|
INSERT PACING LEAD & CONNECT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.80 |
| Max. Negotiated Rate |
$850.56 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$770.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.34
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
INSERT PACING LEAD & CONNECT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
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
|
|
|
INSERT PACING LEAD & CONNECT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
76101256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.70 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Aetna Commercial |
$682.22
|
| Rate for Payer: Anthem Medicaid |
$304.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.08
|
| 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 |
$443.00
|
| Rate for Payer: Cash Price |
$443.00
|
| Rate for Payer: Cigna Commercial |
$735.38
|
| Rate for Payer: First Health Commercial |
$841.70
|
| Rate for Payer: Humana Commercial |
$753.10
|
| Rate for Payer: Humana KY Medicaid |
$304.70
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Kentucky WC Medicaid |
$307.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$726.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$779.68
|
| Rate for Payer: Ohio Health Group HMO |
$664.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$770.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.34
|
| Rate for Payer: PHCS Commercial |
$850.56
|
| Rate for Payer: United Healthcare All Payer |
$779.68
|
|
|
INSERT PERITONEAL SHUNT
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERITONEAL SHUNT
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERITONEAL SHUNT
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
76102002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,107.46 |
| Rate for Payer: Aetna Commercial |
$1,107.46
|
| Rate for Payer: Ambetter Exchange |
$745.25
|
| Rate for Payer: Anthem Medicaid |
$570.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$745.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$894.30
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,035.23
|
| Rate for Payer: Healthspan PPO |
$933.94
|
| Rate for Payer: Humana Medicaid |
$570.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$745.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.00
|
| Rate for Payer: Molina Healthcare Passport |
$570.59
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$968.83
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
|
|
INSERT PERITONEAL SHUNT(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
761P2002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,107.46 |
| Rate for Payer: Aetna Commercial |
$1,107.46
|
| Rate for Payer: Ambetter Exchange |
$745.25
|
| Rate for Payer: Anthem Medicaid |
$570.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$745.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$894.30
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,035.23
|
| Rate for Payer: Healthspan PPO |
$933.94
|
| Rate for Payer: Humana Medicaid |
$570.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$745.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.00
|
| Rate for Payer: Molina Healthcare Passport |
$570.59
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$968.83
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
|
|
INSERT PERM PACEMAKER
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERM PACEMAKER
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.92 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$903.03
|
| Rate for Payer: Ambetter Exchange |
$482.92
|
| Rate for Payer: Anthem Medicaid |
$505.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.50
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$799.67
|
| Rate for Payer: Healthspan PPO |
$887.86
|
| Rate for Payer: Humana Medicaid |
$505.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.97
|
| Rate for Payer: Molina Healthcare Passport |
$505.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.80
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.92
|
|
|
INSERT PERM PACEMAKER
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
76101244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
INSERT PERM PACEMAKER(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
761P1244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.92 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$903.03
|
| Rate for Payer: Ambetter Exchange |
$482.92
|
| Rate for Payer: Anthem Medicaid |
$505.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.50
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$799.67
|
| Rate for Payer: Healthspan PPO |
$887.86
|
| Rate for Payer: Humana Medicaid |
$505.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$742.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.97
|
| Rate for Payer: Molina Healthcare Passport |
$505.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.80
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.92
|
|
|
INSERT PICVAD CATH <5 Y/O
|
Professional
|
Both
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$3,398.40 |
| 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 |
$2,832.00
|
| Rate for Payer: Cash Price |
$2,832.00
|
| 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 |
$3,398.40
|
| 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 PICVAD CATH <5 Y/O
|
Facility
|
OP
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,947.85 |
| Max. Negotiated Rate |
$5,437.44 |
| Rate for Payer: Aetna Commercial |
$4,361.28
|
| Rate for Payer: Anthem Medicaid |
$1,947.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,417.92
|
| 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 |
$2,832.00
|
| Rate for Payer: Cash Price |
$2,832.00
|
| Rate for Payer: Cigna Commercial |
$4,701.12
|
| Rate for Payer: First Health Commercial |
$5,380.80
|
| Rate for Payer: Humana Commercial |
$4,814.40
|
| Rate for Payer: Humana KY Medicaid |
$1,947.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,644.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,986.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,984.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,927.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.16
|
| Rate for Payer: PHCS Commercial |
$5,437.44
|
| Rate for Payer: United Healthcare All Payer |
$4,984.32
|
|
|
INSERT PICVAD CATH <5 Y/O
|
Facility
|
IP
|
$5,664.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
76102663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,699.20 |
| Max. Negotiated Rate |
$5,437.44 |
| Rate for Payer: Aetna Commercial |
$4,361.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,417.92
|
| Rate for Payer: Cash Price |
$2,832.00
|
| Rate for Payer: Cigna Commercial |
$4,701.12
|
| Rate for Payer: First Health Commercial |
$5,380.80
|
| Rate for Payer: Humana Commercial |
$4,814.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,644.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,984.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,927.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.16
|
| Rate for Payer: PHCS Commercial |
$5,437.44
|
| Rate for Payer: United Healthcare All Payer |
$4,984.32
|
|
|
INSERT PICVAD CATH <5 Y/O (P
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761P2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$1,364.62 |
| 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 |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| 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 |
$324.00
|
| 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 PICVAD CATH <5 Y/O (T
|
Facility
|
IP
|
$5,124.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761T2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,537.20 |
| Max. Negotiated Rate |
$4,919.04 |
| Rate for Payer: Aetna Commercial |
$3,945.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.72
|
| Rate for Payer: Cash Price |
$2,562.00
|
| Rate for Payer: Cigna Commercial |
$4,252.92
|
| Rate for Payer: First Health Commercial |
$4,867.80
|
| Rate for Payer: Humana Commercial |
$4,355.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,509.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,457.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,535.56
|
| Rate for Payer: PHCS Commercial |
$4,919.04
|
| Rate for Payer: United Healthcare All Payer |
$4,509.12
|
|
|
INSERT PICVAD CATH <5 Y/O (T
|
Facility
|
OP
|
$5,124.00
|
|
|
Service Code
|
HCPCS 36570
|
| Hospital Charge Code |
761T2663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,762.14 |
| Max. Negotiated Rate |
$4,919.04 |
| Rate for Payer: Aetna Commercial |
$3,945.48
|
| Rate for Payer: Anthem Medicaid |
$1,762.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.72
|
| 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 |
$2,562.00
|
| Rate for Payer: Cash Price |
$2,562.00
|
| Rate for Payer: Cigna Commercial |
$4,252.92
|
| Rate for Payer: First Health Commercial |
$4,867.80
|
| Rate for Payer: Humana Commercial |
$4,355.40
|
| Rate for Payer: Humana KY Medicaid |
$1,762.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,797.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,509.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,457.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,535.56
|
| Rate for Payer: PHCS Commercial |
$4,919.04
|
| Rate for Payer: United Healthcare All Payer |
$4,509.12
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
IP
|
$5,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$4,979.52 |
| Rate for Payer: Aetna Commercial |
$3,993.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.86
|
| Rate for Payer: Cash Price |
$2,593.50
|
| Rate for Payer: Cigna Commercial |
$4,305.21
|
| Rate for Payer: First Health Commercial |
$4,927.65
|
| Rate for Payer: Humana Commercial |
$4,408.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,564.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,512.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.03
|
| Rate for Payer: PHCS Commercial |
$4,979.52
|
| Rate for Payer: United Healthcare All Payer |
$4,564.56
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
IP
|
$10,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,056.10 |
| Max. Negotiated Rate |
$9,779.52 |
| Rate for Payer: Aetna Commercial |
$7,843.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,945.86
|
| Rate for Payer: Cash Price |
$5,093.50
|
| Rate for Payer: Cigna Commercial |
$8,455.21
|
| Rate for Payer: First Health Commercial |
$9,677.65
|
| Rate for Payer: Humana Commercial |
$8,658.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,353.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,518.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,056.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,964.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,640.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,862.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,029.03
|
| Rate for Payer: PHCS Commercial |
$9,779.52
|
| Rate for Payer: United Healthcare All Payer |
$8,964.56
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
OP
|
$5,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$4,979.52 |
| Rate for Payer: Aetna Commercial |
$3,993.99
|
| Rate for Payer: Anthem Medicaid |
$1,783.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.86
|
| 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 |
$2,593.50
|
| Rate for Payer: Cash Price |
$2,593.50
|
| Rate for Payer: Cigna Commercial |
$4,305.21
|
| Rate for Payer: First Health Commercial |
$4,927.65
|
| Rate for Payer: Humana Commercial |
$4,408.95
|
| Rate for Payer: Humana KY Medicaid |
$1,783.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,564.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,512.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.03
|
| Rate for Payer: PHCS Commercial |
$4,979.52
|
| Rate for Payer: United Healthcare All Payer |
$4,564.56
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
OP
|
$10,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$9,779.52 |
| Rate for Payer: Aetna Commercial |
$7,843.99
|
| Rate for Payer: Anthem Medicaid |
$3,503.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,945.86
|
| 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 |
$5,093.50
|
| Rate for Payer: Cash Price |
$5,093.50
|
| Rate for Payer: Cigna Commercial |
$8,455.21
|
| Rate for Payer: First Health Commercial |
$9,677.65
|
| Rate for Payer: Humana Commercial |
$8,658.95
|
| Rate for Payer: Humana KY Medicaid |
$3,503.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,538.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,353.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,518.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,573.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,964.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,640.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,862.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,029.03
|
| Rate for Payer: PHCS Commercial |
$9,779.52
|
| Rate for Payer: United Healthcare All Payer |
$8,964.56
|
|
|
INSERT PLACE HEART CATH
|
Professional
|
Both
|
$10,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.46 |
| Max. Negotiated Rate |
$6,112.20 |
| Rate for Payer: Aetna Commercial |
$176.41
|
| Rate for Payer: Ambetter Exchange |
$82.46
|
| Rate for Payer: Anthem Medicaid |
$143.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.95
|
| Rate for Payer: Cash Price |
$5,093.50
|
| Rate for Payer: Cash Price |
$5,093.50
|
| Rate for Payer: Cigna Commercial |
$209.50
|
| Rate for Payer: Healthspan PPO |
$179.87
|
| Rate for Payer: Humana Medicaid |
$143.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.49
|
| Rate for Payer: Molina Healthcare Passport |
$143.62
|
| Rate for Payer: Multiplan PHCS |
$6,112.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.20
|
| Rate for Payer: UHCCP Medicaid |
$3,565.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.46
|
|
|
INSERT PLACE HEART CATH (P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761P2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.46 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$176.41
|
| Rate for Payer: Ambetter Exchange |
$82.46
|
| Rate for Payer: Anthem Medicaid |
$143.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.95
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$209.50
|
| Rate for Payer: Healthspan PPO |
$179.87
|
| Rate for Payer: Humana Medicaid |
$143.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.49
|
| Rate for Payer: Molina Healthcare Passport |
$143.62
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.20
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.46
|
|
|
INSERT PLACE HEART CATH (T
|
Facility
|
OP
|
$5,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761T2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$4,979.52 |
| Rate for Payer: Aetna Commercial |
$3,993.99
|
| Rate for Payer: Anthem Medicaid |
$1,783.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.86
|
| 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 |
$2,593.50
|
| Rate for Payer: Cash Price |
$2,593.50
|
| Rate for Payer: Cigna Commercial |
$4,305.21
|
| Rate for Payer: First Health Commercial |
$4,927.65
|
| Rate for Payer: Humana Commercial |
$4,408.95
|
| Rate for Payer: Humana KY Medicaid |
$1,783.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,564.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,512.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.03
|
| Rate for Payer: PHCS Commercial |
$4,979.52
|
| Rate for Payer: United Healthcare All Payer |
$4,564.56
|
|
|
INSERT PLACE HEART CATH (T
|
Facility
|
IP
|
$5,187.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761T2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$4,979.52 |
| Rate for Payer: Aetna Commercial |
$3,993.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.86
|
| Rate for Payer: Cash Price |
$2,593.50
|
| Rate for Payer: Cigna Commercial |
$4,305.21
|
| Rate for Payer: First Health Commercial |
$4,927.65
|
| Rate for Payer: Humana Commercial |
$4,408.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,564.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,512.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.03
|
| Rate for Payer: PHCS Commercial |
$4,979.52
|
| Rate for Payer: United Healthcare All Payer |
$4,564.56
|
|
