|
PLACE CECOSTOMY TUBE PERC
|
Facility
|
OP
|
$4,317.00
|
|
|
Service Code
|
HCPCS 49442
|
| Hospital Charge Code |
76102006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$4,144.32 |
| Rate for Payer: Aetna Commercial |
$3,324.09
|
| Rate for Payer: Anthem Medicaid |
$1,484.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$2,158.50
|
| Rate for Payer: Cash Price |
$2,158.50
|
| Rate for Payer: Cigna Commercial |
$3,583.11
|
| Rate for Payer: First Health Commercial |
$4,101.15
|
| Rate for Payer: Humana Commercial |
$3,669.45
|
| Rate for Payer: Humana KY Medicaid |
$1,484.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,514.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,798.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,755.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.73
|
| Rate for Payer: PHCS Commercial |
$4,144.32
|
| Rate for Payer: United Healthcare All Payer |
$3,798.96
|
|
|
PLACE CECOSTOMY TUBE PERC
|
Facility
|
IP
|
$4,317.00
|
|
|
Service Code
|
HCPCS 49442
|
| Hospital Charge Code |
76102006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,295.10 |
| Max. Negotiated Rate |
$4,144.32 |
| Rate for Payer: Aetna Commercial |
$3,324.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.26
|
| Rate for Payer: Cash Price |
$2,158.50
|
| Rate for Payer: Cigna Commercial |
$3,583.11
|
| Rate for Payer: First Health Commercial |
$4,101.15
|
| Rate for Payer: Humana Commercial |
$3,669.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,798.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,755.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.73
|
| Rate for Payer: PHCS Commercial |
$4,144.32
|
| Rate for Payer: United Healthcare All Payer |
$3,798.96
|
|
|
PLACE CECOSTOMY TUBE PERC(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 49442
|
| Hospital Charge Code |
761P2006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.29 |
| Max. Negotiated Rate |
$1,291.96 |
| Rate for Payer: Aetna Commercial |
$338.46
|
| Rate for Payer: Ambetter Exchange |
$192.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$190.29
|
| Rate for Payer: Anthem Medicaid |
$851.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.32
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$311.30
|
| Rate for Payer: Healthspan PPO |
$1,291.96
|
| Rate for Payer: Humana Medicaid |
$851.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.56
|
| Rate for Payer: Molina Healthcare Passport |
$851.53
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$250.60
|
| Rate for Payer: UHCCP Medicaid |
$199.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.77
|
|
|
PLACE CECOSTOMY TUBE PERC(T
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 49442
|
| Hospital Charge Code |
761T2006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.77 |
| Max. Negotiated Rate |
$2,704.32 |
| Rate for Payer: Aetna Commercial |
$2,169.09
|
| Rate for Payer: Anthem Medicaid |
$968.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna Commercial |
$2,338.11
|
| Rate for Payer: First Health Commercial |
$2,676.15
|
| Rate for Payer: Humana Commercial |
$2,394.45
|
| Rate for Payer: Humana KY Medicaid |
$968.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$978.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$988.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,943.73
|
| Rate for Payer: PHCS Commercial |
$2,704.32
|
| Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
|
PLACE CECOSTOMY TUBE PERC(T
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 49442
|
| Hospital Charge Code |
761T2006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$845.10 |
| Max. Negotiated Rate |
$2,704.32 |
| Rate for Payer: Aetna Commercial |
$2,169.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna Commercial |
$2,338.11
|
| Rate for Payer: First Health Commercial |
$2,676.15
|
| Rate for Payer: Humana Commercial |
$2,394.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,943.73
|
| Rate for Payer: PHCS Commercial |
$2,704.32
|
| Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
|
PLACE DUOD/JEJ TUBE PERC
|
Professional
|
Both
|
$3,406.24
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
76102005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$2,043.74 |
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Ambetter Exchange |
$226.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.51
|
| Rate for Payer: Anthem Medicaid |
$1,044.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$226.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$226.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$271.93
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$375.25
|
| Rate for Payer: Healthspan PPO |
$1,443.03
|
| Rate for Payer: Humana Medicaid |
$1,044.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$226.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,064.97
|
| Rate for Payer: Molina Healthcare Passport |
$1,044.09
|
| Rate for Payer: Multiplan PHCS |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.59
|
| Rate for Payer: UHCCP Medicaid |
$252.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,054.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$226.61
|
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
OP
|
$3,406.24
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
76102005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,171.41 |
| Max. Negotiated Rate |
$3,269.99 |
| Rate for Payer: Aetna Commercial |
$2,622.80
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.18
|
| Rate for Payer: First Health Commercial |
$3,235.93
|
| Rate for Payer: Humana Commercial |
$2,895.30
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,269.99
|
| Rate for Payer: United Healthcare All Payer |
$2,997.49
|
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
IP
|
$3,406.24
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
76102005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,021.87 |
| Max. Negotiated Rate |
$3,269.99 |
| Rate for Payer: Aetna Commercial |
$2,622.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.87
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.18
|
| Rate for Payer: First Health Commercial |
$3,235.93
|
| Rate for Payer: Humana Commercial |
$2,895.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,269.99
|
| Rate for Payer: United Healthcare All Payer |
$2,997.49
|
|
|
PLACE DUOD/JEJ TUBE PERC(P
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
761P2005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$1,443.03 |
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Ambetter Exchange |
$226.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.51
|
| Rate for Payer: Anthem Medicaid |
$1,044.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$226.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$226.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$271.93
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$375.25
|
| Rate for Payer: Healthspan PPO |
$1,443.03
|
| Rate for Payer: Humana Medicaid |
$1,044.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$226.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,064.97
|
| Rate for Payer: Molina Healthcare Passport |
$1,044.09
|
| Rate for Payer: Multiplan PHCS |
$267.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.59
|
| Rate for Payer: UHCCP Medicaid |
$252.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,054.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$226.61
|
|
|
PLACE DUOD/JEJ TUBE PERC(T
|
Facility
|
OP
|
$2,961.24
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
761T2005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.37 |
| Max. Negotiated Rate |
$2,842.79 |
| Rate for Payer: Aetna Commercial |
$2,280.15
|
| Rate for Payer: Anthem Medicaid |
$1,018.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,309.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,480.62
|
| Rate for Payer: Cash Price |
$1,480.62
|
| Rate for Payer: Cigna Commercial |
$2,457.83
|
| Rate for Payer: First Health Commercial |
$2,813.18
|
| Rate for Payer: Humana Commercial |
$2,517.05
|
| Rate for Payer: Humana KY Medicaid |
$1,018.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,028.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,428.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,185.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,038.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,605.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,576.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.26
|
| Rate for Payer: PHCS Commercial |
$2,842.79
|
| Rate for Payer: United Healthcare All Payer |
$2,605.89
|
|
|
PLACE DUOD/JEJ TUBE PERC(T
|
Facility
|
IP
|
$2,961.24
|
|
|
Service Code
|
HCPCS 49441
|
| Hospital Charge Code |
761T2005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$888.37 |
| Max. Negotiated Rate |
$2,842.79 |
| Rate for Payer: Aetna Commercial |
$2,280.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,309.77
|
| Rate for Payer: Cash Price |
$1,480.62
|
| Rate for Payer: Cigna Commercial |
$2,457.83
|
| Rate for Payer: First Health Commercial |
$2,813.18
|
| Rate for Payer: Humana Commercial |
$2,517.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,428.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,185.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$888.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,605.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,576.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.26
|
| Rate for Payer: PHCS Commercial |
$2,842.79
|
| Rate for Payer: United Healthcare All Payer |
$2,605.89
|
|
|
PLACE GASTROSTOMY TUBE PERC
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 49440
|
| Hospital Charge Code |
76102698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.07 |
| Max. Negotiated Rate |
$1,335.12 |
| Rate for Payer: Aetna Commercial |
$378.42
|
| Rate for Payer: Ambetter Exchange |
$190.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$204.18
|
| Rate for Payer: Anthem Medicaid |
$882.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.08
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$344.84
|
| Rate for Payer: Healthspan PPO |
$1,335.12
|
| Rate for Payer: Humana Medicaid |
$882.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$899.73
|
| Rate for Payer: Molina Healthcare Passport |
$882.09
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.09
|
| Rate for Payer: UHCCP Medicaid |
$214.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$890.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.07
|
|
|
PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$2,649.89
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
|
|
PLACEMENT OF SETON
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
76102863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
76102863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$48.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$48.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$48.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
PLACEMENT OF SETON
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
76102863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$309.53 |
| Rate for Payer: Aetna Commercial |
$309.53
|
| Rate for Payer: Ambetter Exchange |
$110.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.35
|
| Rate for Payer: Anthem Medicaid |
$168.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.91
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: Healthspan PPO |
$295.34
|
| Rate for Payer: Humana Medicaid |
$168.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.09
|
| Rate for Payer: Molina Healthcare Passport |
$168.72
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$143.99
|
| Rate for Payer: UHCCP Medicaid |
$124.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.76
|
|
|
PLACE OF CATH FOR BRACHYTHERAP
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 31643
|
| Hospital Charge Code |
410P0051
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$296.60 |
| Rate for Payer: Aetna Commercial |
$296.60
|
| Rate for Payer: Ambetter Exchange |
$157.90
|
| Rate for Payer: Anthem Medicaid |
$161.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.48
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$269.19
|
| Rate for Payer: Healthspan PPO |
$231.58
|
| Rate for Payer: Humana Medicaid |
$161.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.62
|
| Rate for Payer: Molina Healthcare Passport |
$161.39
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.27
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.90
|
|
|
PLACE OF CATH FOR BRACHYTHERAP
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 31643
|
| Hospital Charge Code |
41000051
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$296.60 |
| Rate for Payer: Aetna Commercial |
$296.60
|
| Rate for Payer: Ambetter Exchange |
$157.90
|
| Rate for Payer: Anthem Medicaid |
$161.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.48
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$269.19
|
| Rate for Payer: Healthspan PPO |
$231.58
|
| Rate for Payer: Humana Medicaid |
$161.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.62
|
| Rate for Payer: Molina Healthcare Passport |
$161.39
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.27
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.90
|
|
|
PLACE OF CATH FOR BRACHYTHERAP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 31643
|
| Hospital Charge Code |
41000051
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
PLACE OF CATH FOR BRACHYTHERAP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 31643
|
| Hospital Charge Code |
41000051
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
PLACE RADIOTHER BALLOON CATH
|
Facility
|
IP
|
$4,010.50
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,203.15 |
| Max. Negotiated Rate |
$3,850.08 |
| Rate for Payer: Aetna Commercial |
$3,088.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.19
|
| Rate for Payer: Cash Price |
$2,005.25
|
| Rate for Payer: Cigna Commercial |
$3,328.72
|
| Rate for Payer: First Health Commercial |
$3,809.97
|
| Rate for Payer: Humana Commercial |
$3,408.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,288.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,959.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,529.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,007.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,489.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.24
|
| Rate for Payer: PHCS Commercial |
$3,850.08
|
| Rate for Payer: United Healthcare All Payer |
$3,529.24
|
|
|
PLACE RADIOTHER BALLOON CATH
|
Facility
|
OP
|
$4,010.50
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,203.15 |
| Max. Negotiated Rate |
$3,850.08 |
| Rate for Payer: Aetna Commercial |
$3,088.09
|
| Rate for Payer: Anthem Medicaid |
$1,379.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.19
|
| Rate for Payer: Cash Price |
$2,005.25
|
| Rate for Payer: Cigna Commercial |
$3,328.72
|
| Rate for Payer: First Health Commercial |
$3,809.97
|
| Rate for Payer: Humana Commercial |
$3,408.93
|
| Rate for Payer: Humana KY Medicaid |
$1,379.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,393.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,288.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,959.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,406.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,529.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,007.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,489.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.24
|
| Rate for Payer: PHCS Commercial |
$3,850.08
|
| Rate for Payer: United Healthcare All Payer |
$3,529.24
|
|
|
PLACE RADIOTHER BALLOON CATH
|
Professional
|
Both
|
$4,010.50
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$2,406.30 |
| Rate for Payer: Aetna Commercial |
$138.69
|
| Rate for Payer: Ambetter Exchange |
$89.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.94
|
| Rate for Payer: Cash Price |
$2,005.25
|
| Rate for Payer: Cash Price |
$2,005.25
|
| Rate for Payer: Cigna Commercial |
$134.24
|
| Rate for Payer: Healthspan PPO |
$110.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.12
|
| Rate for Payer: Multiplan PHCS |
$2,406.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.86
|
| Rate for Payer: UHCCP Medicaid |
$1,403.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.12
|
|
|
PLACE RADIOTHER BALLOON CATH(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
761P0298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$138.69 |
| Rate for Payer: Aetna Commercial |
$138.69
|
| Rate for Payer: Ambetter Exchange |
$89.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.94
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$134.24
|
| Rate for Payer: Healthspan PPO |
$110.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.12
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.86
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.12
|
|
|
PLACE RADIOTHER BALLOON CATH(T
|
Facility
|
OP
|
$3,810.50
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
761T0298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.15 |
| Max. Negotiated Rate |
$3,658.08 |
| Rate for Payer: Aetna Commercial |
$2,934.09
|
| Rate for Payer: Anthem Medicaid |
$1,310.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.19
|
| Rate for Payer: Cash Price |
$1,905.25
|
| Rate for Payer: Cigna Commercial |
$3,162.72
|
| Rate for Payer: First Health Commercial |
$3,619.97
|
| Rate for Payer: Humana Commercial |
$3,238.93
|
| Rate for Payer: Humana KY Medicaid |
$1,310.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,323.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,124.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,336.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,353.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,857.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,048.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.24
|
| Rate for Payer: PHCS Commercial |
$3,658.08
|
| Rate for Payer: United Healthcare All Payer |
$3,353.24
|
|
