|
INSERT NON-TUNNEL CV CATH <5
|
Facility
|
IP
|
$2,267.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761T2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.10 |
| Max. Negotiated Rate |
$2,176.32 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,813.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,972.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.23
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
INSERT NON-TUNNEL CV CATH <5
|
Facility
|
OP
|
$2,267.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761T2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.62 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem Medicaid |
$779.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Humana KY Medicaid |
$779.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$787.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$795.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,813.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,972.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.23
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Facility
|
OP
|
$2,881.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.78 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,218.37
|
| Rate for Payer: Anthem Medicaid |
$990.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$2,391.23
|
| Rate for Payer: First Health Commercial |
$2,736.95
|
| Rate for Payer: Humana Commercial |
$2,448.85
|
| Rate for Payer: Humana KY Medicaid |
$990.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,000.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,010.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,506.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,987.89
|
| Rate for Payer: PHCS Commercial |
$2,765.76
|
| Rate for Payer: United Healthcare All Payer |
$2,535.28
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Facility
|
IP
|
$2,881.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.30 |
| Max. Negotiated Rate |
$2,765.76 |
| Rate for Payer: Aetna Commercial |
$2,218.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.18
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$2,391.23
|
| Rate for Payer: First Health Commercial |
$2,736.95
|
| Rate for Payer: Humana Commercial |
$2,448.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,506.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,987.89
|
| Rate for Payer: PHCS Commercial |
$2,765.76
|
| Rate for Payer: United Healthcare All Payer |
$2,535.28
|
|
|
INSERT NON-TUNNEL CV CATH<5
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$1,728.60 |
| Rate for Payer: Aetna Commercial |
$498.14
|
| Rate for Payer: Ambetter Exchange |
$315.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$226.66
|
| Rate for Payer: Anthem Medicaid |
$1,208.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.13
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cash Price |
$1,440.50
|
| Rate for Payer: Cigna Commercial |
$459.04
|
| Rate for Payer: Healthspan PPO |
$1,364.62
|
| Rate for Payer: Humana Medicaid |
$1,208.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$383.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,233.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,208.95
|
| Rate for Payer: Multiplan PHCS |
$1,728.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.64
|
| Rate for Payer: UHCCP Medicaid |
$237.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,221.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.11
|
|
|
INSERT NON-TUNNEL CV CATH <5(P
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
761P2665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$368.40 |
| Rate for Payer: Aetna Commercial |
$198.42
|
| Rate for Payer: Ambetter Exchange |
$79.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.42
|
| Rate for Payer: Anthem Medicaid |
$237.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.47
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$190.41
|
| Rate for Payer: Healthspan PPO |
$322.12
|
| Rate for Payer: Humana Medicaid |
$237.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.20
|
| Rate for Payer: Molina Healthcare Passport |
$237.45
|
| Rate for Payer: Multiplan PHCS |
$368.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.43
|
| Rate for Payer: UHCCP Medicaid |
$45.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.56
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
OP
|
$5,711.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761T1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,964.01 |
| Max. Negotiated Rate |
$5,482.56 |
| Rate for Payer: Aetna Commercial |
$4,397.47
|
| Rate for Payer: Anthem Medicaid |
$1,964.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,454.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,855.50
|
| Rate for Payer: Cash Price |
$2,855.50
|
| Rate for Payer: Cigna Commercial |
$4,740.13
|
| Rate for Payer: First Health Commercial |
$5,425.45
|
| Rate for Payer: Humana Commercial |
$4,854.35
|
| Rate for Payer: Humana KY Medicaid |
$1,964.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,984.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,683.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,214.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,003.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,025.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,968.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,940.59
|
| Rate for Payer: PHCS Commercial |
$5,482.56
|
| Rate for Payer: United Healthcare All Payer |
$5,025.68
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
IP
|
$5,711.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761T1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,713.30 |
| Max. Negotiated Rate |
$5,482.56 |
| Rate for Payer: Aetna Commercial |
$4,397.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,454.58
|
| Rate for Payer: Cash Price |
$2,855.50
|
| Rate for Payer: Cigna Commercial |
$4,740.13
|
| Rate for Payer: First Health Commercial |
$5,425.45
|
| Rate for Payer: Humana Commercial |
$4,854.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,683.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,214.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,713.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,025.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,968.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,940.59
|
| Rate for Payer: PHCS Commercial |
$5,482.56
|
| Rate for Payer: United Healthcare All Payer |
$5,025.68
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Professional
|
Both
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.71 |
| Max. Negotiated Rate |
$4,420.80 |
| Rate for Payer: Aetna Commercial |
$485.21
|
| Rate for Payer: Ambetter Exchange |
$293.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.71
|
| Rate for Payer: Anthem Medicaid |
$1,088.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.08
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$458.98
|
| Rate for Payer: Healthspan PPO |
$1,414.20
|
| Rate for Payer: Humana Medicaid |
$1,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.38
|
| Rate for Payer: Multiplan PHCS |
$4,420.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.42
|
| Rate for Payer: UHCCP Medicaid |
$228.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.40
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
OP
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,533.86 |
| Max. Negotiated Rate |
$7,073.28 |
| Rate for Payer: Aetna Commercial |
$5,673.36
|
| Rate for Payer: Anthem Medicaid |
$2,533.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,747.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$6,115.44
|
| Rate for Payer: First Health Commercial |
$6,999.60
|
| Rate for Payer: Humana Commercial |
$6,262.80
|
| Rate for Payer: Humana KY Medicaid |
$2,533.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,559.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,041.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,437.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,584.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,483.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,526.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,894.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,410.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.92
|
| Rate for Payer: PHCS Commercial |
$7,073.28
|
| Rate for Payer: United Healthcare All Payer |
$6,483.84
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
761P1479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.71 |
| Max. Negotiated Rate |
$1,414.20 |
| Rate for Payer: Aetna Commercial |
$485.21
|
| Rate for Payer: Ambetter Exchange |
$293.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.71
|
| Rate for Payer: Anthem Medicaid |
$1,088.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.08
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cash Price |
$828.50
|
| Rate for Payer: Cigna Commercial |
$458.98
|
| Rate for Payer: Healthspan PPO |
$1,414.20
|
| Rate for Payer: Humana Medicaid |
$1,088.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.38
|
| Rate for Payer: Multiplan PHCS |
$994.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.42
|
| Rate for Payer: UHCCP Medicaid |
$228.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.40
|
|
|
INSERT OF PERIP CENTRAL VENOUS
|
Facility
|
IP
|
$7,368.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
76101479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,210.40 |
| Max. Negotiated Rate |
$7,073.28 |
| Rate for Payer: Aetna Commercial |
$5,673.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,747.04
|
| Rate for Payer: Cash Price |
$3,684.00
|
| Rate for Payer: Cigna Commercial |
$6,115.44
|
| Rate for Payer: First Health Commercial |
$6,999.60
|
| Rate for Payer: Humana Commercial |
$6,262.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,041.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,437.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,210.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,483.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,526.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,894.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,410.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.92
|
| Rate for Payer: PHCS Commercial |
$7,073.28
|
| Rate for Payer: United Healthcare All Payer |
$6,483.84
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
761P1246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.44 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$587.07
|
| Rate for Payer: Ambetter Exchange |
$302.44
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.93
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$552.18
|
| Rate for Payer: Healthspan PPO |
$577.20
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$302.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.17
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.44
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.44 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$587.07
|
| Rate for Payer: Ambetter Exchange |
$302.44
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.93
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$552.18
|
| Rate for Payer: Healthspan PPO |
$577.20
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$302.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.17
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.44
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$10,705.58 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INSERT OR REPL PACEMAKER GENER
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
76101246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INSERT PACEMKR PULSE GEN ONL(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
761P1247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.83 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$668.78
|
| Rate for Payer: Ambetter Exchange |
$314.83
|
| Rate for Payer: Anthem Medicaid |
$346.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.80
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$626.76
|
| Rate for Payer: Healthspan PPO |
$657.54
|
| Rate for Payer: Humana Medicaid |
$346.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.07
|
| Rate for Payer: Molina Healthcare Passport |
$346.15
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.28
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.83
|
|
|
INSERT PACEMKR PULSE GEN ONLY
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.83 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$668.78
|
| Rate for Payer: Ambetter Exchange |
$314.83
|
| Rate for Payer: Anthem Medicaid |
$346.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.80
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$626.76
|
| Rate for Payer: Healthspan PPO |
$657.54
|
| Rate for Payer: Humana Medicaid |
$346.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.07
|
| Rate for Payer: Molina Healthcare Passport |
$346.15
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.28
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.83
|
|
|
INSERT PACEMKR PULSE GEN ONLY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
INSERT PACEMKR PULSE GEN ONLY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
76101247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
INSERT PACING ELECTRODE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$791.63 |
| Rate for Payer: Aetna Commercial |
$791.63
|
| Rate for Payer: Ambetter Exchange |
$431.02
|
| Rate for Payer: Anthem Medicaid |
$329.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.22
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$722.37
|
| Rate for Payer: Healthspan PPO |
$778.33
|
| Rate for Payer: Humana Medicaid |
$329.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.89
|
| Rate for Payer: Molina Healthcare Passport |
$329.30
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.33
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.02
|
|
|
INSERT PACING ELECTRODE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT PACING ELECTRODE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
76101257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT PACING ELECTRODE(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
761P1257
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$791.63 |
| Rate for Payer: Aetna Commercial |
$791.63
|
| Rate for Payer: Ambetter Exchange |
$431.02
|
| Rate for Payer: Anthem Medicaid |
$329.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.22
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$722.37
|
| Rate for Payer: Healthspan PPO |
$778.33
|
| Rate for Payer: Humana Medicaid |
$329.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.89
|
| Rate for Payer: Molina Healthcare Passport |
$329.30
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.33
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.02
|
|
|
INSERT PACING LEAD & CONNEC(P
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
761P1256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$878.67 |
| Rate for Payer: Aetna Commercial |
$878.67
|
| Rate for Payer: Ambetter Exchange |
$477.19
|
| Rate for Payer: Anthem Medicaid |
$370.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.63
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$811.53
|
| Rate for Payer: Healthspan PPO |
$863.91
|
| Rate for Payer: Humana Medicaid |
$370.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.96
|
| Rate for Payer: Molina Healthcare Passport |
$370.55
|
| Rate for Payer: Multiplan PHCS |
$531.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.35
|
| Rate for Payer: UHCCP Medicaid |
$310.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$374.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.19
|
|
