|
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 |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| 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 |
$2,447.74 |
| Rate for Payer: Aetna Commercial |
$2,447.74
|
| Rate for Payer: Ambetter Exchange |
$1,254.31
|
| Rate for Payer: Anthem Medicaid |
$1,178.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,254.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,254.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,505.17
|
| 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 |
$2,406.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,254.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.31
|
| 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 |
$1,630.60
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,189.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,254.31
|
|
|
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 |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| 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 |
$2,447.74 |
| Rate for Payer: Aetna Commercial |
$2,447.74
|
| Rate for Payer: Ambetter Exchange |
$1,254.31
|
| Rate for Payer: Anthem Medicaid |
$1,178.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,254.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,254.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,505.17
|
| 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 |
$2,406.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,254.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.31
|
| 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 |
$1,630.60
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,189.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,254.31
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Professional
|
Both
|
$2,982.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Ambetter Exchange |
$89.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.85
|
| Rate for Payer: Anthem Medicaid |
$230.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.30
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$139.05
|
| Rate for Payer: Healthspan PPO |
$317.79
|
| Rate for Payer: Humana Medicaid |
$230.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.80
|
| Rate for Payer: Molina Healthcare Passport |
$230.20
|
| Rate for Payer: Multiplan PHCS |
$1,789.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.25
|
| Rate for Payer: UHCCP Medicaid |
$70.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$232.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.42
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,982.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,025.51 |
| Max. Negotiated Rate |
$2,862.72 |
| Rate for Payer: Aetna Commercial |
$2,296.14
|
| Rate for Payer: Anthem Medicaid |
$1,025.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$2,475.06
|
| Rate for Payer: First Health Commercial |
$2,832.90
|
| Rate for Payer: Humana Commercial |
$2,534.70
|
| Rate for Payer: Humana KY Medicaid |
$1,025.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,035.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,445.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,200.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,046.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,624.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,236.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,594.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,057.58
|
| Rate for Payer: PHCS Commercial |
$2,862.72
|
| Rate for Payer: United Healthcare All Payer |
$2,624.16
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
45000237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
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 |
$865.94 |
| 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 |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,964.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,259.00
|
| 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 |
$1,435.35
|
| 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 |
$1,722.42
|
| 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 |
$2,014.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,190.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.42
|
| 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
|
$2,982.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
76101478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.60 |
| Max. Negotiated Rate |
$2,862.72 |
| Rate for Payer: Aetna Commercial |
$2,296.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.96
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$2,475.06
|
| Rate for Payer: First Health Commercial |
$2,832.90
|
| Rate for Payer: Humana Commercial |
$2,534.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,445.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,200.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,624.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,236.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,594.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,057.58
|
| Rate for Payer: PHCS Commercial |
$2,862.72
|
| Rate for Payer: United Healthcare All Payer |
$2,624.16
|
|
|
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 |
$755.40 |
| 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 |
$2,014.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,190.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.42
|
| 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
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
IP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
45000237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSJ PICC 5 YR+ W/O IMAGING
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
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: Ambetter Exchange |
$89.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.85
|
| Rate for Payer: Anthem Medicaid |
$230.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.30
|
| 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 |
$230.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.80
|
| Rate for Payer: Molina Healthcare Passport |
$230.20
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.25
|
| Rate for Payer: UHCCP Medicaid |
$70.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$232.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.42
|
|
|
INSJ PICC 5 YR+ W/O IMAGING(T
|
Facility
|
OP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
761T1478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.34 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem Medicaid |
$922.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Humana KY Medicaid |
$922.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$931.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$940.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSJ PICC 5 YR+ W/O IMAGING(T
|
Facility
|
IP
|
$2,682.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
761T1478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$804.60 |
| Max. Negotiated Rate |
$2,574.72 |
| Rate for Payer: Aetna Commercial |
$2,065.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,091.96
|
| Rate for Payer: Cash Price |
$1,341.00
|
| Rate for Payer: Cigna Commercial |
$2,226.06
|
| Rate for Payer: First Health Commercial |
$2,547.90
|
| Rate for Payer: Humana Commercial |
$2,279.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,199.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,979.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,360.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,011.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,850.58
|
| Rate for Payer: PHCS Commercial |
$2,574.72
|
| Rate for Payer: United Healthcare All Payer |
$2,360.16
|
|
|
INSJ PICC RS&I 5 YR+
|
Professional
|
Both
|
$3,712.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
76101480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$2,227.20 |
| Rate for Payer: Ambetter Exchange |
$78.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$298.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.67
|
| Rate for Payer: Cash Price |
$1,856.00
|
| Rate for Payer: Cash Price |
$1,856.00
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Humana Medicaid |
$298.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.11
|
| Rate for Payer: Molina Healthcare Passport |
$298.15
|
| Rate for Payer: Multiplan PHCS |
$2,227.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.48
|
| Rate for Payer: UHCCP Medicaid |
$72.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.06
|
|
|
INSJ PICC RS&I 5 YR+
|
Facility
|
IP
|
$3,712.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
76101480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.60 |
| Max. Negotiated Rate |
$3,563.52 |
| Rate for Payer: Aetna Commercial |
$2,858.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,895.36
|
| Rate for Payer: Cash Price |
$1,856.00
|
| Rate for Payer: Cigna Commercial |
$3,080.96
|
| Rate for Payer: First Health Commercial |
$3,526.40
|
| Rate for Payer: Humana Commercial |
$3,155.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,043.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,739.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,113.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,266.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,969.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,229.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,561.28
|
| Rate for Payer: PHCS Commercial |
$3,563.52
|
| Rate for Payer: United Healthcare All Payer |
$3,266.56
|
|
|
INSJ PICC RS&I 5 YR+
|
Facility
|
OP
|
$3,712.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
76101480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,276.56 |
| Max. Negotiated Rate |
$3,563.52 |
| Rate for Payer: Aetna Commercial |
$2,858.24
|
| Rate for Payer: Anthem Medicaid |
$1,276.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,895.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,856.00
|
| Rate for Payer: Cash Price |
$1,856.00
|
| Rate for Payer: Cigna Commercial |
$3,080.96
|
| Rate for Payer: First Health Commercial |
$3,526.40
|
| Rate for Payer: Humana Commercial |
$3,155.20
|
| Rate for Payer: Humana KY Medicaid |
$1,276.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,289.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,043.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,739.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,302.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,266.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,969.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,229.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,561.28
|
| Rate for Payer: PHCS Commercial |
$3,563.52
|
| Rate for Payer: United Healthcare All Payer |
$3,266.56
|
|
|
INSJ PICC RS&I 5 YR+(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
761P1480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$304.11 |
| Rate for Payer: Ambetter Exchange |
$78.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$298.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.67
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Humana Medicaid |
$298.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.11
|
| Rate for Payer: Molina Healthcare Passport |
$298.15
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.48
|
| Rate for Payer: UHCCP Medicaid |
$72.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.06
|
|
|
INSJ PICC RS&I 5 YR+(T
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
761T1480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,026.60 |
| Max. Negotiated Rate |
$3,285.12 |
| Rate for Payer: Aetna Commercial |
$2,634.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,669.16
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,840.26
|
| Rate for Payer: First Health Commercial |
$3,250.90
|
| Rate for Payer: Humana Commercial |
$2,908.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,806.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,525.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,011.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,977.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.18
|
| Rate for Payer: PHCS Commercial |
$3,285.12
|
| Rate for Payer: United Healthcare All Payer |
$3,011.36
|
|
|
INSJ PICC RS&I 5 YR+(T
|
Facility
|
OP
|
$3,422.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
761T1480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.83 |
| Max. Negotiated Rate |
$3,285.12 |
| Rate for Payer: Aetna Commercial |
$2,634.94
|
| Rate for Payer: Anthem Medicaid |
$1,176.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,669.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,840.26
|
| Rate for Payer: First Health Commercial |
$3,250.90
|
| Rate for Payer: Humana Commercial |
$2,908.70
|
| Rate for Payer: Humana KY Medicaid |
$1,176.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,188.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,806.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,525.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,200.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,011.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,977.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.18
|
| Rate for Payer: PHCS Commercial |
$3,285.12
|
| Rate for Payer: United Healthcare All Payer |
$3,011.36
|
|
|
INS MARK ABD/PEL FOR RT PERQ
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 49411
|
| Hospital Charge Code |
76103032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$509.73 |
| Rate for Payer: Aetna Commercial |
$312.94
|
| Rate for Payer: Ambetter Exchange |
$174.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$174.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$318.03
|
| Rate for Payer: Healthspan PPO |
$509.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$174.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.58
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.95
|
| Rate for Payer: UHCCP Medicaid |
$123.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.58
|
|
|
INSPACE BALLOON IMPLANT - LARG
|
Facility
|
OP
|
$31,231.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,369.38 |
| Max. Negotiated Rate |
$29,982.00 |
| Rate for Payer: Aetna Commercial |
$24,048.06
|
| Rate for Payer: Anthem Medicaid |
$10,740.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,360.38
|
| Rate for Payer: Cash Price |
$15,615.62
|
| Rate for Payer: Cigna Commercial |
$25,921.94
|
| Rate for Payer: First Health Commercial |
$29,669.69
|
| Rate for Payer: Humana Commercial |
$26,546.56
|
| Rate for Payer: Humana KY Medicaid |
$10,740.43
|
| Rate for Payer: Kentucky WC Medicaid |
$10,849.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,609.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,048.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,369.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,955.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,483.50
|
| Rate for Payer: Ohio Health Group HMO |
$23,423.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,171.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,549.56
|
| Rate for Payer: PHCS Commercial |
$29,982.00
|
| Rate for Payer: United Healthcare All Payer |
$27,483.50
|
|
|
INSPACE BALLOON IMPLANT - LARG
|
Facility
|
IP
|
$31,231.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,369.38 |
| Max. Negotiated Rate |
$29,982.00 |
| Rate for Payer: Aetna Commercial |
$24,048.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,360.38
|
| Rate for Payer: Cash Price |
$15,615.62
|
| Rate for Payer: Cigna Commercial |
$25,921.94
|
| Rate for Payer: First Health Commercial |
$29,669.69
|
| Rate for Payer: Humana Commercial |
$26,546.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,609.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,048.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,369.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,483.50
|
| Rate for Payer: Ohio Health Group HMO |
$23,423.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,171.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,549.56
|
| Rate for Payer: PHCS Commercial |
$29,982.00
|
| Rate for Payer: United Healthcare All Payer |
$27,483.50
|
|
