|
INTRODUCER SHEATH ULTRA 9FR*23
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCER SHEATH ULTRA 9FR*23
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODUCTION OF GI TUBE
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 44500
|
| Hospital Charge Code |
76101853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.80 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
INTRODUCTION OF GI TUBE
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 44500
|
| Hospital Charge Code |
76101853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$7,375.33
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,268.09 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
|
|
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 |
$754.85 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Ambetter Exchange |
$83.10
|
| 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 Individual/Medicaid |
$83.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| 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 |
$108.03
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.10
|
|
|
INTRO NDL ICATH UPR/LXTR AR(T
|
Facility
|
OP
|
$1,417.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
761T1437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.10 |
| Max. Negotiated Rate |
$1,360.32 |
| Rate for Payer: Aetna Commercial |
$1,091.09
|
| Rate for Payer: Anthem Medicaid |
$487.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,105.26
|
| Rate for Payer: Cash Price |
$708.50
|
| Rate for Payer: Cigna Commercial |
$1,176.11
|
| Rate for Payer: First Health Commercial |
$1,346.15
|
| Rate for Payer: Humana Commercial |
$1,204.45
|
| Rate for Payer: Humana KY Medicaid |
$487.31
|
| Rate for Payer: Kentucky WC Medicaid |
$492.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,161.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,045.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$425.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$497.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,246.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,062.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.73
|
| Rate for Payer: PHCS Commercial |
$1,360.32
|
| Rate for Payer: United Healthcare All Payer |
$1,246.96
|
|
|
INTRO NDL ICATH UPR/LXTR AR(T
|
Facility
|
IP
|
$1,417.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
761T1437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.10 |
| Max. Negotiated Rate |
$1,360.32 |
| Rate for Payer: Aetna Commercial |
$1,091.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,105.26
|
| Rate for Payer: Cash Price |
$708.50
|
| Rate for Payer: Cigna Commercial |
$1,176.11
|
| Rate for Payer: First Health Commercial |
$1,346.15
|
| Rate for Payer: Humana Commercial |
$1,204.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,161.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,045.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$425.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,246.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,062.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.73
|
| Rate for Payer: PHCS Commercial |
$1,360.32
|
| Rate for Payer: United Healthcare All Payer |
$1,246.96
|
|
|
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 |
$1,275.60 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Ambetter Exchange |
$83.10
|
| 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 Individual/Medicaid |
$83.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| 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 |
$108.03
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.10
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
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 |
$637.80 |
| 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 |
$1,700.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.94
|
| 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
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
45000234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.70 |
| 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 |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| 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
|
$1,369.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
45000234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.70 |
| 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 |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| 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
|
IP
|
$2,126.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
48100100
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$637.80 |
| 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 |
$1,700.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.94
|
| 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
|
$2,174.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
INTRO NDL ICATH UPR/LXTR ART
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
76101437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$1,304.40 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Ambetter Exchange |
$83.10
|
| 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 Individual/Medicaid |
$83.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cash Price |
$1,087.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.68
|
| Rate for Payer: Molina Healthcare Passport |
$102.63
|
| Rate for Payer: Multiplan PHCS |
$1,304.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.03
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.10
|
|
|
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 |
$754.85 |
| Rate for Payer: Aetna Commercial |
$179.27
|
| Rate for Payer: Ambetter Exchange |
$83.10
|
| 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 Individual/Medicaid |
$83.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| 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 |
$108.03
|
| Rate for Payer: UHCCP Medicaid |
$75.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.10
|
|
|
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 |
$410.70 |
| 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 |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| 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 |
$410.70 |
| 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 |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.61
|
| Rate for Payer: PHCS Commercial |
$1,314.24
|
| Rate for Payer: United Healthcare All Payer |
$1,204.72
|
|
|
INTRO NEEDLE OR VENOUS CATH
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
76101428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.40 |
| 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 |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| 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 |
$44.40 |
| 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 |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
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 |
$103.60 |
| 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 |
$12.69
|
| 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 |
$12.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.94
|
| Rate for Payer: Molina Healthcare Passport |
$12.69
|
| 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 |
$12.82
|
|
|
INTRO OF CATHETER - IVC
|
Facility
|
OP
|
$3,443.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,032.90 |
| Max. Negotiated Rate |
$3,305.28 |
| Rate for Payer: Aetna Commercial |
$2,651.11
|
| Rate for Payer: Anthem Medicaid |
$1,184.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.54
|
| Rate for Payer: Cash Price |
$1,721.50
|
| Rate for Payer: Cigna Commercial |
$2,857.69
|
| Rate for Payer: First Health Commercial |
$3,270.85
|
| Rate for Payer: Humana Commercial |
$2,926.55
|
| Rate for Payer: Humana KY Medicaid |
$1,184.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,196.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,540.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,207.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,029.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,375.67
|
| Rate for Payer: PHCS Commercial |
$3,305.28
|
| Rate for Payer: United Healthcare All Payer |
$3,029.84
|
|
|
INTRO OF CATHETER - IVC
|
Professional
|
Both
|
$3,443.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.32 |
| Max. Negotiated Rate |
$2,065.80 |
| Rate for Payer: Aetna Commercial |
$215.46
|
| Rate for Payer: Ambetter Exchange |
$100.93
|
| 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 Individual/Medicaid |
$100.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.12
|
| Rate for Payer: Cash Price |
$1,721.50
|
| Rate for Payer: Cash Price |
$1,721.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.14
|
| Rate for Payer: Molina Healthcare Passport |
$135.43
|
| Rate for Payer: Multiplan PHCS |
$2,065.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.21
|
| Rate for Payer: UHCCP Medicaid |
$91.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.93
|
|
|
INTRO OF CATHETER - IVC
|
Facility
|
IP
|
$3,443.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
76101431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,032.90 |
| Max. Negotiated Rate |
$3,305.28 |
| Rate for Payer: Aetna Commercial |
$2,651.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.54
|
| Rate for Payer: Cash Price |
$1,721.50
|
| Rate for Payer: Cigna Commercial |
$2,857.69
|
| Rate for Payer: First Health Commercial |
$3,270.85
|
| Rate for Payer: Humana Commercial |
$2,926.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,540.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,029.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,375.67
|
| Rate for Payer: PHCS Commercial |
$3,305.28
|
| Rate for Payer: United Healthcare All Payer |
$3,029.84
|
|
