commercial |
$250.80
|
| Rate for Payer: Humana Commercial |
$224.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.32
|
| Rate for Payer: Ohio Health Group HMO |
$198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.16
|
| Rate for Payer: PHCS Commercial |
$253.44
|
| Rate for Payer: United Healthcare All Payer |
$232.32
|
|
|
INSERTION OF SUBCU RESEV
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 61215
|
| Hospital Charge Code |
76102284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.68 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$749.15
|
| Rate for Payer: Ambetter Exchange |
$498.68
|
| Rate for Payer: Anthem Medicaid |
$575.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$498.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$498.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$598.42
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$645.70
|
| Rate for Payer: Healthspan PPO |
$584.91
|
| Rate for Payer: Humana Medicaid |
$575.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$638.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$498.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$498.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$587.43
|
| Rate for Payer: Molina Healthcare Passport |
$575.91
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$648.28
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$498.68
|
|
|
INSERTION OF SUBCU RESEV
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 61215
|
| Hospital Charge Code |
76102284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
