|
INSERT X 3 #3 LM/RL-9MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
INS EXT HEART AST DEVIMPELLA
|
Facility
|
OP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
48100007
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$3,700.80 |
| Rate for Payer: Aetna Commercial |
$2,968.35
|
| Rate for Payer: Anthem Medicaid |
$1,325.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.90
|
| Rate for Payer: Cash Price |
$1,927.50
|
| Rate for Payer: Cigna Commercial |
$3,199.65
|
| Rate for Payer: First Health Commercial |
$3,662.25
|
| Rate for Payer: Humana Commercial |
$3,276.75
|
| Rate for Payer: Humana KY Medicaid |
$1,325.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,844.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.05
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
INS EXT HEART AST DEVIMPELLA
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
76101332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$817.68 |
| Rate for Payer: Anthem Medicaid |
$351.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$817.68
|
| Rate for Payer: Healthspan PPO |
$557.84
|
| Rate for Payer: Humana Medicaid |
$351.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.67
|
| Rate for Payer: Molina Healthcare Passport |
$351.64
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.16
|
|
|
INS EXT HEART AST DEVIMPELLA
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
76101332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
INS EXT HEART AST DEVIMPELLA
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
76101332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
INS EXT HEART AST DEVIMPELLA
|
Facility
|
IP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
48100007
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$3,700.80 |
| Rate for Payer: Aetna Commercial |
$2,968.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.90
|
| Rate for Payer: Cash Price |
$1,927.50
|
| Rate for Payer: Cigna Commercial |
$3,199.65
|
| Rate for Payer: First Health Commercial |
$3,662.25
|
| Rate for Payer: Humana Commercial |
$3,276.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,844.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.05
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
INS EXT HEART AST DEVIMPELLA(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
761P1332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$817.68 |
| Rate for Payer: Anthem Medicaid |
$351.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$817.68
|
| Rate for Payer: Healthspan PPO |
$557.84
|
| Rate for Payer: Humana Medicaid |
$351.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.67
|
| Rate for Payer: Molina Healthcare Passport |
$351.64
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.16
|
|
|
IN-SITU VEIN BYPASS; POPLITEAL
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35587
|
| Hospital Charge Code |
76101405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
IN-SITU VEIN BYPASS; POPLITEAL
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35587
|
| Hospital Charge Code |
761P1405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,447.74
|
| Rate for Payer: Anthem Medicaid |
$1,178.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,366.68
|
| Rate for Payer: Healthspan PPO |
$2,406.60
|
| Rate for Payer: Humana Medicaid |
$1,178.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,901.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,201.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,178.19
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,189.97
|
|
|
IN-SITU VEIN BYPASS; POPLITEAL
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35587
|
| Hospital Charge Code |
76101405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
IN-SITU VEIN BYPASS; POPLITEAL
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35587
|
| Hospital Charge Code |
76101405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,447.74
|
| Rate for Payer: Anthem Medicaid |
$1,178.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,366.68
|
| Rate for Payer: Healthspan PPO |
$2,406.60
|
| Rate for Payer: Humana Medicaid |
$1,178.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,901.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,201.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,178.19
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,189.97
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$2,818.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$2,818.00 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.85
|
| Rate for Payer: Anthem Medicaid |
$71.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,818.00
|
| Rate for Payer: Cash Price |
$1,409.00
|
| Rate for Payer: Cash Price |
$1,409.00
|
| Rate for Payer: Cigna Commercial |
$139.05
|
| Rate for Payer: Healthspan PPO |
$317.79
|
| Rate for Payer: Humana Medicaid |
$71.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.57
|
| Rate for Payer: Molina Healthcare Passport |
$71.15
|
| Rate for Payer: Multiplan PHCS |
$1,690.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,972.60
|
| Rate for Payer: UHCCP Medicaid |
$70.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.86
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
45000237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| 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 |
$1,384.93
|
| 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 |
$1,661.92
|
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.34 |
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| 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 |
$1,384.93
|
| 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 |
$1,661.92
|
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,818.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.34 |
| Max. Negotiated Rate |
$2,705.28 |
| Rate for Payer: Aetna Commercial |
$2,169.86
|
| Rate for Payer: Anthem Medicaid |
$969.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,198.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,409.00
|
| Rate for Payer: Cash Price |
$1,409.00
|
| Rate for Payer: Cigna Commercial |
$2,338.94
|
| Rate for Payer: First Health Commercial |
$2,677.10
|
| Rate for Payer: Humana Commercial |
$2,395.30
|
| Rate for Payer: Humana KY Medicaid |
$969.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$978.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,310.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,079.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$988.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,479.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,113.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$563.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.58
|
| Rate for Payer: PHCS Commercial |
$2,705.28
|
| Rate for Payer: United Healthcare All Payer |
$2,479.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,818.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.34 |
| Max. Negotiated Rate |
$2,705.28 |
| Rate for Payer: Aetna Commercial |
$2,169.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,198.04
|
| Rate for Payer: Cash Price |
$1,409.00
|
| Rate for Payer: Cigna Commercial |
$2,338.94
|
| Rate for Payer: First Health Commercial |
$2,677.10
|
| Rate for Payer: Humana Commercial |
$2,395.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,310.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,079.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,479.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,113.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$563.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.58
|
| Rate for Payer: PHCS Commercial |
$2,705.28
|
| Rate for Payer: United Healthcare All Payer |
$2,479.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
45000237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.34 |
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| 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 |
$1,384.93
|
| 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 |
$1,661.92
|
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$327.34 |
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
761P1478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$317.79 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.85
|
| Rate for Payer: Anthem Medicaid |
$71.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$139.05
|
| Rate for Payer: Healthspan PPO |
$317.79
|
| Rate for Payer: Humana Medicaid |
$71.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.57
|
| Rate for Payer: Molina Healthcare Passport |
$71.15
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$70.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.86
|
|
|
INSJ PICC 5 YR+ W/O IMAGING(T
|
Facility
|
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
761T1478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.34 |
| Max. Negotiated Rate |
$2,417.28 |
| Rate for Payer: Aetna Commercial |
$1,938.86
|
| Rate for Payer: Anthem Medicaid |
$865.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| 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 |
$1,384.93
|
| 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 |
$1,661.92
|
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC 5 YR+ W/O IMAGING(T
|
Facility
|
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
761T1478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.34 |
| 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 |
$503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.58
|
| Rate for Payer: PHCS Commercial |
$2,417.28
|
| Rate for Payer: United Healthcare All Payer |
$2,215.84
|
|
|
INSJ PICC RS&I 5 YR+
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
76101480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$69.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,504.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Humana Medicaid |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.09
|
| Rate for Payer: Molina Healthcare Passport |
$69.70
|
| Rate for Payer: Multiplan PHCS |
$2,102.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,452.80
|
| Rate for Payer: UHCCP Medicaid |
$72.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.40
|
|
|
INSJ PICC RS&I 5 YR+
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
76101480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.52 |
| Max. Negotiated Rate |
$3,363.84 |
| Rate for Payer: Aetna Commercial |
$2,698.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.12
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cigna Commercial |
$2,908.32
|
| Rate for Payer: First Health Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial |
$2,978.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.24
|
| Rate for Payer: PHCS Commercial |
$3,363.84
|
| Rate for Payer: United Healthcare All Payer |
$3,083.52
|
|
