|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
45000251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| 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: 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 |
$198.00
|
| 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
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
76101643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| 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: 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 |
$189.90
|
| 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
|
|
|
INTRVASC US NONCORONARY 1ST
|
Facility
|
OP
|
$4,766.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.58 |
| Max. Negotiated Rate |
$4,575.36 |
| Rate for Payer: Aetna Commercial |
$3,669.82
|
| Rate for Payer: Anthem Medicaid |
$1,639.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.48
|
| Rate for Payer: Cash Price |
$2,383.00
|
| Rate for Payer: Cigna Commercial |
$3,955.78
|
| Rate for Payer: First Health Commercial |
$4,527.70
|
| Rate for Payer: Humana Commercial |
$4,051.10
|
| Rate for Payer: Humana KY Medicaid |
$1,639.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,194.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.46
|
| Rate for Payer: PHCS Commercial |
$4,575.36
|
| Rate for Payer: United Healthcare All Payer |
$4,194.08
|
|
|
INTRVASC US NONCORONARY 1ST
|
Professional
|
Both
|
$4,766.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.78 |
| Max. Negotiated Rate |
$4,766.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.13
|
| Rate for Payer: Anthem Medicaid |
$75.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,766.00
|
| Rate for Payer: Cash Price |
$2,383.00
|
| Rate for Payer: Cash Price |
$2,383.00
|
| Rate for Payer: Cigna Commercial |
$156.09
|
| Rate for Payer: Humana Medicaid |
$75.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.30
|
| Rate for Payer: Molina Healthcare Passport |
$75.78
|
| Rate for Payer: Multiplan PHCS |
$2,859.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,336.20
|
| Rate for Payer: UHCCP Medicaid |
$79.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.54
|
|
|
INTRVASC US NONCORONARY 1ST
|
Facility
|
IP
|
$4,766.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.58 |
| Max. Negotiated Rate |
$4,575.36 |
| Rate for Payer: Aetna Commercial |
$3,669.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.48
|
| Rate for Payer: Cash Price |
$2,383.00
|
| Rate for Payer: Cigna Commercial |
$3,955.78
|
| Rate for Payer: First Health Commercial |
$4,527.70
|
| Rate for Payer: Humana Commercial |
$4,051.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,194.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.46
|
| Rate for Payer: PHCS Commercial |
$4,575.36
|
| Rate for Payer: United Healthcare All Payer |
$4,194.08
|
|
|
INTRVASC US NONCORONARY 1ST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
761P1572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.13
|
| Rate for Payer: Anthem Medicaid |
$75.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$156.09
|
| Rate for Payer: Humana Medicaid |
$75.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.30
|
| Rate for Payer: Molina Healthcare Passport |
$75.78
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$79.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.54
|
|
|
INTRVASC US NONCORONARY 1ST(T
|
Facility
|
IP
|
$4,666.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
761T1572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.58 |
| Max. Negotiated Rate |
$4,479.36 |
| Rate for Payer: Aetna Commercial |
$3,592.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.48
|
| Rate for Payer: Cash Price |
$2,333.00
|
| Rate for Payer: Cigna Commercial |
$3,872.78
|
| Rate for Payer: First Health Commercial |
$4,432.70
|
| Rate for Payer: Humana Commercial |
$3,966.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.46
|
| Rate for Payer: PHCS Commercial |
$4,479.36
|
| Rate for Payer: United Healthcare All Payer |
$4,106.08
|
|
|
INTRVASC US NONCORONARY 1ST(T
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
761T1572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.58 |
| Max. Negotiated Rate |
$4,479.36 |
| Rate for Payer: Aetna Commercial |
$3,592.82
|
| Rate for Payer: Anthem Medicaid |
$1,604.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.48
|
| Rate for Payer: Cash Price |
$2,333.00
|
| Rate for Payer: Cigna Commercial |
$3,872.78
|
| Rate for Payer: First Health Commercial |
$4,432.70
|
| Rate for Payer: Humana Commercial |
$3,966.10
|
| Rate for Payer: Humana KY Medicaid |
$1,604.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,620.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.46
|
| Rate for Payer: PHCS Commercial |
$4,479.36
|
| Rate for Payer: United Healthcare All Payer |
$4,106.08
|
|
|
INTRVASC US NONCORONARY ADDL
|
Facility
|
OP
|
$3,813.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.69 |
| Max. Negotiated Rate |
$3,660.48 |
| Rate for Payer: Aetna Commercial |
$2,936.01
|
| Rate for Payer: Anthem Medicaid |
$1,311.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Cash Price |
$1,906.50
|
| Rate for Payer: Cigna Commercial |
$3,164.79
|
| Rate for Payer: First Health Commercial |
$3,622.35
|
| Rate for Payer: Humana Commercial |
$3,241.05
|
| Rate for Payer: Humana KY Medicaid |
$1,311.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,126.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,859.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.03
|
| Rate for Payer: PHCS Commercial |
$3,660.48
|
| Rate for Payer: United Healthcare All Payer |
$3,355.44
|
|
|
INTRVASC US NONCORONARY ADDL
|
Professional
|
Both
|
$3,813.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$3,813.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.93
|
| Rate for Payer: Anthem Medicaid |
$60.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,813.00
|
| Rate for Payer: Cash Price |
$1,906.50
|
| Rate for Payer: Cash Price |
$1,906.50
|
| Rate for Payer: Cigna Commercial |
$124.89
|
| Rate for Payer: Humana Medicaid |
$60.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.81
|
| Rate for Payer: Molina Healthcare Passport |
$60.60
|
| Rate for Payer: Multiplan PHCS |
$2,287.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,669.10
|
| Rate for Payer: UHCCP Medicaid |
$63.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.21
|
|
|
INTRVASC US NONCORONARY ADDL
|
Facility
|
IP
|
$3,813.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.69 |
| Max. Negotiated Rate |
$3,660.48 |
| Rate for Payer: Aetna Commercial |
$2,936.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.14
|
| Rate for Payer: Cash Price |
$1,906.50
|
| Rate for Payer: Cigna Commercial |
$3,164.79
|
| Rate for Payer: First Health Commercial |
$3,622.35
|
| Rate for Payer: Humana Commercial |
$3,241.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,126.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,859.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.03
|
| Rate for Payer: PHCS Commercial |
$3,660.48
|
| Rate for Payer: United Healthcare All Payer |
$3,355.44
|
|
|
INTRVASC US NONCORONARY ADD(P
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761P1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.93
|
| Rate for Payer: Anthem Medicaid |
$60.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$124.89
|
| Rate for Payer: Humana Medicaid |
$60.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.81
|
| Rate for Payer: Molina Healthcare Passport |
$60.60
|
| Rate for Payer: Multiplan PHCS |
$109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.10
|
| Rate for Payer: UHCCP Medicaid |
$63.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.21
|
|
|
INTRVASC US NONCORONARY ADD(T
|
Facility
|
IP
|
$3,630.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761T1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$3,484.80 |
| Rate for Payer: Aetna Commercial |
$2,795.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,831.40
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cigna Commercial |
$3,012.90
|
| Rate for Payer: First Health Commercial |
$3,448.50
|
| Rate for Payer: Humana Commercial |
$3,085.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,976.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,678.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,194.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.30
|
| Rate for Payer: PHCS Commercial |
$3,484.80
|
| Rate for Payer: United Healthcare All Payer |
$3,194.40
|
|
|
INTRVASC US NONCORONARY ADD(T
|
Facility
|
OP
|
$3,630.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761T1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.90 |
| Max. Negotiated Rate |
$3,484.80 |
| Rate for Payer: Aetna Commercial |
$2,795.10
|
| Rate for Payer: Anthem Medicaid |
$1,248.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,831.40
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cigna Commercial |
$3,012.90
|
| Rate for Payer: First Health Commercial |
$3,448.50
|
| Rate for Payer: Humana Commercial |
$3,085.50
|
| Rate for Payer: Humana KY Medicaid |
$1,248.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,261.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,976.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,678.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,273.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,194.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.30
|
| Rate for Payer: PHCS Commercial |
$3,484.80
|
| Rate for Payer: United Healthcare All Payer |
$3,194.40
|
|
|
INTSTM PERC EXTENSION
|
Facility
|
IP
|
$3,118.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.44 |
| Max. Negotiated Rate |
$2,994.00 |
| Rate for Payer: Aetna Commercial |
$2,401.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,432.62
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cigna Commercial |
$2,588.56
|
| Rate for Payer: First Health Commercial |
$2,962.81
|
| Rate for Payer: Humana Commercial |
$2,650.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,557.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,301.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$935.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,744.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,339.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.81
|
| Rate for Payer: PHCS Commercial |
$2,994.00
|
| Rate for Payer: United Healthcare All Payer |
$2,744.50
|
|
|
INTSTM PERC EXTENSION
|
Facility
|
OP
|
$3,118.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.44 |
| Max. Negotiated Rate |
$2,994.00 |
| Rate for Payer: Aetna Commercial |
$2,401.44
|
| Rate for Payer: Anthem Medicaid |
$1,072.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,432.62
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cigna Commercial |
$2,588.56
|
| Rate for Payer: First Health Commercial |
$2,962.81
|
| Rate for Payer: Humana Commercial |
$2,650.94
|
| Rate for Payer: Humana KY Medicaid |
$1,072.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,083.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,557.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,301.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$935.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,744.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,339.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.81
|
| Rate for Payer: PHCS Commercial |
$2,994.00
|
| Rate for Payer: United Healthcare All Payer |
$2,744.50
|
|
|
INTUBATION
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem Medicaid |
$341.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Humana KY Medicaid |
$341.15
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$344.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.52
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
INTUBATION
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.35 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$171.24
|
| Rate for Payer: Anthem Medicaid |
$102.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$992.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$166.53
|
| Rate for Payer: Healthspan PPO |
$144.41
|
| Rate for Payer: Humana Medicaid |
$102.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.40
|
| Rate for Payer: Molina Healthcare Passport |
$102.35
|
| Rate for Payer: Multiplan PHCS |
$595.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$694.40
|
| Rate for Payer: UHCCP Medicaid |
$347.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.37
|
|
|
INTUBATION
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.52
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
|
Facility
|
OP
|
$295.72
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
|
|
INTUBATION(P
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410P0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna Commercial |
$171.24
|
| Rate for Payer: Anthem Medicaid |
$102.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$166.53
|
| Rate for Payer: Healthspan PPO |
$144.41
|
| Rate for Payer: Humana Medicaid |
$102.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.40
|
| Rate for Payer: Molina Healthcare Passport |
$102.35
|
| Rate for Payer: Multiplan PHCS |
$130.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.60
|
| Rate for Payer: UHCCP Medicaid |
$76.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.37
|
|
|
INTUBATION(T
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410T0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.62 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: Aetna Commercial |
$595.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.72
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$642.42
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: Humana Commercial |
$657.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.12
|
| Rate for Payer: Ohio Health Group HMO |
$580.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.94
|
| Rate for Payer: PHCS Commercial |
$743.04
|
| Rate for Payer: United Healthcare All Payer |
$681.12
|
|
|
INTUBATION(T
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410T0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.62 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: Aetna Commercial |
$595.98
|
| Rate for Payer: Anthem Medicaid |
$266.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$642.42
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: Humana Commercial |
$657.90
|
| Rate for Payer: Humana KY Medicaid |
$266.18
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$268.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.12
|
| Rate for Payer: Ohio Health Group HMO |
$580.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.94
|
| Rate for Payer: PHCS Commercial |
$743.04
|
| Rate for Payer: United Healthcare All Payer |
$681.12
|
|
|
INTUITRAK AAA .014 GUIDEWIRE
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
INTUITRAK AAA .014 GUIDEWIRE
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
