|
REPLC TUNEL VEN ACC SAME SITE
|
Facility
|
OP
|
$7,674.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
76101486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$997.62 |
| Max. Negotiated Rate |
$7,367.04 |
| Rate for Payer: Aetna Commercial |
$5,908.98
|
| Rate for Payer: Anthem Medicaid |
$2,639.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.72
|
| 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 |
$3,837.00
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$6,369.42
|
| Rate for Payer: First Health Commercial |
$7,290.30
|
| Rate for Payer: Humana Commercial |
$6,522.90
|
| Rate for Payer: Humana KY Medicaid |
$2,639.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,378.94
|
| Rate for Payer: PHCS Commercial |
$7,367.04
|
| Rate for Payer: United Healthcare All Payer |
$6,753.12
|
|
|
REPLC TUNEL VEN ACC SAME SITE
|
Facility
|
IP
|
$7,674.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
76101486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$997.62 |
| Max. Negotiated Rate |
$7,367.04 |
| Rate for Payer: Aetna Commercial |
$5,908.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.72
|
| Rate for Payer: Cash Price |
$3,837.00
|
| Rate for Payer: Cigna Commercial |
$6,369.42
|
| Rate for Payer: First Health Commercial |
$7,290.30
|
| Rate for Payer: Humana Commercial |
$6,522.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,378.94
|
| Rate for Payer: PHCS Commercial |
$7,367.04
|
| Rate for Payer: United Healthcare All Payer |
$6,753.12
|
|
|
REPLC TUNEL VEN ACC SAME SIT(P
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
761P1486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$1,430.00 |
| 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 |
$1,430.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| 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 |
$858.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,001.00
|
| Rate for Payer: UHCCP Medicaid |
$212.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.90
|
|
|
REPLC TUNEL VEN ACC SAME SIT(T
|
Facility
|
OP
|
$6,244.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
761T1486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.72 |
| Max. Negotiated Rate |
$5,994.24 |
| Rate for Payer: Aetna Commercial |
$4,807.88
|
| Rate for Payer: Anthem Medicaid |
$2,147.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,870.32
|
| 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 |
$3,122.00
|
| Rate for Payer: Cash Price |
$3,122.00
|
| Rate for Payer: Cigna Commercial |
$5,182.52
|
| Rate for Payer: First Health Commercial |
$5,931.80
|
| Rate for Payer: Humana Commercial |
$5,307.40
|
| Rate for Payer: Humana KY Medicaid |
$2,147.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,169.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,120.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,608.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,494.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,935.64
|
| Rate for Payer: PHCS Commercial |
$5,994.24
|
| Rate for Payer: United Healthcare All Payer |
$5,494.72
|
|
|
REPLC TUNEL VEN ACC SAME SIT(T
|
Facility
|
IP
|
$6,244.00
|
|
|
Service Code
|
HCPCS 36582
|
| Hospital Charge Code |
761T1486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.72 |
| Max. Negotiated Rate |
$5,994.24 |
| Rate for Payer: Aetna Commercial |
$4,807.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,870.32
|
| Rate for Payer: Cash Price |
$3,122.00
|
| Rate for Payer: Cigna Commercial |
$5,182.52
|
| Rate for Payer: First Health Commercial |
$5,931.80
|
| Rate for Payer: Humana Commercial |
$5,307.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,120.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,608.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,873.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,494.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,935.64
|
| Rate for Payer: PHCS Commercial |
$5,994.24
|
| Rate for Payer: United Healthcare All Payer |
$5,494.72
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
761P1496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$101.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$47.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$92.05
|
| Rate for Payer: Healthspan PPO |
$151.85
|
| Rate for Payer: Humana Medicaid |
$47.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.61
|
| Rate for Payer: Molina Healthcare Passport |
$47.66
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$31.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.14
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
76101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.68 |
| Max. Negotiated Rate |
$2,434.56 |
| Rate for Payer: Aetna Commercial |
$1,952.72
|
| Rate for Payer: Anthem Medicaid |
$872.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cigna Commercial |
$2,104.88
|
| Rate for Payer: First Health Commercial |
$2,409.20
|
| Rate for Payer: Humana Commercial |
$2,155.60
|
| Rate for Payer: Humana KY Medicaid |
$872.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$881.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,079.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,871.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.16
|
| Rate for Payer: PHCS Commercial |
$2,434.56
|
| Rate for Payer: United Healthcare All Payer |
$2,231.68
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
761T1496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$2,242.56 |
| Rate for Payer: Aetna Commercial |
$1,798.72
|
| Rate for Payer: Anthem Medicaid |
$803.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,822.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,938.88
|
| Rate for Payer: First Health Commercial |
$2,219.20
|
| Rate for Payer: Humana Commercial |
$1,985.60
|
| Rate for Payer: Humana KY Medicaid |
$803.35
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$811.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,915.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$819.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,055.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,752.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.16
|
| Rate for Payer: PHCS Commercial |
$2,242.56
|
| Rate for Payer: United Healthcare All Payer |
$2,055.68
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
76101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.68 |
| Max. Negotiated Rate |
$2,434.56 |
| Rate for Payer: Aetna Commercial |
$1,952.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.08
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cigna Commercial |
$2,104.88
|
| Rate for Payer: First Health Commercial |
$2,409.20
|
| Rate for Payer: Humana Commercial |
$2,155.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,079.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,871.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$760.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.16
|
| Rate for Payer: PHCS Commercial |
$2,434.56
|
| Rate for Payer: United Healthcare All Payer |
$2,231.68
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Professional
|
Both
|
$2,536.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
76101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: Aetna Commercial |
$101.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$47.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,536.00
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cigna Commercial |
$92.05
|
| Rate for Payer: Healthspan PPO |
$151.85
|
| Rate for Payer: Humana Medicaid |
$47.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.61
|
| Rate for Payer: Molina Healthcare Passport |
$47.66
|
| Rate for Payer: Multiplan PHCS |
$1,521.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,775.20
|
| Rate for Payer: UHCCP Medicaid |
$31.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.14
|
|
|
REPOSITION CENTRAL VENOUS LINE
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
761T1496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$2,242.56 |
| Rate for Payer: Aetna Commercial |
$1,798.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,822.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,938.88
|
| Rate for Payer: First Health Commercial |
$2,219.20
|
| Rate for Payer: Humana Commercial |
$1,985.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,915.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,055.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,752.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.16
|
| Rate for Payer: PHCS Commercial |
$2,242.56
|
| Rate for Payer: United Healthcare All Payer |
$2,055.68
|
|
|
REPOSITIONING OF PACEMAKER
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
76101249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPOSITIONING OF PACEMAKER
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
76101249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$529.92
|
| Rate for Payer: Anthem Medicaid |
$227.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$501.15
|
| Rate for Payer: Healthspan PPO |
$521.02
|
| Rate for Payer: Humana Medicaid |
$227.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$431.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.85
|
| Rate for Payer: Molina Healthcare Passport |
$227.30
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.57
|
|
|
REPOSITIONING OF PACEMAKER
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
76101249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPOSITIONING OF PACEMAKER(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
761P1249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$529.92
|
| Rate for Payer: Anthem Medicaid |
$227.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$501.15
|
| Rate for Payer: Healthspan PPO |
$521.02
|
| Rate for Payer: Humana Medicaid |
$227.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$431.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.85
|
| Rate for Payer: Molina Healthcare Passport |
$227.30
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.57
|
|
|
REPOSITIONING OF PREVIOUSLY IMPLANTED SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 33273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,395.89 |
| Max. Negotiated Rate |
$4,754.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,754.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,584.45
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
|
|
REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR IMPLANTABLE DEFIBRILLATOR (RIGHT ATRIAL OR RIGHT VENTRICULAR) ELECTRODE
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 33215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 33993
|
| Hospital Charge Code |
76101334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.20
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
REPOSITION VAD DIFF SESSION
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 33993
|
| Hospital Charge Code |
76101334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Anthem Medicaid |
$147.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$341.97
|
| Rate for Payer: Healthspan PPO |
$233.72
|
| Rate for Payer: Humana Medicaid |
$147.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.15
|
| Rate for Payer: Molina Healthcare Passport |
$147.21
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.00
|
| Rate for Payer: UHCCP Medicaid |
$147.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.68
|
|
|
REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 33993
|
| Hospital Charge Code |
76101334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.20
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
REPOSITION VAD DIFF SESSION(P
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 33993
|
| Hospital Charge Code |
761P1334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Anthem Medicaid |
$147.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$341.97
|
| Rate for Payer: Healthspan PPO |
$233.72
|
| Rate for Payer: Humana Medicaid |
$147.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.15
|
| Rate for Payer: Molina Healthcare Passport |
$147.21
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.00
|
| Rate for Payer: UHCCP Medicaid |
$147.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.68
|
|
|
REPR BLD VESSEL LOWER EXTREM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| 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 |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR BLD VESSEL LOWER EXTREM
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.02 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,647.93
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,587.72
|
| Rate for Payer: Healthspan PPO |
$1,620.24
|
| Rate for Payer: Humana Medicaid |
$687.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.76
|
| Rate for Payer: Molina Healthcare Passport |
$687.02
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.89
|
|
|
REPR BLD VESSEL LOWER EXTREM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR BLD VESSEL LOWER EXTREM(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
761P1378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.02 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,647.93
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,587.72
|
| Rate for Payer: Healthspan PPO |
$1,620.24
|
| Rate for Payer: Humana Medicaid |
$687.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.76
|
| Rate for Payer: Molina Healthcare Passport |
$687.02
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.89
|
|
