|
INSPACE BALLOON IMPLANT - MEDI
|
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 - MEDI
|
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
|
|
|
INS PICC <5 YR W/O IMAGING
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
76102652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.90 |
| Max. Negotiated Rate |
$2,460.48 |
| Rate for Payer: Aetna Commercial |
$1,973.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,999.14
|
| Rate for Payer: Cash Price |
$1,281.50
|
| Rate for Payer: Cigna Commercial |
$2,127.29
|
| Rate for Payer: First Health Commercial |
$2,434.85
|
| Rate for Payer: Humana Commercial |
$2,178.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,101.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,891.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$768.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,255.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,922.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,229.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,768.47
|
| Rate for Payer: PHCS Commercial |
$2,460.48
|
| Rate for Payer: United Healthcare All Payer |
$2,255.44
|
|
|
INS PICC <5 YR W/O IMAGING
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
76102652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$1,537.80 |
| Rate for Payer: Aetna Commercial |
$152.93
|
| Rate for Payer: Ambetter Exchange |
$87.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.74
|
| Rate for Payer: Anthem Medicaid |
$273.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.36
|
| Rate for Payer: Cash Price |
$1,281.50
|
| Rate for Payer: Cash Price |
$1,281.50
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Healthspan PPO |
$361.93
|
| Rate for Payer: Humana Medicaid |
$273.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.63
|
| Rate for Payer: Molina Healthcare Passport |
$273.17
|
| Rate for Payer: Multiplan PHCS |
$1,537.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.14
|
| Rate for Payer: UHCCP Medicaid |
$73.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.80
|
|
|
INS PICC <5 YR W/O IMAGING
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
76102652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$881.42 |
| Max. Negotiated Rate |
$2,460.48 |
| Rate for Payer: Aetna Commercial |
$1,973.51
|
| Rate for Payer: Anthem Medicaid |
$881.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,999.14
|
| 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 |
$1,281.50
|
| Rate for Payer: Cash Price |
$1,281.50
|
| Rate for Payer: Cigna Commercial |
$2,127.29
|
| Rate for Payer: First Health Commercial |
$2,434.85
|
| Rate for Payer: Humana Commercial |
$2,178.55
|
| Rate for Payer: Humana KY Medicaid |
$881.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$890.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,101.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,891.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$899.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,255.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,922.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,229.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,768.47
|
| Rate for Payer: PHCS Commercial |
$2,460.48
|
| Rate for Payer: United Healthcare All Payer |
$2,255.44
|
|
|
INS PICC <5 YR W/O IMAGING (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
761P2652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$361.93 |
| Rate for Payer: Aetna Commercial |
$152.93
|
| Rate for Payer: Ambetter Exchange |
$87.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.74
|
| Rate for Payer: Anthem Medicaid |
$273.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.36
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Healthspan PPO |
$361.93
|
| Rate for Payer: Humana Medicaid |
$273.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.63
|
| Rate for Payer: Molina Healthcare Passport |
$273.17
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.14
|
| Rate for Payer: UHCCP Medicaid |
$73.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.80
|
|
|
INS PICC <5 YR W/O IMAGING (T
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
761T2652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.25 |
| Max. Negotiated Rate |
$2,172.48 |
| Rate for Payer: Aetna Commercial |
$1,742.51
|
| Rate for Payer: Anthem Medicaid |
$778.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,765.14
|
| 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 |
$1,131.50
|
| Rate for Payer: Cash Price |
$1,131.50
|
| Rate for Payer: Cigna Commercial |
$1,878.29
|
| Rate for Payer: First Health Commercial |
$2,149.85
|
| Rate for Payer: Humana Commercial |
$1,923.55
|
| Rate for Payer: Humana KY Medicaid |
$778.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$786.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,855.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,670.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$793.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,991.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,697.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,968.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.47
|
| Rate for Payer: PHCS Commercial |
$2,172.48
|
| Rate for Payer: United Healthcare All Payer |
$1,991.44
|
|
|
INS PICC <5 YR W/O IMAGING (T
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
761T2652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$678.90 |
| Max. Negotiated Rate |
$2,172.48 |
| Rate for Payer: Aetna Commercial |
$1,742.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,765.14
|
| Rate for Payer: Cash Price |
$1,131.50
|
| Rate for Payer: Cigna Commercial |
$1,878.29
|
| Rate for Payer: First Health Commercial |
$2,149.85
|
| Rate for Payer: Humana Commercial |
$1,923.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,855.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,670.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,991.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,697.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,968.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.47
|
| Rate for Payer: PHCS Commercial |
$2,172.48
|
| Rate for Payer: United Healthcare All Payer |
$1,991.44
|
|
|
INSPRA EPLERENONE 25MG TAB
|
Facility
|
IP
|
$9.40
|
|
|
Service Code
|
NDC 59762110702
|
| Hospital Charge Code |
25000782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.33
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.80
|
| Rate for Payer: First Health Commercial |
$8.93
|
| Rate for Payer: Humana Commercial |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.27
|
| Rate for Payer: Ohio Health Group HMO |
$7.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Payer |
$8.27
|
|
|
INSPRA EPLERENONE 25MG TAB
|
Facility
|
OP
|
$9.40
|
|
|
Service Code
|
NDC 59762110702
|
| Hospital Charge Code |
25000782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$7.24
|
| Rate for Payer: Anthem Medicaid |
$3.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.33
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.80
|
| Rate for Payer: First Health Commercial |
$8.93
|
| Rate for Payer: Humana Commercial |
$7.99
|
| Rate for Payer: Humana KY Medicaid |
$3.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.27
|
| Rate for Payer: Ohio Health Group HMO |
$7.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Payer |
$8.27
|
|
|
INSPRA(EPLERENONE)50MG TAB
|
Facility
|
OP
|
$31.79
|
|
|
Service Code
|
NDC 58151014393
|
| Hospital Charge Code |
25000783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Anthem Medicaid |
$10.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.20
|
| Rate for Payer: Humana Commercial |
$27.02
|
| Rate for Payer: Humana KY Medicaid |
$10.93
|
| Rate for Payer: Kentucky WC Medicaid |
$11.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.94
|
| Rate for Payer: PHCS Commercial |
$30.52
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
|
|
INSPRA(EPLERENONE)50MG TAB
|
Facility
|
IP
|
$31.79
|
|
|
Service Code
|
NDC 58151014393
|
| Hospital Charge Code |
25000783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.20
|
| Rate for Payer: Humana Commercial |
$27.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.94
|
| Rate for Payer: PHCS Commercial |
$30.52
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
|
|
INS/REP SUBQ DEFIBRILLATOR
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
76101277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
INS/REP SUBQ DEFIBRILLATOR
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
76101277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$41,473.96 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,624.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,473.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,992.75
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$29,624.26
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,549.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
INS/REP SUBQ DEFIBRILLATOR
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
76101277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Ambetter Exchange |
$522.27
|
| Rate for Payer: Anthem Medicaid |
$471.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.72
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$1,071.27
|
| Rate for Payer: Humana Medicaid |
$471.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$480.61
|
| Rate for Payer: Molina Healthcare Passport |
$471.19
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.95
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$475.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.27
|
|
|
INS/REP SUBQ DEFIBRILLATOR(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
761P1277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,071.27 |
| Rate for Payer: Ambetter Exchange |
$522.27
|
| Rate for Payer: Anthem Medicaid |
$471.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.72
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$1,071.27
|
| Rate for Payer: Humana Medicaid |
$471.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$480.61
|
| Rate for Payer: Molina Healthcare Passport |
$471.19
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.95
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$475.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.27
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$112.46 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
761T2067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
761T2067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.24 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$116.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Humana KY Medicaid |
$116.24
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$117.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
761P2067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$228.06 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Ambetter Exchange |
$71.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.11
|
| Rate for Payer: Anthem Medicaid |
$93.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.15
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$176.26
|
| Rate for Payer: Humana Medicaid |
$93.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.59
|
| Rate for Payer: Molina Healthcare Passport |
$93.72
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.33
|
| Rate for Payer: UHCCP Medicaid |
$46.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.79
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$382.80 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Ambetter Exchange |
$71.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.11
|
| Rate for Payer: Anthem Medicaid |
$93.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.15
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$176.26
|
| Rate for Payer: Humana Medicaid |
$93.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.59
|
| Rate for Payer: Molina Healthcare Passport |
$93.72
|
| Rate for Payer: Multiplan PHCS |
$382.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.33
|
| Rate for Payer: UHCCP Medicaid |
$46.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.79
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
45000281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem Medicaid |
$219.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Humana KY Medicaid |
$219.41
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$221.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.22
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
45000281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.24 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$116.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Humana KY Medicaid |
$116.24
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$117.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
