|
REP CATH
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
76101481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.31 |
| Max. Negotiated Rate |
$1,715.52 |
| Rate for Payer: Aetna Commercial |
$1,375.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.86
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$1,483.21
|
| Rate for Payer: First Health Commercial |
$1,697.65
|
| Rate for Payer: Humana Commercial |
$1,518.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.97
|
| Rate for Payer: PHCS Commercial |
$1,715.52
|
| Rate for Payer: United Healthcare All Payer |
$1,572.56
|
|
|
REP CATH
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
76101481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$1,787.00 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.68
|
| Rate for Payer: Anthem Medicaid |
$41.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,787.00
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$60.55
|
| Rate for Payer: Healthspan PPO |
$190.37
|
| Rate for Payer: Humana Medicaid |
$41.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.11
|
| Rate for Payer: Molina Healthcare Passport |
$41.28
|
| Rate for Payer: Multiplan PHCS |
$1,072.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,250.90
|
| Rate for Payer: UHCCP Medicaid |
$30.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.69
|
|
|
REP CATH(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761P1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.68
|
| Rate for Payer: Anthem Medicaid |
$41.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$60.55
|
| Rate for Payer: Healthspan PPO |
$190.37
|
| Rate for Payer: Humana Medicaid |
$41.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.11
|
| Rate for Payer: Molina Healthcare Passport |
$41.28
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$30.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.69
|
|
|
REP CATH(T
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761T1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.01 |
| Max. Negotiated Rate |
$1,513.92 |
| Rate for Payer: Aetna Commercial |
$1,214.29
|
| Rate for Payer: Anthem Medicaid |
$542.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cigna Commercial |
$1,308.91
|
| Rate for Payer: First Health Commercial |
$1,498.15
|
| Rate for Payer: Humana Commercial |
$1,340.45
|
| Rate for Payer: Humana KY Medicaid |
$542.33
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$547.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.87
|
| Rate for Payer: PHCS Commercial |
$1,513.92
|
| Rate for Payer: United Healthcare All Payer |
$1,387.76
|
|
|
REP CATH(T
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761T1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.01 |
| Max. Negotiated Rate |
$1,513.92 |
| Rate for Payer: Aetna Commercial |
$1,214.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.06
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cigna Commercial |
$1,308.91
|
| Rate for Payer: First Health Commercial |
$1,498.15
|
| Rate for Payer: Humana Commercial |
$1,340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.87
|
| Rate for Payer: PHCS Commercial |
$1,513.92
|
| Rate for Payer: United Healthcare All Payer |
$1,387.76
|
|
|
REPLACE AORTIC VALVE
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE AORTIC VALVE
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE AORTIC VALVE
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,833.47
|
| Rate for Payer: Anthem Medicaid |
$2,134.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,509.19
|
| Rate for Payer: Healthspan PPO |
$4,752.25
|
| Rate for Payer: Humana Medicaid |
$2,134.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,070.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,176.77
|
| Rate for Payer: Molina Healthcare Passport |
$2,134.09
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,155.43
|
|
|
REPLACE AORTIC VALVE(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
761P1286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,833.47
|
| Rate for Payer: Anthem Medicaid |
$2,134.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,509.19
|
| Rate for Payer: Healthspan PPO |
$4,752.25
|
| Rate for Payer: Humana Medicaid |
$2,134.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,070.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,176.77
|
| Rate for Payer: Molina Healthcare Passport |
$2,134.09
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,155.43
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$22,561.84 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,115.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,561.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,756.06
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$16,115.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,338.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REPLACE ELBOW JOINT
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$2,207.39
|
| Rate for Payer: Anthem Medicaid |
$1,225.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,375.72
|
| Rate for Payer: Healthspan PPO |
$1,999.42
|
| Rate for Payer: Humana Medicaid |
$1,225.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,873.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,249.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,225.00
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,237.25
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REPLACE ELBOW JOINT(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
761P0525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$2,207.39
|
| Rate for Payer: Anthem Medicaid |
$1,225.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,375.72
|
| Rate for Payer: Healthspan PPO |
$1,999.42
|
| Rate for Payer: Humana Medicaid |
$1,225.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,873.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,249.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,225.00
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,237.25
|
|
|
REPLACE G-J TUBE PERC
|
Professional
|
Both
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.87 |
| Max. Negotiated Rate |
$1,930.50 |
| Rate for Payer: Aetna Commercial |
$237.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.43
|
| Rate for Payer: Anthem Medicaid |
$119.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,930.50
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$214.13
|
| Rate for Payer: Healthspan PPO |
$1,080.30
|
| Rate for Payer: Humana Medicaid |
$119.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.27
|
| Rate for Payer: Molina Healthcare Passport |
$119.87
|
| Rate for Payer: Multiplan PHCS |
$1,158.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,351.35
|
| Rate for Payer: UHCCP Medicaid |
$140.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.07
|
|
|
REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.96 |
| Max. Negotiated Rate |
$1,853.28 |
| Rate for Payer: Aetna Commercial |
$1,486.48
|
| Rate for Payer: Anthem Medicaid |
$663.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.79
|
| 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 |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$1,602.32
|
| Rate for Payer: First Health Commercial |
$1,833.98
|
| Rate for Payer: Humana Commercial |
$1,640.92
|
| Rate for Payer: Humana KY Medicaid |
$663.90
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.46
|
| Rate for Payer: PHCS Commercial |
$1,853.28
|
| Rate for Payer: United Healthcare All Payer |
$1,698.84
|
|
|
REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.96 |
| Max. Negotiated Rate |
$1,853.28 |
| Rate for Payer: Aetna Commercial |
$1,486.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.79
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$1,602.32
|
| Rate for Payer: First Health Commercial |
$1,833.98
|
| Rate for Payer: Humana Commercial |
$1,640.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.46
|
| Rate for Payer: PHCS Commercial |
$1,853.28
|
| Rate for Payer: United Healthcare All Payer |
$1,698.84
|
|
|
REPLACE G-J TUBE PERC(P
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761P2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.87 |
| Max. Negotiated Rate |
$1,080.30 |
| Rate for Payer: Aetna Commercial |
$237.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.43
|
| Rate for Payer: Anthem Medicaid |
$119.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$214.13
|
| Rate for Payer: Healthspan PPO |
$1,080.30
|
| Rate for Payer: Humana Medicaid |
$119.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.27
|
| Rate for Payer: Molina Healthcare Passport |
$119.87
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$140.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.07
|
|
|
REPLACE G-J TUBE PERC(T
|
Facility
|
IP
|
$1,590.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761T2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.76 |
| Max. Negotiated Rate |
$1,526.88 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.59
|
| Rate for Payer: Cash Price |
$795.25
|
| Rate for Payer: Cigna Commercial |
$1,320.12
|
| Rate for Payer: First Health Commercial |
$1,510.98
|
| Rate for Payer: Humana Commercial |
$1,351.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.06
|
| Rate for Payer: PHCS Commercial |
$1,526.88
|
| Rate for Payer: United Healthcare All Payer |
$1,399.64
|
|
|
REPLACE G-J TUBE PERC(T
|
Facility
|
OP
|
$1,590.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761T2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.76 |
| Max. Negotiated Rate |
$1,526.88 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: Anthem Medicaid |
$546.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.59
|
| 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 |
$795.25
|
| Rate for Payer: Cash Price |
$795.25
|
| Rate for Payer: Cigna Commercial |
$1,320.12
|
| Rate for Payer: First Health Commercial |
$1,510.98
|
| Rate for Payer: Humana Commercial |
$1,351.92
|
| Rate for Payer: Humana KY Medicaid |
$546.97
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$552.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.06
|
| Rate for Payer: PHCS Commercial |
$1,526.88
|
| Rate for Payer: United Healthcare All Payer |
$1,399.64
|
|
|
REPLACEMENT AORTIC VALVE
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
REPLACEMENT AORTIC VALVE
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
REPLACEMENT AORTIC VALVE
|
Professional
|
Both
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.00 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$3,946.45
|
| Rate for Payer: Anthem Medicaid |
$1,782.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,700.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,759.68
|
| Rate for Payer: Healthspan PPO |
$3,880.13
|
| Rate for Payer: Humana Medicaid |
$1,782.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,244.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,818.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,782.46
|
| Rate for Payer: Multiplan PHCS |
$2,820.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,290.00
|
| Rate for Payer: UHCCP Medicaid |
$1,645.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,800.28
|
|
|
REPLACEMENT AORTIC VALVE(P
|
Professional
|
Both
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
761P1285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.00 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$3,946.45
|
| Rate for Payer: Anthem Medicaid |
$1,782.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,700.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,759.68
|
| Rate for Payer: Healthspan PPO |
$3,880.13
|
| Rate for Payer: Humana Medicaid |
$1,782.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,244.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,818.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,782.46
|
| Rate for Payer: Multiplan PHCS |
$2,820.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,290.00
|
| Rate for Payer: UHCCP Medicaid |
$1,645.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,800.28
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
761P1484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$113.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.55
|
| Rate for Payer: Anthem Medicaid |
$52.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$103.05
|
| Rate for Payer: Healthspan PPO |
$272.84
|
| Rate for Payer: Humana Medicaid |
$52.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.41
|
| Rate for Payer: Molina Healthcare Passport |
$52.36
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$52.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.88
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Professional
|
Both
|
$3,230.91
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
76101484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$3,230.91 |
| Rate for Payer: Aetna Commercial |
$113.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.55
|
| Rate for Payer: Anthem Medicaid |
$52.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,230.91
|
| Rate for Payer: Cash Price |
$1,615.45
|
| Rate for Payer: Cash Price |
$1,615.45
|
| Rate for Payer: Cigna Commercial |
$103.05
|
| Rate for Payer: Healthspan PPO |
$272.84
|
| Rate for Payer: Humana Medicaid |
$52.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.41
|
| Rate for Payer: Molina Healthcare Passport |
$52.36
|
| Rate for Payer: Multiplan PHCS |
$1,938.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,261.64
|
| Rate for Payer: UHCCP Medicaid |
$52.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.88
|
|
