|
REMOT AFTLOAD HDR 2-12 CHANEL
|
Facility
|
OP
|
$6,377.00
|
|
|
Service Code
|
HCPCS 77771
|
| Hospital Charge Code |
33300033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$620.01 |
| Max. Negotiated Rate |
$6,121.92 |
| Rate for Payer: Aetna Commercial |
$4,910.29
|
| Rate for Payer: Anthem Medicaid |
$2,193.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,974.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$3,188.50
|
| Rate for Payer: Cash Price |
$3,188.50
|
| Rate for Payer: Cigna Commercial |
$5,292.91
|
| Rate for Payer: First Health Commercial |
$6,058.15
|
| Rate for Payer: Humana Commercial |
$5,420.45
|
| Rate for Payer: Humana KY Medicaid |
$2,193.05
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,215.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,237.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,611.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,782.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,275.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$829.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,976.87
|
| Rate for Payer: PHCS Commercial |
$6,121.92
|
| Rate for Payer: United Healthcare All Payer |
$5,611.76
|
|
|
REMOT AFTLOAD HDR 2-12 CHANEL
|
Facility
|
IP
|
$6,377.00
|
|
|
Service Code
|
HCPCS 77771
|
| Hospital Charge Code |
33300033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$829.01 |
| Max. Negotiated Rate |
$6,121.92 |
| Rate for Payer: Aetna Commercial |
$4,910.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,974.06
|
| Rate for Payer: Cash Price |
$3,188.50
|
| Rate for Payer: Cigna Commercial |
$5,292.91
|
| Rate for Payer: First Health Commercial |
$6,058.15
|
| Rate for Payer: Humana Commercial |
$5,420.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,913.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,611.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,782.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,275.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$829.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,976.87
|
| Rate for Payer: PHCS Commercial |
$6,121.92
|
| Rate for Payer: United Healthcare All Payer |
$5,611.76
|
|
|
REMOT AFTLOAD HDR 2-12 CHANE(P
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 77771
|
| Hospital Charge Code |
333P0033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$145.25 |
| Max. Negotiated Rate |
$942.31 |
| Rate for Payer: Anthem Medicaid |
$450.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$415.00
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$942.31
|
| Rate for Payer: Humana Medicaid |
$450.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.11
|
| Rate for Payer: Molina Healthcare Passport |
$450.11
|
| Rate for Payer: Multiplan PHCS |
$249.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.50
|
| Rate for Payer: UHCCP Medicaid |
$145.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.61
|
|
|
REMOT AFTLOAD HDR 2-12 CHANE(T
|
Facility
|
IP
|
$5,962.00
|
|
|
Service Code
|
HCPCS 77771
|
| Hospital Charge Code |
333T0033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$775.06 |
| Max. Negotiated Rate |
$5,723.52 |
| Rate for Payer: Aetna Commercial |
$4,590.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,650.36
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cigna Commercial |
$4,948.46
|
| Rate for Payer: First Health Commercial |
$5,663.90
|
| Rate for Payer: Humana Commercial |
$5,067.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,848.22
|
| Rate for Payer: PHCS Commercial |
$5,723.52
|
| Rate for Payer: United Healthcare All Payer |
$5,246.56
|
|
|
REMOT AFTLOAD HDR 2-12 CHANE(T
|
Facility
|
OP
|
$5,962.00
|
|
|
Service Code
|
HCPCS 77771
|
| Hospital Charge Code |
333T0033
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$620.01 |
| Max. Negotiated Rate |
$5,723.52 |
| Rate for Payer: Aetna Commercial |
$4,590.74
|
| Rate for Payer: Anthem Medicaid |
$2,050.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,650.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cigna Commercial |
$4,948.46
|
| Rate for Payer: First Health Commercial |
$5,663.90
|
| Rate for Payer: Humana Commercial |
$5,067.70
|
| Rate for Payer: Humana KY Medicaid |
$2,050.33
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,071.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,091.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,848.22
|
| Rate for Payer: PHCS Commercial |
$5,723.52
|
| Rate for Payer: United Healthcare All Payer |
$5,246.56
|
|
|
REMOT AFTLOAD HDR ICHANEL
|
Facility
|
OP
|
$4,384.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$569.92 |
| Max. Negotiated Rate |
$4,208.64 |
| Rate for Payer: Aetna Commercial |
$3,375.68
|
| Rate for Payer: Anthem Medicaid |
$1,507.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,419.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cigna Commercial |
$3,638.72
|
| Rate for Payer: First Health Commercial |
$4,164.80
|
| Rate for Payer: Humana Commercial |
$3,726.40
|
| Rate for Payer: Humana KY Medicaid |
$1,507.66
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,594.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,235.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,857.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.04
|
| Rate for Payer: PHCS Commercial |
$4,208.64
|
| Rate for Payer: United Healthcare All Payer |
$3,857.92
|
|
|
REMOT AFTLOAD HDR ICHANEL
|
Facility
|
IP
|
$4,384.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$569.92 |
| Max. Negotiated Rate |
$4,208.64 |
| Rate for Payer: Aetna Commercial |
$3,375.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,419.52
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cigna Commercial |
$3,638.72
|
| Rate for Payer: First Health Commercial |
$4,164.80
|
| Rate for Payer: Humana Commercial |
$3,726.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,594.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,235.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,315.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,857.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.04
|
| Rate for Payer: PHCS Commercial |
$4,208.64
|
| Rate for Payer: United Healthcare All Payer |
$3,857.92
|
|
|
REMOT AFTLOAD HDR ICHANEL
|
Professional
|
Both
|
$4,384.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$127.13 |
| Max. Negotiated Rate |
$4,384.00 |
| Rate for Payer: Anthem Medicaid |
$241.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,384.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cash Price |
$2,192.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Humana Medicaid |
$241.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.11
|
| Rate for Payer: Molina Healthcare Passport |
$241.28
|
| Rate for Payer: Multiplan PHCS |
$2,630.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,068.80
|
| Rate for Payer: UHCCP Medicaid |
$1,534.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.69
|
|
|
REMOT AFTLOAD HDR ICHANEL(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
333P0032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$127.13 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Anthem Medicaid |
$241.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Humana Medicaid |
$241.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.11
|
| Rate for Payer: Molina Healthcare Passport |
$241.28
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.69
|
|
|
REMOT AFTLOAD HDR ICHANEL(T
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
333T0032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$521.17 |
| Max. Negotiated Rate |
$3,848.64 |
| Rate for Payer: Aetna Commercial |
$3,086.93
|
| Rate for Payer: Anthem Medicaid |
$1,378.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,127.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$2,004.50
|
| Rate for Payer: Cash Price |
$2,004.50
|
| Rate for Payer: Cigna Commercial |
$3,327.47
|
| Rate for Payer: First Health Commercial |
$3,808.55
|
| Rate for Payer: Humana Commercial |
$3,407.65
|
| Rate for Payer: Humana KY Medicaid |
$1,378.70
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,392.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,287.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,958.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,406.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.79
|
| Rate for Payer: PHCS Commercial |
$3,848.64
|
| Rate for Payer: United Healthcare All Payer |
$3,527.92
|
|
|
REMOT AFTLOAD HDR ICHANEL(T
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
HCPCS 77770
|
| Hospital Charge Code |
333T0032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$521.17 |
| Max. Negotiated Rate |
$3,848.64 |
| Rate for Payer: Aetna Commercial |
$3,086.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,127.02
|
| Rate for Payer: Cash Price |
$2,004.50
|
| Rate for Payer: Cigna Commercial |
$3,327.47
|
| Rate for Payer: First Health Commercial |
$3,808.55
|
| Rate for Payer: Humana Commercial |
$3,407.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,287.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,958.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.79
|
| Rate for Payer: PHCS Commercial |
$3,848.64
|
| Rate for Payer: United Healthcare All Payer |
$3,527.92
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 93228
|
| Hospital Charge Code |
48000074
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 93228
|
| Hospital Charge Code |
48000074
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Anthem Medicaid |
$21.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.00
|
| Rate for Payer: Healthspan PPO |
$40.02
|
| Rate for Payer: Humana Medicaid |
$21.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.49
|
| Rate for Payer: Molina Healthcare Passport |
$21.07
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.28
|
|
|
REMOTE 30 DAY ECG REV/REPORT
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 93228
|
| Hospital Charge Code |
48000074
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
REMOVAL ARTERY CLOT; FEMORAL
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 34201
|
| Hospital Charge Code |
76101340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.89 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,695.15
|
| Rate for Payer: Anthem Medicaid |
$517.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,552.51
|
| Rate for Payer: Healthspan PPO |
$1,666.66
|
| Rate for Payer: Humana Medicaid |
$517.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.25
|
| Rate for Payer: Molina Healthcare Passport |
$517.89
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.07
|
|
|
REMOVAL ARTERY CLOT; FEMORAL
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 34201
|
| Hospital Charge Code |
76101340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REMOVAL ARTERY CLOT; FEMORAL
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 34201
|
| Hospital Charge Code |
76101340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REMOVAL ARTERY CLOT; FEMORAL(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 34201
|
| Hospital Charge Code |
761P1340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.89 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,695.15
|
| Rate for Payer: Anthem Medicaid |
$517.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,552.51
|
| Rate for Payer: Healthspan PPO |
$1,666.66
|
| Rate for Payer: Humana Medicaid |
$517.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.25
|
| Rate for Payer: Molina Healthcare Passport |
$517.89
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.07
|
|
|
REMOVAL BILIARY DRG CATH
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REMOVAL BILIARY DRG CATH
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.86
|
| Rate for Payer: Anthem Medicaid |
$81.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$166.41
|
| Rate for Payer: Humana Medicaid |
$81.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.79
|
| Rate for Payer: Molina Healthcare Passport |
$81.17
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$84.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.98
|
|
|
REMOVAL BILIARY DRG CATH
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
360P1273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.86
|
| Rate for Payer: Anthem Medicaid |
$81.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$166.41
|
| Rate for Payer: Humana Medicaid |
$81.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.79
|
| Rate for Payer: Molina Healthcare Passport |
$81.17
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$84.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.98
|
|
|
REMOVAL BILIARY DRG CATH
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REMOVAL DUCT BREAST
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.63 |
| Max. Negotiated Rate |
$5,396.00 |
| Rate for Payer: Aetna Commercial |
$412.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.63
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,396.00
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Healthspan PPO |
$463.94
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$3,237.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,777.20
|
| Rate for Payer: UHCCP Medicaid |
$174.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
|
|
REMOVAL DUCT BREAST
|
Facility
|
OP
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$701.48 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem Medicaid |
$1,855.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| 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 |
$2,698.00
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Humana KY Medicaid |
$1,855.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,874.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,892.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,672.76
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
|
REMOVAL DUCT BREAST
|
Facility
|
IP
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$701.48 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,672.76
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
