|
REPLACEMENT AORTIC VALVE
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.00 |
| 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 |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
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 |
$3,946.45 |
| Rate for Payer: Aetna Commercial |
$3,946.45
|
| Rate for Payer: Ambetter Exchange |
$2,131.29
|
| Rate for Payer: Anthem Medicaid |
$1,782.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,131.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,131.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,557.55
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,131.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.29
|
| 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 |
$2,770.68
|
| Rate for Payer: UHCCP Medicaid |
$1,645.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,800.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,131.29
|
|
|
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 |
$272.84 |
| Rate for Payer: Aetna Commercial |
$113.77
|
| Rate for Payer: Ambetter Exchange |
$60.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.55
|
| Rate for Payer: Anthem Medicaid |
$192.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.83
|
| 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 |
$192.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare Passport |
$192.65
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.90
|
| Rate for Payer: UHCCP Medicaid |
$52.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.69
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Facility
|
OP
|
$3,230.91
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
76101484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,111.11 |
| Max. Negotiated Rate |
$3,101.67 |
| Rate for Payer: Aetna Commercial |
$2,487.80
|
| Rate for Payer: Anthem Medicaid |
$1,111.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,615.45
|
| Rate for Payer: Cash Price |
$1,615.45
|
| Rate for Payer: Cigna Commercial |
$2,681.66
|
| Rate for Payer: First Health Commercial |
$3,069.36
|
| Rate for Payer: Humana Commercial |
$2,746.27
|
| Rate for Payer: Humana KY Medicaid |
$1,111.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.33
|
| Rate for Payer: PHCS Commercial |
$3,101.67
|
| Rate for Payer: United Healthcare All Payer |
$2,843.20
|
|
|
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 |
$1,938.55 |
| Rate for Payer: Aetna Commercial |
$113.77
|
| Rate for Payer: Ambetter Exchange |
$60.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.55
|
| Rate for Payer: Anthem Medicaid |
$192.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.83
|
| 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 |
$192.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare Passport |
$192.65
|
| Rate for Payer: Multiplan PHCS |
$1,938.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.90
|
| Rate for Payer: UHCCP Medicaid |
$52.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.69
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Facility
|
OP
|
$2,880.91
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
761T1484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.74 |
| Max. Negotiated Rate |
$2,765.67 |
| Rate for Payer: Aetna Commercial |
$2,218.30
|
| Rate for Payer: Anthem Medicaid |
$990.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,440.45
|
| Rate for Payer: Cash Price |
$1,440.45
|
| Rate for Payer: Cigna Commercial |
$2,391.16
|
| Rate for Payer: First Health Commercial |
$2,736.86
|
| Rate for Payer: Humana Commercial |
$2,448.77
|
| Rate for Payer: Humana KY Medicaid |
$990.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,000.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,010.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,506.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,987.83
|
| Rate for Payer: PHCS Commercial |
$2,765.67
|
| Rate for Payer: United Healthcare All Payer |
$2,535.20
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Facility
|
IP
|
$2,880.91
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
761T1484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.27 |
| Max. Negotiated Rate |
$2,765.67 |
| Rate for Payer: Aetna Commercial |
$2,218.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,247.11
|
| Rate for Payer: Cash Price |
$1,440.45
|
| Rate for Payer: Cigna Commercial |
$2,391.16
|
| Rate for Payer: First Health Commercial |
$2,736.86
|
| Rate for Payer: Humana Commercial |
$2,448.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,362.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,126.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,535.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,506.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,987.83
|
| Rate for Payer: PHCS Commercial |
$2,765.67
|
| Rate for Payer: United Healthcare All Payer |
$2,535.20
|
|
|
REPLACEMENT CENTRAL VENOUS LIN
|
Facility
|
IP
|
$3,230.91
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
76101484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$969.27 |
| Max. Negotiated Rate |
$3,101.67 |
| Rate for Payer: Aetna Commercial |
$2,487.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.11
|
| Rate for Payer: Cash Price |
$1,615.45
|
| Rate for Payer: Cigna Commercial |
$2,681.66
|
| Rate for Payer: First Health Commercial |
$3,069.36
|
| Rate for Payer: Humana Commercial |
$2,746.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.33
|
| Rate for Payer: PHCS Commercial |
$3,101.67
|
| Rate for Payer: United Healthcare All Payer |
$2,843.20
|
|
|
REPLACEMENT OF AORTIC VALVE
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33412
|
| Hospital Charge Code |
76101287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$4,281.28 |
| Rate for Payer: Aetna Commercial |
$4,281.28
|
| Rate for Payer: Ambetter Exchange |
$2,942.99
|
| Rate for Payer: Anthem Medicaid |
$2,164.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,942.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,942.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,531.59
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$4,084.15
|
| Rate for Payer: Healthspan PPO |
$4,209.34
|
| Rate for Payer: Humana Medicaid |
$2,164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,491.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,942.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,207.61
|
| Rate for Payer: Molina Healthcare Passport |
$2,164.32
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,825.89
|
| Rate for Payer: UHCCP Medicaid |
$1,277.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,185.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,942.99
|
|
|
REPLACEMENT OF AORTIC VALVE
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33412
|
| Hospital Charge Code |
76101287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.23
|
| 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 |
$1,255.23
|
| 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 |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
REPLACEMENT OF AORTIC VALVE
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33412
|
| Hospital Charge Code |
76101287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,095.00 |
| 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 |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
REPLACEMENT OF AORTIC VALVE(P
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 33412
|
| Hospital Charge Code |
761P1287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$4,281.28 |
| Rate for Payer: Aetna Commercial |
$4,281.28
|
| Rate for Payer: Ambetter Exchange |
$2,942.99
|
| Rate for Payer: Anthem Medicaid |
$2,164.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,942.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,942.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,531.59
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$4,084.15
|
| Rate for Payer: Healthspan PPO |
$4,209.34
|
| Rate for Payer: Humana Medicaid |
$2,164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,491.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,942.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,207.61
|
| Rate for Payer: Molina Healthcare Passport |
$2,164.32
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,825.89
|
| Rate for Payer: UHCCP Medicaid |
$1,277.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,185.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,942.99
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$314.61
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
|
|
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT IMPLANT
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 11970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
REPLACE MITRAL VALVE
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33430
|
| Hospital Charge Code |
76101291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$4,672.95 |
| Rate for Payer: Aetna Commercial |
$4,672.95
|
| Rate for Payer: Ambetter Exchange |
$2,629.93
|
| Rate for Payer: Anthem Medicaid |
$1,946.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,629.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,629.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,155.92
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,304.55
|
| Rate for Payer: Healthspan PPO |
$4,594.42
|
| Rate for Payer: Humana Medicaid |
$1,946.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,962.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,629.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,985.43
|
| Rate for Payer: Molina Healthcare Passport |
$1,946.50
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,418.91
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,965.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,629.93
|
|
|
REPLACE MITRAL VALVE
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33430
|
| Hospital Charge Code |
76101291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| 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 |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE MITRAL VALVE
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33430
|
| Hospital Charge Code |
76101291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| 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 |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE MITRAL VALVE(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33430
|
| Hospital Charge Code |
761P1291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$4,672.95 |
| Rate for Payer: Aetna Commercial |
$4,672.95
|
| Rate for Payer: Ambetter Exchange |
$2,629.93
|
| Rate for Payer: Anthem Medicaid |
$1,946.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,629.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,629.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,155.92
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,304.55
|
| Rate for Payer: Healthspan PPO |
$4,594.42
|
| Rate for Payer: Humana Medicaid |
$1,946.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,962.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,629.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,985.43
|
| Rate for Payer: Molina Healthcare Passport |
$1,946.50
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,418.91
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,965.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,629.93
|
|
|
REPLACE PICC CATH
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
76101487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$848.40 |
| Max. Negotiated Rate |
$2,714.88 |
| Rate for Payer: Aetna Commercial |
$2,177.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,205.84
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: Cigna Commercial |
$2,347.24
|
| Rate for Payer: First Health Commercial |
$2,686.60
|
| Rate for Payer: Humana Commercial |
$2,403.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,318.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,087.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$848.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,488.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,121.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,460.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,951.32
|
| Rate for Payer: PHCS Commercial |
$2,714.88
|
| Rate for Payer: United Healthcare All Payer |
$2,488.64
|
|
|
REPLACE PICC CATH
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
76101487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$2,714.88 |
| Rate for Payer: Aetna Commercial |
$2,177.56
|
| Rate for Payer: Anthem Medicaid |
$972.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,205.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: Cigna Commercial |
$2,347.24
|
| Rate for Payer: First Health Commercial |
$2,686.60
|
| Rate for Payer: Humana Commercial |
$2,403.80
|
| Rate for Payer: Humana KY Medicaid |
$972.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$982.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,318.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,087.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$992.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,488.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,121.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,460.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,951.32
|
| Rate for Payer: PHCS Commercial |
$2,714.88
|
| Rate for Payer: United Healthcare All Payer |
$2,488.64
|
|
|
REPLACE PICC CATH
|
Professional
|
Both
|
$2,828.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
76101487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,696.80 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Ambetter Exchange |
$55.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.96
|
| Rate for Payer: Anthem Medicaid |
$201.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.29
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: Healthspan PPO |
$268.62
|
| Rate for Payer: Humana Medicaid |
$201.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.07
|
| Rate for Payer: Molina Healthcare Passport |
$201.05
|
| Rate for Payer: Multiplan PHCS |
$1,696.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.81
|
| Rate for Payer: UHCCP Medicaid |
$48.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.24
|
|
|
REPLACE PICC CATH(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
761P1487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$268.62 |
| Rate for Payer: Aetna Commercial |
$116.52
|
| Rate for Payer: Ambetter Exchange |
$55.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.96
|
| Rate for Payer: Anthem Medicaid |
$201.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.29
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: Healthspan PPO |
$268.62
|
| Rate for Payer: Humana Medicaid |
$201.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.07
|
| Rate for Payer: Molina Healthcare Passport |
$201.05
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.81
|
| Rate for Payer: UHCCP Medicaid |
$48.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.24
|
|
|
REPLACE PICC CATH(T
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
761T1487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$852.18 |
| Max. Negotiated Rate |
$2,378.88 |
| Rate for Payer: Aetna Commercial |
$1,908.06
|
| Rate for Payer: Anthem Medicaid |
$852.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,932.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$2,056.74
|
| Rate for Payer: First Health Commercial |
$2,354.10
|
| Rate for Payer: Humana Commercial |
$2,106.30
|
| Rate for Payer: Humana KY Medicaid |
$852.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$860.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,031.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,828.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$869.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,180.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,858.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,155.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,709.82
|
| Rate for Payer: PHCS Commercial |
$2,378.88
|
| Rate for Payer: United Healthcare All Payer |
$2,180.64
|
|
|
REPLACE PICC CATH(T
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
761T1487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$2,378.88 |
| Rate for Payer: Aetna Commercial |
$1,908.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,932.84
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$2,056.74
|
| Rate for Payer: First Health Commercial |
$2,354.10
|
| Rate for Payer: Humana Commercial |
$2,106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,031.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,828.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,180.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,858.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,155.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,709.82
|
| Rate for Payer: PHCS Commercial |
$2,378.88
|
| Rate for Payer: United Healthcare All Payer |
$2,180.64
|
|
|
REPLACE PICVAD CATH
|
Facility
|
IP
|
$5,819.00
|
|
|
Service Code
|
HCPCS 36585
|
| Hospital Charge Code |
76101488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,745.70 |
| Max. Negotiated Rate |
$5,586.24 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,538.82
|
| Rate for Payer: Cash Price |
$2,909.50
|
| Rate for Payer: Cigna Commercial |
$4,829.77
|
| Rate for Payer: First Health Commercial |
$5,528.05
|
| Rate for Payer: Humana Commercial |
$4,946.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,771.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,294.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,745.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,120.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,364.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,062.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,015.11
|
| Rate for Payer: PHCS Commercial |
$5,586.24
|
| Rate for Payer: United Healthcare All Payer |
$5,120.72
|
|
