|
INTRO NDL ICATH UPR/LXTR AR(P
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
761P1437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$757.00 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.85
|
| Rate for Payer: Anthem Medicaid |
$102.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.00
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$164.98
|
| Rate for Payer: Healthspan PPO |
$754.85
|
| Rate for Payer: Humana Medicaid |
$102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.68
|
| Rate for Payer: Molina Healthcare Passport |
$102.63
|
| Rate for Payer: Multiplan PHCS |
$454.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$529.90
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
|
|
INTRO NDL ICATH UPR/LXTR AR(T
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
761T1437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem Medicaid |
$470.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Humana KY Medicaid |
$470.80
|
| Rate for Payer: Kentucky WC Medicaid |
$475.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$480.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NDL ICATH UPR/LXTR AR(T
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
761T1437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
48100100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$276.38 |
| Max. Negotiated Rate |
$2,040.96 |
| Rate for Payer: Aetna Commercial |
$1,637.02
|
| Rate for Payer: Anthem Medicaid |
$731.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.28
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$1,764.58
|
| Rate for Payer: First Health Commercial |
$2,019.70
|
| Rate for Payer: Humana Commercial |
$1,807.10
|
| Rate for Payer: Humana KY Medicaid |
$731.13
|
| Rate for Payer: Kentucky WC Medicaid |
$738.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.06
|
| Rate for Payer: PHCS Commercial |
$2,040.96
|
| Rate for Payer: United Healthcare All Payer |
$1,870.88
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
45000234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem Medicaid |
$470.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Humana KY Medicaid |
$470.80
|
| Rate for Payer: Kentucky WC Medicaid |
$475.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$480.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$2,126.00 |
| Rate for Payer: Healthspan PPO |
$754.85
|
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.85
|
| Rate for Payer: Anthem Medicaid |
$102.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,126.00
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$164.98
|
| Rate for Payer: Humana Medicaid |
$102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.68
|
| Rate for Payer: Molina Healthcare Passport |
$102.63
|
| Rate for Payer: Multiplan PHCS |
$1,275.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,488.20
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.38 |
| Max. Negotiated Rate |
$2,040.96 |
| Rate for Payer: Aetna Commercial |
$1,637.02
|
| Rate for Payer: Anthem Medicaid |
$731.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.28
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$1,764.58
|
| Rate for Payer: First Health Commercial |
$2,019.70
|
| Rate for Payer: Humana Commercial |
$1,807.10
|
| Rate for Payer: Humana KY Medicaid |
$731.13
|
| Rate for Payer: Kentucky WC Medicaid |
$738.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.06
|
| Rate for Payer: PHCS Commercial |
$2,040.96
|
| Rate for Payer: United Healthcare All Payer |
$1,870.88
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.38 |
| Max. Negotiated Rate |
$2,040.96 |
| Rate for Payer: Aetna Commercial |
$1,637.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.28
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$1,764.58
|
| Rate for Payer: First Health Commercial |
$2,019.70
|
| Rate for Payer: Humana Commercial |
$1,807.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.06
|
| Rate for Payer: PHCS Commercial |
$2,040.96
|
| Rate for Payer: United Healthcare All Payer |
$1,870.88
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
48100100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$276.38 |
| Max. Negotiated Rate |
$2,040.96 |
| Rate for Payer: Aetna Commercial |
$1,637.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.28
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$1,764.58
|
| Rate for Payer: First Health Commercial |
$2,019.70
|
| Rate for Payer: Humana Commercial |
$1,807.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.06
|
| Rate for Payer: PHCS Commercial |
$2,040.96
|
| Rate for Payer: United Healthcare All Payer |
$1,870.88
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
48100100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$2,126.00 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.85
|
| Rate for Payer: Anthem Medicaid |
$102.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,126.00
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cash Price |
$1,063.00
|
| Rate for Payer: Cigna Commercial |
$164.98
|
| Rate for Payer: Healthspan PPO |
$754.85
|
| Rate for Payer: Humana Medicaid |
$102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.68
|
| Rate for Payer: Molina Healthcare Passport |
$102.63
|
| Rate for Payer: Multiplan PHCS |
$1,275.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,488.20
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
45000234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NDL ICATH UPR/LXTR ART(P
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
481P0100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$757.00 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.85
|
| Rate for Payer: Anthem Medicaid |
$102.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.00
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$164.98
|
| Rate for Payer: Healthspan PPO |
$754.85
|
| Rate for Payer: Humana Medicaid |
$102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.68
|
| Rate for Payer: Molina Healthcare Passport |
$102.63
|
| Rate for Payer: Multiplan PHCS |
$454.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$529.90
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
|
|
INTRO NDL ICATH UPR/LXTR ART(T
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
481T0100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NDL ICATH UPR/LXTR ART(T
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
481T0100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$1,314.24 |
| Rate for Payer: Aetna Commercial |
$1,054.13
|
| Rate for Payer: Anthem Medicaid |
$470.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.82
|
| Rate for Payer: Cash Price |
$684.50
|
| Rate for Payer: Cigna Commercial |
$1,136.27
|
| Rate for Payer: First Health Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial |
$1,163.65
|
| Rate for Payer: Humana KY Medicaid |
$470.80
|
| Rate for Payer: Kentucky WC Medicaid |
$475.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,122.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,010.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$480.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,204.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$273.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.39
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NEEDLE OR VENOUS CATH
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
76101428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.34
|
| Rate for Payer: Anthem Medicaid |
$9.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$43.26
|
| Rate for Payer: Healthspan PPO |
$39.07
|
| Rate for Payer: Humana Medicaid |
$9.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.66
|
| Rate for Payer: Molina Healthcare Passport |
$9.47
|
| Rate for Payer: Multiplan PHCS |
$88.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.60
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.56
|
|
|
INTRO NEEDLE OR VENOUS CATH
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
76101428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.88
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
INTRO NEEDLE OR VENOUS CATH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
76101428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem Medicaid |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Humana KY Medicaid |
$50.90
|
| Rate for Payer: Kentucky WC Medicaid |
$51.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.88
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
INTRO OF CATHETER - IVC
|
Facility
|
OP
|
$3,297.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.61 |
| Max. Negotiated Rate |
$3,165.12 |
| Rate for Payer: Aetna Commercial |
$2,538.69
|
| Rate for Payer: Anthem Medicaid |
$1,133.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.66
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cigna Commercial |
$2,736.51
|
| Rate for Payer: First Health Commercial |
$3,132.15
|
| Rate for Payer: Humana Commercial |
$2,802.45
|
| Rate for Payer: Humana KY Medicaid |
$1,133.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,145.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,156.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.07
|
| Rate for Payer: PHCS Commercial |
$3,165.12
|
| Rate for Payer: United Healthcare All Payer |
$2,901.36
|
|
|
INTRO OF CATHETER - IVC
|
Professional
|
Both
|
$3,297.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.32 |
| Max. Negotiated Rate |
$3,297.00 |
| Rate for Payer: Aetna Commercial |
$215.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.32
|
| Rate for Payer: Anthem Medicaid |
$135.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,297.00
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Healthspan PPO |
$905.83
|
| Rate for Payer: Humana Medicaid |
$135.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$159.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.14
|
| Rate for Payer: Molina Healthcare Passport |
$135.43
|
| Rate for Payer: Multiplan PHCS |
$1,978.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,307.90
|
| Rate for Payer: UHCCP Medicaid |
$91.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.78
|
|
|
INTRO OF CATHETER - IVC
|
Facility
|
IP
|
$3,297.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.61 |
| Max. Negotiated Rate |
$3,165.12 |
| Rate for Payer: Aetna Commercial |
$2,538.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.66
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cigna Commercial |
$2,736.51
|
| Rate for Payer: First Health Commercial |
$3,132.15
|
| Rate for Payer: Humana Commercial |
$2,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.07
|
| Rate for Payer: PHCS Commercial |
$3,165.12
|
| Rate for Payer: United Healthcare All Payer |
$2,901.36
|
|
|
INTRO OF CATHETER - IVC(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
761P1431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.32 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$215.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.32
|
| Rate for Payer: Anthem Medicaid |
$135.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Healthspan PPO |
$905.83
|
| Rate for Payer: Humana Medicaid |
$135.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$159.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.14
|
| Rate for Payer: Molina Healthcare Passport |
$135.43
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$91.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.78
|
|
|
INTRO OF CATHETER - IVC(T
|
Facility
|
OP
|
$2,247.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
761T1431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.11 |
| Max. Negotiated Rate |
$2,157.12 |
| Rate for Payer: Aetna Commercial |
$1,730.19
|
| Rate for Payer: Anthem Medicaid |
$772.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.66
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cigna Commercial |
$1,865.01
|
| Rate for Payer: First Health Commercial |
$2,134.65
|
| Rate for Payer: Humana Commercial |
$1,909.95
|
| Rate for Payer: Humana KY Medicaid |
$772.74
|
| Rate for Payer: Kentucky WC Medicaid |
$780.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,842.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,977.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.57
|
| Rate for Payer: PHCS Commercial |
$2,157.12
|
| Rate for Payer: United Healthcare All Payer |
$1,977.36
|
|
|
INTRO OF CATHETER - IVC(T
|
Facility
|
IP
|
$2,247.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
761T1431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.11 |
| Max. Negotiated Rate |
$2,157.12 |
| Rate for Payer: Aetna Commercial |
$1,730.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.66
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cigna Commercial |
$1,865.01
|
| Rate for Payer: First Health Commercial |
$2,134.65
|
| Rate for Payer: Humana Commercial |
$1,909.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,842.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,977.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.57
|
| Rate for Payer: PHCS Commercial |
$2,157.12
|
| Rate for Payer: United Healthcare All Payer |
$1,977.36
|
|
|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
45000251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
76101643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
