|
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 |
$905.83 |
| 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 |
$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: 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 |
$630.00
|
| 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(T
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
761T1431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.90 |
| Max. Negotiated Rate |
$2,297.28 |
| Rate for Payer: Aetna Commercial |
$1,842.61
|
| Rate for Payer: Anthem Medicaid |
$822.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.54
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cigna Commercial |
$1,986.19
|
| Rate for Payer: First Health Commercial |
$2,273.35
|
| Rate for Payer: Humana Commercial |
$2,034.05
|
| Rate for Payer: Humana KY Medicaid |
$822.95
|
| Rate for Payer: Kentucky WC Medicaid |
$831.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,962.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,766.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.17
|
| Rate for Payer: PHCS Commercial |
$2,297.28
|
| Rate for Payer: United Healthcare All Payer |
$2,105.84
|
|
|
INTRO OF CATHETER - IVC(T
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
761T1431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.90 |
| Max. Negotiated Rate |
$2,297.28 |
| Rate for Payer: Aetna Commercial |
$1,842.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.54
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cigna Commercial |
$1,986.19
|
| Rate for Payer: First Health Commercial |
$2,273.35
|
| Rate for Payer: Humana Commercial |
$2,034.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,962.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,766.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.17
|
| Rate for Payer: PHCS Commercial |
$2,297.28
|
| Rate for Payer: United Healthcare All Payer |
$2,105.84
|
|
|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
76101643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.90 |
| 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 |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
45000251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.97 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
INTRORA I&DTNGUEFLRMOUT LINGUA
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
45000251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.00 |
| 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 |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| 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 |
$217.69 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INTRVASC US NONCORONARY 1ST
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
INTRVASC US NONCORONARY 1ST
|
Professional
|
Both
|
$5,069.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.13 |
| Max. Negotiated Rate |
$3,041.40 |
| Rate for Payer: Ambetter Exchange |
$83.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.13
|
| Rate for Payer: Anthem Medicaid |
$1,033.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.21
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$156.09
|
| Rate for Payer: Humana Medicaid |
$1,033.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.71
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.05
|
| Rate for Payer: Multiplan PHCS |
$3,041.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.56
|
| Rate for Payer: UHCCP Medicaid |
$79.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.51
|
|
|
INTRVASC US NONCORONARY 1ST
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
76101572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
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 |
$1,053.71 |
| Rate for Payer: Ambetter Exchange |
$83.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.13
|
| Rate for Payer: Anthem Medicaid |
$1,033.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.21
|
| 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 |
$1,033.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.71
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.05
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.56
|
| Rate for Payer: UHCCP Medicaid |
$79.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.51
|
|
|
INTRVASC US NONCORONARY 1ST(T
|
Facility
|
OP
|
$4,969.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
761T1572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,490.70 |
| Max. Negotiated Rate |
$4,770.24 |
| Rate for Payer: Aetna Commercial |
$3,826.13
|
| Rate for Payer: Anthem Medicaid |
$1,708.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,875.82
|
| Rate for Payer: Cash Price |
$2,484.50
|
| Rate for Payer: Cigna Commercial |
$4,124.27
|
| Rate for Payer: First Health Commercial |
$4,720.55
|
| Rate for Payer: Humana Commercial |
$4,223.65
|
| Rate for Payer: Humana KY Medicaid |
$1,708.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,726.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,074.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,490.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,743.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,372.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,975.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,428.61
|
| Rate for Payer: PHCS Commercial |
$4,770.24
|
| Rate for Payer: United Healthcare All Payer |
$4,372.72
|
|
|
INTRVASC US NONCORONARY 1ST(T
|
Facility
|
IP
|
$4,969.00
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
761T1572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,490.70 |
| Max. Negotiated Rate |
$4,770.24 |
| Rate for Payer: Aetna Commercial |
$3,826.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,875.82
|
| Rate for Payer: Cash Price |
$2,484.50
|
| Rate for Payer: Cigna Commercial |
$4,124.27
|
| Rate for Payer: First Health Commercial |
$4,720.55
|
| Rate for Payer: Humana Commercial |
$4,223.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,074.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,490.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,372.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,975.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,428.61
|
| Rate for Payer: PHCS Commercial |
$4,770.24
|
| Rate for Payer: United Healthcare All Payer |
$4,372.72
|
|
|
INTRVASC US NONCORONARY ADDL
|
Professional
|
Both
|
$4,049.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$2,429.40 |
| Rate for Payer: Ambetter Exchange |
$66.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.93
|
| Rate for Payer: Anthem Medicaid |
$164.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.85
|
| Rate for Payer: Cash Price |
$2,024.50
|
| Rate for Payer: Cash Price |
$2,024.50
|
| Rate for Payer: Cigna Commercial |
$124.89
|
| Rate for Payer: Humana Medicaid |
$164.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.64
|
| Rate for Payer: Molina Healthcare Passport |
$164.35
|
| Rate for Payer: Multiplan PHCS |
$2,429.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.50
|
| Rate for Payer: UHCCP Medicaid |
$63.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.54
|
|
|
INTRVASC US NONCORONARY ADDL
|
Facility
|
IP
|
$4,049.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,214.70 |
| Max. Negotiated Rate |
$3,887.04 |
| Rate for Payer: Aetna Commercial |
$3,117.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,158.22
|
| Rate for Payer: Cash Price |
$2,024.50
|
| Rate for Payer: Cigna Commercial |
$3,360.67
|
| Rate for Payer: First Health Commercial |
$3,846.55
|
| Rate for Payer: Humana Commercial |
$3,441.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,320.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,988.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,563.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,522.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,793.81
|
| Rate for Payer: PHCS Commercial |
$3,887.04
|
| Rate for Payer: United Healthcare All Payer |
$3,563.12
|
|
|
INTRVASC US NONCORONARY ADDL
|
Facility
|
OP
|
$4,049.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
76101573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,214.70 |
| Max. Negotiated Rate |
$3,887.04 |
| Rate for Payer: Aetna Commercial |
$3,117.73
|
| Rate for Payer: Anthem Medicaid |
$1,392.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,158.22
|
| Rate for Payer: Cash Price |
$2,024.50
|
| Rate for Payer: Cigna Commercial |
$3,360.67
|
| Rate for Payer: First Health Commercial |
$3,846.55
|
| Rate for Payer: Humana Commercial |
$3,441.65
|
| Rate for Payer: Humana KY Medicaid |
$1,392.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,320.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,988.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,420.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,563.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,522.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,793.81
|
| Rate for Payer: PHCS Commercial |
$3,887.04
|
| Rate for Payer: United Healthcare All Payer |
$3,563.12
|
|
|
INTRVASC US NONCORONARY ADD(P
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761P1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$167.64 |
| Rate for Payer: Ambetter Exchange |
$66.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.93
|
| Rate for Payer: Anthem Medicaid |
$164.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.85
|
| 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 |
$164.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.64
|
| Rate for Payer: Molina Healthcare Passport |
$164.35
|
| Rate for Payer: Multiplan PHCS |
$109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.50
|
| Rate for Payer: UHCCP Medicaid |
$63.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.54
|
|
|
INTRVASC US NONCORONARY ADD(T
|
Facility
|
IP
|
$3,866.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761T1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,159.80 |
| Max. Negotiated Rate |
$3,711.36 |
| Rate for Payer: Aetna Commercial |
$2,976.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,015.48
|
| Rate for Payer: Cash Price |
$1,933.00
|
| Rate for Payer: Cigna Commercial |
$3,208.78
|
| Rate for Payer: First Health Commercial |
$3,672.70
|
| Rate for Payer: Humana Commercial |
$3,286.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,170.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,853.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,402.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,899.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,092.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,363.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,667.54
|
| Rate for Payer: PHCS Commercial |
$3,711.36
|
| Rate for Payer: United Healthcare All Payer |
$3,402.08
|
|
|
INTRVASC US NONCORONARY ADD(T
|
Facility
|
OP
|
$3,866.00
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
761T1573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,159.80 |
| Max. Negotiated Rate |
$3,711.36 |
| Rate for Payer: Aetna Commercial |
$2,976.82
|
| Rate for Payer: Anthem Medicaid |
$1,329.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,015.48
|
| Rate for Payer: Cash Price |
$1,933.00
|
| Rate for Payer: Cigna Commercial |
$3,208.78
|
| Rate for Payer: First Health Commercial |
$3,672.70
|
| Rate for Payer: Humana Commercial |
$3,286.10
|
| Rate for Payer: Humana KY Medicaid |
$1,329.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,343.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,170.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,853.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,356.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,402.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,899.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,092.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,363.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,667.54
|
| Rate for Payer: PHCS Commercial |
$3,711.36
|
| Rate for Payer: United Healthcare All Payer |
$3,402.08
|
|
|
INTSTM PERC EXTENSION
|
Facility
|
OP
|
$2,965.62
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.69 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Aetna Commercial |
$2,283.53
|
| Rate for Payer: Anthem Medicaid |
$1,019.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,313.18
|
| Rate for Payer: Cash Price |
$1,482.81
|
| Rate for Payer: Cigna Commercial |
$2,461.46
|
| Rate for Payer: First Health Commercial |
$2,817.34
|
| Rate for Payer: Humana Commercial |
$2,520.78
|
| Rate for Payer: Humana KY Medicaid |
$1,019.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,030.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,040.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,224.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.28
|
| Rate for Payer: PHCS Commercial |
$2,847.00
|
| Rate for Payer: United Healthcare All Payer |
$2,609.75
|
|
|
INTSTM PERC EXTENSION
|
Facility
|
IP
|
$2,965.62
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.69 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Aetna Commercial |
$2,283.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,313.18
|
| Rate for Payer: Cash Price |
$1,482.81
|
| Rate for Payer: Cigna Commercial |
$2,461.46
|
| Rate for Payer: First Health Commercial |
$2,817.34
|
| Rate for Payer: Humana Commercial |
$2,520.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,224.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.28
|
| Rate for Payer: PHCS Commercial |
$2,847.00
|
| Rate for Payer: United Healthcare All Payer |
$2,609.75
|
|
|
INTUBATION
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.35 |
| Max. Negotiated Rate |
$625.20 |
| Rate for Payer: Aetna Commercial |
$171.24
|
| Rate for Payer: Ambetter Exchange |
$135.14
|
| Rate for Payer: Anthem Medicaid |
$102.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.17
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$135.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.40
|
| Rate for Payer: Molina Healthcare Passport |
$102.35
|
| Rate for Payer: Multiplan PHCS |
$625.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.68
|
| Rate for Payer: UHCCP Medicaid |
$364.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.14
|
|
|
INTUBATION
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
INTUBATION
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
|
Facility
|
OP
|
$300.40
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
|
