|
REPLACE PICVAD CATH(T
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
HCPCS 36585
|
| Hospital Charge Code |
761T1488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.77 |
| Max. Negotiated Rate |
$5,115.84 |
| Rate for Payer: Aetna Commercial |
$4,103.33
|
| Rate for Payer: Anthem Medicaid |
$1,832.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,156.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,664.50
|
| Rate for Payer: Cash Price |
$2,664.50
|
| Rate for Payer: Cigna Commercial |
$4,423.07
|
| Rate for Payer: First Health Commercial |
$5,062.55
|
| Rate for Payer: Humana Commercial |
$4,529.65
|
| Rate for Payer: Humana KY Medicaid |
$1,832.64
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,851.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,369.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,869.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,689.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,996.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.99
|
| Rate for Payer: PHCS Commercial |
$5,115.84
|
| Rate for Payer: United Healthcare All Payer |
$4,689.52
|
|
|
REPLACE TISSUE EXPANDER
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 11970
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPLACE TISSUE EXPANDER
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 11970
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPLACE TISSUE EXPANDER
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 11970
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.51 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$861.40
|
| Rate for Payer: Anthem Medicaid |
$462.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$818.24
|
| Rate for Payer: Healthspan PPO |
$688.77
|
| Rate for Payer: Humana Medicaid |
$462.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$760.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$471.76
|
| Rate for Payer: Molina Healthcare Passport |
$462.51
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.14
|
|
|
REPLACE TRICUSPDVALVE CPBYPASS
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33465
|
| Hospital Charge Code |
76101294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Humana KY Medicaid |
$1,255.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
REPLACE TRICUSPDVALVE CPBYPASS
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33465
|
| Hospital Charge Code |
76101294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$4,498.59 |
| Rate for Payer: Aetna Commercial |
$4,498.59
|
| Rate for Payer: Anthem Medicaid |
$1,800.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,650.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$4,039.03
|
| Rate for Payer: Healthspan PPO |
$4,422.99
|
| Rate for Payer: Humana Medicaid |
$1,800.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,877.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,836.52
|
| Rate for Payer: Molina Healthcare Passport |
$1,800.51
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,555.00
|
| Rate for Payer: UHCCP Medicaid |
$1,277.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,818.52
|
|
|
REPLACE TRICUSPDVALVE CPBYPASS
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33465
|
| Hospital Charge Code |
761P1294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$4,498.59 |
| Rate for Payer: Aetna Commercial |
$4,498.59
|
| Rate for Payer: Anthem Medicaid |
$1,800.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,650.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$4,039.03
|
| Rate for Payer: Healthspan PPO |
$4,422.99
|
| Rate for Payer: Humana Medicaid |
$1,800.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,877.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,836.52
|
| Rate for Payer: Molina Healthcare Passport |
$1,800.51
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,555.00
|
| Rate for Payer: UHCCP Medicaid |
$1,277.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,818.52
|
|
|
REPLACE TRICUSPDVALVE CPBYPASS
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33465
|
| Hospital Charge Code |
76101294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
REPLACE TUNNELED CV CATH
|
Professional
|
Both
|
$5,792.29
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
76101483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$5,792.29 |
| Rate for Payer: Aetna Commercial |
$329.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.48
|
| Rate for Payer: Anthem Medicaid |
$172.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,792.29
|
| Rate for Payer: Cash Price |
$2,896.14
|
| Rate for Payer: Cash Price |
$2,896.14
|
| Rate for Payer: Cigna Commercial |
$317.54
|
| Rate for Payer: Healthspan PPO |
$585.40
|
| Rate for Payer: Humana Medicaid |
$172.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.71
|
| Rate for Payer: Molina Healthcare Passport |
$172.26
|
| Rate for Payer: Multiplan PHCS |
$3,475.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,054.60
|
| Rate for Payer: UHCCP Medicaid |
$108.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.98
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$5,917.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
76101485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.21 |
| Max. Negotiated Rate |
$5,680.32 |
| Rate for Payer: Aetna Commercial |
$4,556.09
|
| Rate for Payer: Anthem Medicaid |
$2,034.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,615.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,958.50
|
| Rate for Payer: Cash Price |
$2,958.50
|
| Rate for Payer: Cigna Commercial |
$4,911.11
|
| Rate for Payer: First Health Commercial |
$5,621.15
|
| Rate for Payer: Humana Commercial |
$5,029.45
|
| Rate for Payer: Humana KY Medicaid |
$2,034.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,055.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,851.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,366.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,075.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,206.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,437.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,183.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.27
|
| Rate for Payer: PHCS Commercial |
$5,680.32
|
| Rate for Payer: United Healthcare All Payer |
$5,206.96
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$5,917.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
76101485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.21 |
| Max. Negotiated Rate |
$5,680.32 |
| Rate for Payer: Aetna Commercial |
$4,556.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,615.26
|
| Rate for Payer: Cash Price |
$2,958.50
|
| Rate for Payer: Cigna Commercial |
$4,911.11
|
| Rate for Payer: First Health Commercial |
$5,621.15
|
| Rate for Payer: Humana Commercial |
$5,029.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,851.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,366.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,775.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,206.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,437.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,183.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,834.27
|
| Rate for Payer: PHCS Commercial |
$5,680.32
|
| Rate for Payer: United Healthcare All Payer |
$5,206.96
|
|
|
REPLACE TUNNELED CV CATH
|
Professional
|
Both
|
$5,917.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
76101485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$5,917.00 |
| Rate for Payer: Aetna Commercial |
$312.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.93
|
| Rate for Payer: Anthem Medicaid |
$161.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,917.00
|
| Rate for Payer: Cash Price |
$2,958.50
|
| Rate for Payer: Cash Price |
$2,958.50
|
| Rate for Payer: Cigna Commercial |
$294.70
|
| Rate for Payer: Healthspan PPO |
$875.34
|
| Rate for Payer: Humana Medicaid |
$161.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.51
|
| Rate for Payer: Molina Healthcare Passport |
$161.28
|
| Rate for Payer: Multiplan PHCS |
$3,550.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,141.90
|
| Rate for Payer: UHCCP Medicaid |
$149.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.89
|
|
|
REPLACE TUNNELED CV CATH
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 36583
|
| Hospital Charge Code |
761P2714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.42 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.42
|
| Rate for Payer: Anthem Medicaid |
$237.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,435.00
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$440.57
|
| Rate for Payer: Healthspan PPO |
$1,220.81
|
| Rate for Payer: Humana Medicaid |
$237.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$423.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.24
|
| Rate for Payer: Molina Healthcare Passport |
$237.49
|
| Rate for Payer: Multiplan PHCS |
$861.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,004.50
|
| Rate for Payer: UHCCP Medicaid |
$227.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.86
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$5,792.29
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
76101483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$5,560.60 |
| Rate for Payer: Aetna Commercial |
$4,460.06
|
| Rate for Payer: Anthem Medicaid |
$1,991.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,517.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,896.14
|
| Rate for Payer: Cash Price |
$2,896.14
|
| Rate for Payer: Cigna Commercial |
$4,807.60
|
| Rate for Payer: First Health Commercial |
$5,502.68
|
| Rate for Payer: Humana Commercial |
$4,923.45
|
| Rate for Payer: Humana KY Medicaid |
$1,991.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,012.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,749.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,274.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,031.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,097.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,344.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,158.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$753.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,795.61
|
| Rate for Payer: PHCS Commercial |
$5,560.60
|
| Rate for Payer: United Healthcare All Payer |
$5,097.22
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 36583
|
| Hospital Charge Code |
76102714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$1,377.60 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$444.85
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$5,792.29
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
76101483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$5,560.60 |
| Rate for Payer: Aetna Commercial |
$4,460.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,517.99
|
| Rate for Payer: Cash Price |
$2,896.14
|
| Rate for Payer: Cigna Commercial |
$4,807.60
|
| Rate for Payer: First Health Commercial |
$5,502.68
|
| Rate for Payer: Humana Commercial |
$4,923.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,749.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,274.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,737.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,097.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,344.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,158.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$753.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,795.61
|
| Rate for Payer: PHCS Commercial |
$5,560.60
|
| Rate for Payer: United Healthcare All Payer |
$5,097.22
|
|
|
REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 36583
|
| Hospital Charge Code |
76102714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem Medicaid |
$493.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| 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 |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Humana KY Medicaid |
$493.50
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$498.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$503.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$444.85
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
|
REPLACE TUNNELED CV CATH
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 36583
|
| Hospital Charge Code |
76102714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.42 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.42
|
| Rate for Payer: Anthem Medicaid |
$237.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,435.00
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$440.57
|
| Rate for Payer: Healthspan PPO |
$1,220.81
|
| Rate for Payer: Humana Medicaid |
$237.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$423.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.24
|
| Rate for Payer: Molina Healthcare Passport |
$237.49
|
| Rate for Payer: Multiplan PHCS |
$861.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,004.50
|
| Rate for Payer: UHCCP Medicaid |
$227.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.86
|
|
|
REPLACE TUNNELED CV CATH(P
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
761P1485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna Commercial |
$312.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.93
|
| Rate for Payer: Anthem Medicaid |
$161.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,015.00
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$294.70
|
| Rate for Payer: Healthspan PPO |
$875.34
|
| Rate for Payer: Humana Medicaid |
$161.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.51
|
| Rate for Payer: Molina Healthcare Passport |
$161.28
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$710.50
|
| Rate for Payer: UHCCP Medicaid |
$149.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.89
|
|
|
REPLACE TUNNELED CV CATH(P
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
761P1483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna Commercial |
$329.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.48
|
| Rate for Payer: Anthem Medicaid |
$172.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$820.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$317.54
|
| Rate for Payer: Healthspan PPO |
$585.40
|
| Rate for Payer: Humana Medicaid |
$172.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.71
|
| Rate for Payer: Molina Healthcare Passport |
$172.26
|
| Rate for Payer: Multiplan PHCS |
$492.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$574.00
|
| Rate for Payer: UHCCP Medicaid |
$108.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.98
|
|
|
REPLACE TUNNELED CV CATH(T
|
Facility
|
IP
|
$4,902.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
761T1485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
REPLACE TUNNELED CV CATH(T
|
Facility
|
OP
|
$4,902.00
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
761T1485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem Medicaid |
$1,685.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Humana KY Medicaid |
$1,685.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
REPLACE TUNNELED CV CATH(T
|
Facility
|
IP
|
$4,972.29
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
761T1483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$646.40 |
| Max. Negotiated Rate |
$4,773.40 |
| Rate for Payer: Aetna Commercial |
$3,828.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.39
|
| Rate for Payer: Cash Price |
$2,486.14
|
| Rate for Payer: Cigna Commercial |
$4,127.00
|
| Rate for Payer: First Health Commercial |
$4,723.68
|
| Rate for Payer: Humana Commercial |
$4,226.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,375.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,729.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$994.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$646.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.41
|
| Rate for Payer: PHCS Commercial |
$4,773.40
|
| Rate for Payer: United Healthcare All Payer |
$4,375.62
|
|
|
REPLACE TUNNELED CV CATH(T
|
Facility
|
OP
|
$4,972.29
|
|
|
Service Code
|
HCPCS 36578
|
| Hospital Charge Code |
761T1483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$646.40 |
| Max. Negotiated Rate |
$4,773.40 |
| Rate for Payer: Aetna Commercial |
$3,828.66
|
| Rate for Payer: Anthem Medicaid |
$1,709.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,486.14
|
| Rate for Payer: Cash Price |
$2,486.14
|
| Rate for Payer: Cigna Commercial |
$4,127.00
|
| Rate for Payer: First Health Commercial |
$4,723.68
|
| Rate for Payer: Humana Commercial |
$4,226.45
|
| Rate for Payer: Humana KY Medicaid |
$1,709.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,727.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,744.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,375.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,729.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$994.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$646.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.41
|
| Rate for Payer: PHCS Commercial |
$4,773.40
|
| Rate for Payer: United Healthcare All Payer |
$4,375.62
|
|
|
REPLC TUNEL VEN ACC SAME SITE
|
Professional
|
Both
|
$7,674.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
76101486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$7,674.00 |
| Rate for Payer: Aetna Commercial |
$455.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.65
|
| Rate for Payer: Anthem Medicaid |
$235.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,674.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$436.55
|
| Rate for Payer: Healthspan PPO |
$1,220.21
|
| Rate for Payer: Humana Medicaid |
$235.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$240.25
|
| Rate for Payer: Molina Healthcare Passport |
$235.54
|
| Rate for Payer: Multiplan PHCS |
$4,604.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,371.80
|
| Rate for Payer: UHCCP Medicaid |
$212.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.90
|
|
