|
PERICARDIOCENTESIS W/IMAGING
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Anthem Medicaid |
$190.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,696.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Humana Medicaid |
$190.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$328.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.54
|
| Rate for Payer: Molina Healthcare Passport |
$190.73
|
| Rate for Payer: Multiplan PHCS |
$1,617.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,887.20
|
| Rate for Payer: UHCCP Medicaid |
$943.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.64
|
|
|
PERICARDIOCENTESIS W/IMAGI (P)
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481P0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$328.91 |
| Rate for Payer: Anthem Medicaid |
$190.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Humana Medicaid |
$190.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$328.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.54
|
| Rate for Payer: Molina Healthcare Passport |
$190.73
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.00
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.64
|
|
|
PERICARDIOCENTESIS W/IMAGI (T)
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481T0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
PERICARDIOCENTESIS W/IMAGI (T)
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481T0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem Medicaid |
$837.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Humana KY Medicaid |
$837.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$846.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$854.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.16
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
761P1239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.99 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,351.60
|
| Rate for Payer: Anthem Medicaid |
$757.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: Healthspan PPO |
$1,328.89
|
| Rate for Payer: Humana Medicaid |
$757.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,115.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.15
|
| Rate for Payer: Molina Healthcare Passport |
$757.99
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.57
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.99 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,351.60
|
| Rate for Payer: Anthem Medicaid |
$757.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: Healthspan PPO |
$1,328.89
|
| Rate for Payer: Humana Medicaid |
$757.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,115.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.15
|
| Rate for Payer: Molina Healthcare Passport |
$757.99
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.57
|
|
|
PERIDEX (CHLORHEXIDINE)EA15 ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 116200116
|
| Hospital Charge Code |
25001176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
|
|
PERIDEX (CHLORHEXIDINE)EA15 ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 116200116
|
| Hospital Charge Code |
25001176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
PERIPATCH BIOLOGIC 0.8*8 TAPER
|
Facility
|
IP
|
$2,186.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,099.04 |
| Rate for Payer: Aetna Commercial |
$1,683.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.47
|
| Rate for Payer: Cash Price |
$1,093.25
|
| Rate for Payer: Cigna Commercial |
$1,814.80
|
| Rate for Payer: First Health Commercial |
$2,077.18
|
| Rate for Payer: Humana Commercial |
$1,858.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,639.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.82
|
| Rate for Payer: PHCS Commercial |
$2,099.04
|
| Rate for Payer: United Healthcare All Payer |
$1,924.12
|
|
|
PERIPATCH BIOLOGIC 0.8*8 TAPER
|
Facility
|
OP
|
$2,186.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,099.04 |
| Rate for Payer: Aetna Commercial |
$1,683.60
|
| Rate for Payer: Anthem Medicaid |
$751.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.47
|
| Rate for Payer: Cash Price |
$1,093.25
|
| Rate for Payer: Cigna Commercial |
$1,814.80
|
| Rate for Payer: First Health Commercial |
$2,077.18
|
| Rate for Payer: Humana Commercial |
$1,858.52
|
| Rate for Payer: Humana KY Medicaid |
$751.94
|
| Rate for Payer: Kentucky WC Medicaid |
$759.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,639.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.82
|
| Rate for Payer: PHCS Commercial |
$2,099.04
|
| Rate for Payer: United Healthcare All Payer |
$1,924.12
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$26,095.20
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$17,707.46 |
| Max. Negotiated Rate |
$26,095.20 |
| Rate for Payer: Anthem Medicaid |
$17,707.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,639.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,095.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,163.23
|
| Rate for Payer: Humana KY Medicaid |
$17,707.46
|
| Rate for Payer: Humana Medicare Advantage |
$18,639.43
|
| Rate for Payer: Kentucky WC Medicaid |
$17,884.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,367.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,061.61
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,043.95
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$30,565.54 |
| Max. Negotiated Rate |
$45,043.95 |
| Rate for Payer: Anthem Medicaid |
$30,565.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32,174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45,043.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$43,435.24
|
| Rate for Payer: Humana KY Medicaid |
$30,565.54
|
| Rate for Payer: Humana Medicare Advantage |
$32,174.25
|
| Rate for Payer: Kentucky WC Medicaid |
$30,871.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38,609.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,176.85
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,352.56
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$13,810.66 |
| Max. Negotiated Rate |
$20,352.56 |
| Rate for Payer: Anthem Medicaid |
$13,810.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,537.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,352.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,625.68
|
| Rate for Payer: Humana KY Medicaid |
$13,810.66
|
| Rate for Payer: Humana Medicare Advantage |
$14,537.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13,948.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,445.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,086.88
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$12,481.99
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$8,469.92 |
| Max. Negotiated Rate |
$12,481.99 |
| Rate for Payer: Anthem Medicaid |
$8,469.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,915.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,481.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,036.21
|
| Rate for Payer: Humana KY Medicaid |
$8,469.92
|
| Rate for Payer: Humana Medicare Advantage |
$8,915.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,554.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,698.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,639.32
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$18,438.70
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$12,511.98 |
| Max. Negotiated Rate |
$18,438.70 |
| Rate for Payer: Anthem Medicaid |
$12,511.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,170.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,438.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,780.18
|
| Rate for Payer: Humana KY Medicaid |
$12,511.98
|
| Rate for Payer: Humana Medicare Advantage |
$13,170.50
|
| Rate for Payer: Kentucky WC Medicaid |
$12,637.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,804.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,762.21
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,303.39
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$5,634.44 |
| Max. Negotiated Rate |
$8,303.39 |
| Rate for Payer: Anthem Medicaid |
$5,634.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,930.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,303.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,006.84
|
| Rate for Payer: Humana KY Medicaid |
$5,634.44
|
| Rate for Payer: Humana Medicare Advantage |
$5,930.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,117.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,747.13
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
OP
|
$7,467.93
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$970.83 |
| Max. Negotiated Rate |
$7,169.21 |
| Rate for Payer: Aetna Commercial |
$5,750.31
|
| Rate for Payer: Anthem Medicaid |
$2,568.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$3,733.97
|
| Rate for Payer: Cash Price |
$3,733.97
|
| Rate for Payer: Cigna Commercial |
$6,198.38
|
| Rate for Payer: First Health Commercial |
$7,094.53
|
| Rate for Payer: Humana Commercial |
$6,347.74
|
| Rate for Payer: Humana KY Medicaid |
$2,568.22
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,493.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,315.06
|
| Rate for Payer: PHCS Commercial |
$7,169.21
|
| Rate for Payer: United Healthcare All Payer |
$6,571.78
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
IP
|
$7,467.93
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$970.83 |
| Max. Negotiated Rate |
$7,169.21 |
| Rate for Payer: Aetna Commercial |
$5,750.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.99
|
| Rate for Payer: Cash Price |
$3,733.97
|
| Rate for Payer: Cigna Commercial |
$6,198.38
|
| Rate for Payer: First Health Commercial |
$7,094.53
|
| Rate for Payer: Humana Commercial |
$6,347.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,493.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,315.06
|
| Rate for Payer: PHCS Commercial |
$7,169.21
|
| Rate for Payer: United Healthcare All Payer |
$6,571.78
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
OP
|
$5,867.93
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761T0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.83 |
| Max. Negotiated Rate |
$5,633.21 |
| Rate for Payer: Aetna Commercial |
$4,518.31
|
| Rate for Payer: Anthem Medicaid |
$2,017.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,576.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,933.97
|
| Rate for Payer: Cash Price |
$2,933.97
|
| Rate for Payer: Cigna Commercial |
$4,870.38
|
| Rate for Payer: First Health Commercial |
$5,574.53
|
| Rate for Payer: Humana Commercial |
$4,987.74
|
| Rate for Payer: Humana KY Medicaid |
$2,017.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,038.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,811.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,330.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,058.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,163.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,400.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.06
|
| Rate for Payer: PHCS Commercial |
$5,633.21
|
| Rate for Payer: United Healthcare All Payer |
$5,163.78
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761P0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.98 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,135.38
|
| Rate for Payer: Anthem Medicaid |
$508.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,077.89
|
| Rate for Payer: Healthspan PPO |
$907.84
|
| Rate for Payer: Humana Medicaid |
$508.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,007.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.16
|
| Rate for Payer: Molina Healthcare Passport |
$508.98
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.07
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Professional
|
Both
|
$7,467.93
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.98 |
| Max. Negotiated Rate |
$7,467.93 |
| Rate for Payer: Aetna Commercial |
$1,135.38
|
| Rate for Payer: Anthem Medicaid |
$508.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,467.93
|
| Rate for Payer: Cash Price |
$3,733.97
|
| Rate for Payer: Cash Price |
$3,733.97
|
| Rate for Payer: Cigna Commercial |
$1,077.89
|
| Rate for Payer: Healthspan PPO |
$907.84
|
| Rate for Payer: Humana Medicaid |
$508.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,007.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.16
|
| Rate for Payer: Molina Healthcare Passport |
$508.98
|
| Rate for Payer: Multiplan PHCS |
$4,480.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,227.55
|
| Rate for Payer: UHCCP Medicaid |
$2,613.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.07
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
IP
|
$5,867.93
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761T0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.83 |
| Max. Negotiated Rate |
$5,633.21 |
| Rate for Payer: Aetna Commercial |
$4,518.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,576.99
|
| Rate for Payer: Cash Price |
$2,933.97
|
| Rate for Payer: Cigna Commercial |
$4,870.38
|
| Rate for Payer: First Health Commercial |
$5,574.53
|
| Rate for Payer: Humana Commercial |
$4,987.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,811.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,330.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,760.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,163.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,400.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.06
|
| Rate for Payer: PHCS Commercial |
$5,633.21
|
| Rate for Payer: United Healthcare All Payer |
$5,163.78
|
|
