SEL CATH EA 3RD ORDER ABD/PELV
|
Professional
|
Both
|
$2,908.00
|
|
Service Code
|
HCPCS 36247
|
Hospital Charge Code |
761P1453
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$210.77 |
Max. Negotiated Rate |
$3,010.10 |
Rate for Payer: Aetna Commercial |
$567.10
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$210.77
|
Rate for Payer: Anthem Medicaid |
$297.78
|
Rate for Payer: Buckeye Medicare Advantage |
$2,908.00
|
Rate for Payer: Cash Price |
$1,454.00
|
Rate for Payer: Cash Price |
$1,454.00
|
Rate for Payer: Cigna Commercial |
$522.24
|
Rate for Payer: Healthspan PPO |
$3,010.10
|
Rate for Payer: Humana Medicaid |
$297.78
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$434.57
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
Rate for Payer: Molina Healthcare Passport |
$297.78
|
Rate for Payer: Multiplan PHCS |
$1,744.80
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,035.60
|
Rate for Payer: UHCCP Medicaid |
$221.31
|
Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Professional
|
Both
|
$4,149.00
|
|
Service Code
|
HCPCS 36247
|
Hospital Charge Code |
76101453
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$210.77 |
Max. Negotiated Rate |
$4,149.00 |
Rate for Payer: Aetna Commercial |
$567.10
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$210.77
|
Rate for Payer: Anthem Medicaid |
$297.78
|
Rate for Payer: Buckeye Medicare Advantage |
$4,149.00
|
Rate for Payer: Cash Price |
$2,074.50
|
Rate for Payer: Cash Price |
$2,074.50
|
Rate for Payer: Cigna Commercial |
$522.24
|
Rate for Payer: Healthspan PPO |
$3,010.10
|
Rate for Payer: Humana Medicaid |
$297.78
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$434.57
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.74
|
Rate for Payer: Molina Healthcare Passport |
$297.78
|
Rate for Payer: Multiplan PHCS |
$2,489.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,904.30
|
Rate for Payer: UHCCP Medicaid |
$221.31
|
Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
|
SEL CATH PLCMNT 1ST/2ND ORDE(P
|
Professional
|
Both
|
$1,206.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
761P1433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$131.94 |
Max. Negotiated Rate |
$1,345.46 |
Rate for Payer: Aetna Commercial |
$311.71
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.94
|
Rate for Payer: Anthem Medicaid |
$182.68
|
Rate for Payer: Buckeye Medicare Advantage |
$1,206.00
|
Rate for Payer: Cash Price |
$603.00
|
Rate for Payer: Cash Price |
$603.00
|
Rate for Payer: Cigna Commercial |
$287.09
|
Rate for Payer: Healthspan PPO |
$1,345.46
|
Rate for Payer: Humana Medicaid |
$182.68
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.61
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.33
|
Rate for Payer: Molina Healthcare Passport |
$182.68
|
Rate for Payer: Multiplan PHCS |
$723.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$844.20
|
Rate for Payer: UHCCP Medicaid |
$138.54
|
Rate for Payer: Wellcare CHIP/Medicaid |
$184.51
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Facility
|
OP
|
$3,737.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
76101433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$485.81 |
Max. Negotiated Rate |
$3,587.52 |
Rate for Payer: Aetna Commercial |
$2,877.49
|
Rate for Payer: Anthem Medicaid |
$1,285.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,914.86
|
Rate for Payer: Cash Price |
$1,868.50
|
Rate for Payer: Cigna Commercial |
$3,101.71
|
Rate for Payer: First Health Commercial |
$3,550.15
|
Rate for Payer: Humana Commercial |
$3,176.45
|
Rate for Payer: Humana KY Medicaid |
$1,285.15
|
Rate for Payer: Kentucky WC Medicaid |
$1,298.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,064.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,757.91
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.10
|
Rate for Payer: Molina Healthcare Medicaid |
$1,310.94
|
Rate for Payer: Ohio Health Choice Commercial |
$3,288.56
|
Rate for Payer: Ohio Health Group HMO |
$2,802.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$747.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$485.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,158.47
|
Rate for Payer: PHCS Commercial |
$3,587.52
|
Rate for Payer: United Healthcare All Payer |
$3,288.56
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Facility
|
IP
|
$3,737.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
76101433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$485.81 |
Max. Negotiated Rate |
$3,587.52 |
Rate for Payer: Aetna Commercial |
$2,877.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,914.86
|
Rate for Payer: Cash Price |
$1,868.50
|
Rate for Payer: Cigna Commercial |
$3,101.71
|
Rate for Payer: First Health Commercial |
$3,550.15
|
Rate for Payer: Humana Commercial |
$3,176.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,064.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,757.91
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.10
|
Rate for Payer: Ohio Health Choice Commercial |
$3,288.56
|
Rate for Payer: Ohio Health Group HMO |
$2,802.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$747.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$485.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,158.47
|
Rate for Payer: PHCS Commercial |
$3,587.52
|
Rate for Payer: United Healthcare All Payer |
$3,288.56
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Professional
|
Both
|
$3,737.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
76101433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$131.94 |
Max. Negotiated Rate |
$3,737.00 |
Rate for Payer: Aetna Commercial |
$311.71
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.94
|
Rate for Payer: Anthem Medicaid |
$182.68
|
Rate for Payer: Buckeye Medicare Advantage |
$3,737.00
|
Rate for Payer: Cash Price |
$1,868.50
|
Rate for Payer: Cash Price |
$1,868.50
|
Rate for Payer: Cigna Commercial |
$287.09
|
Rate for Payer: Healthspan PPO |
$1,345.46
|
Rate for Payer: Humana Medicaid |
$182.68
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.61
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.33
|
Rate for Payer: Molina Healthcare Passport |
$182.68
|
Rate for Payer: Multiplan PHCS |
$2,242.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,615.90
|
Rate for Payer: UHCCP Medicaid |
$138.54
|
Rate for Payer: Wellcare CHIP/Medicaid |
$184.51
|
|
SEL CATH PLCMNT 1ST/2ND ORDE(T
|
Facility
|
IP
|
$2,531.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
761T1433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$329.03 |
Max. Negotiated Rate |
$2,429.76 |
Rate for Payer: Aetna Commercial |
$1,948.87
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.18
|
Rate for Payer: Cash Price |
$1,265.50
|
Rate for Payer: Cigna Commercial |
$2,100.73
|
Rate for Payer: First Health Commercial |
$2,404.45
|
Rate for Payer: Humana Commercial |
$2,151.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$759.30
|
Rate for Payer: Ohio Health Choice Commercial |
$2,227.28
|
Rate for Payer: Ohio Health Group HMO |
$1,898.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.61
|
Rate for Payer: PHCS Commercial |
$2,429.76
|
Rate for Payer: United Healthcare All Payer |
$2,227.28
|
|
SEL CATH PLCMNT 1ST/2ND ORDE(T
|
Facility
|
OP
|
$2,531.00
|
|
Service Code
|
HCPCS 36012
|
Hospital Charge Code |
761T1433
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$329.03 |
Max. Negotiated Rate |
$2,429.76 |
Rate for Payer: Aetna Commercial |
$1,948.87
|
Rate for Payer: Anthem Medicaid |
$870.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.18
|
Rate for Payer: Cash Price |
$1,265.50
|
Rate for Payer: Cigna Commercial |
$2,100.73
|
Rate for Payer: First Health Commercial |
$2,404.45
|
Rate for Payer: Humana Commercial |
$2,151.35
|
Rate for Payer: Humana KY Medicaid |
$870.41
|
Rate for Payer: Kentucky WC Medicaid |
$879.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$759.30
|
Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
Rate for Payer: Ohio Health Choice Commercial |
$2,227.28
|
Rate for Payer: Ohio Health Group HMO |
$1,898.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.61
|
Rate for Payer: PHCS Commercial |
$2,429.76
|
Rate for Payer: United Healthcare All Payer |
$2,227.28
|
|
SEL CATH PLCMNT 1ST ORDER
|
Professional
|
Both
|
$3,524.24
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
76101432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$119.60 |
Max. Negotiated Rate |
$3,524.24 |
Rate for Payer: Aetna Commercial |
$278.98
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.60
|
Rate for Payer: Anthem Medicaid |
$148.45
|
Rate for Payer: Buckeye Medicare Advantage |
$3,524.24
|
Rate for Payer: Cash Price |
$1,762.12
|
Rate for Payer: Cash Price |
$1,762.12
|
Rate for Payer: Cigna Commercial |
$259.34
|
Rate for Payer: Healthspan PPO |
$1,429.24
|
Rate for Payer: Humana Medicaid |
$148.45
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.01
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.42
|
Rate for Payer: Molina Healthcare Passport |
$148.45
|
Rate for Payer: Multiplan PHCS |
$2,114.54
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,466.97
|
Rate for Payer: UHCCP Medicaid |
$125.58
|
Rate for Payer: Wellcare CHIP/Medicaid |
$149.93
|
|
SEL CATH PLCMNT 1ST ORDER
|
Facility
|
OP
|
$3,524.24
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
76101432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$458.15 |
Max. Negotiated Rate |
$3,383.27 |
Rate for Payer: Aetna Commercial |
$2,713.66
|
Rate for Payer: Anthem Medicaid |
$1,211.99
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,748.91
|
Rate for Payer: Cash Price |
$1,762.12
|
Rate for Payer: Cigna Commercial |
$2,925.12
|
Rate for Payer: First Health Commercial |
$3,348.03
|
Rate for Payer: Humana Commercial |
$2,995.60
|
Rate for Payer: Humana KY Medicaid |
$1,211.99
|
Rate for Payer: Kentucky WC Medicaid |
$1,224.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,889.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,600.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.27
|
Rate for Payer: Molina Healthcare Medicaid |
$1,236.30
|
Rate for Payer: Ohio Health Choice Commercial |
$3,101.33
|
Rate for Payer: Ohio Health Group HMO |
$2,643.18
|
Rate for Payer: Ohio Health Group PPO Differential |
$704.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$458.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.51
|
Rate for Payer: PHCS Commercial |
$3,383.27
|
Rate for Payer: United Healthcare All Payer |
$3,101.33
|
|
SEL CATH PLCMNT 1ST ORDER
|
Facility
|
IP
|
$3,524.24
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
76101432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$458.15 |
Max. Negotiated Rate |
$3,383.27 |
Rate for Payer: Aetna Commercial |
$2,713.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,748.91
|
Rate for Payer: Cash Price |
$1,762.12
|
Rate for Payer: Cigna Commercial |
$2,925.12
|
Rate for Payer: First Health Commercial |
$3,348.03
|
Rate for Payer: Humana Commercial |
$2,995.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,889.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,600.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.27
|
Rate for Payer: Ohio Health Choice Commercial |
$3,101.33
|
Rate for Payer: Ohio Health Group HMO |
$2,643.18
|
Rate for Payer: Ohio Health Group PPO Differential |
$704.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$458.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.51
|
Rate for Payer: PHCS Commercial |
$3,383.27
|
Rate for Payer: United Healthcare All Payer |
$3,101.33
|
|
SEL CATH PLCMNT 1ST ORDER(P
|
Professional
|
Both
|
$1,535.00
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
761P1432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$119.60 |
Max. Negotiated Rate |
$1,535.00 |
Rate for Payer: Aetna Commercial |
$278.98
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.60
|
Rate for Payer: Anthem Medicaid |
$148.45
|
Rate for Payer: Buckeye Medicare Advantage |
$1,535.00
|
Rate for Payer: Cash Price |
$767.50
|
Rate for Payer: Cash Price |
$767.50
|
Rate for Payer: Cigna Commercial |
$259.34
|
Rate for Payer: Healthspan PPO |
$1,429.24
|
Rate for Payer: Humana Medicaid |
$148.45
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.01
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.42
|
Rate for Payer: Molina Healthcare Passport |
$148.45
|
Rate for Payer: Multiplan PHCS |
$921.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,074.50
|
Rate for Payer: UHCCP Medicaid |
$125.58
|
Rate for Payer: Wellcare CHIP/Medicaid |
$149.93
|
|
SEL CATH PLCMNT 1ST ORDER(T
|
Facility
|
IP
|
$1,989.24
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
761T1432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$258.60 |
Max. Negotiated Rate |
$1,909.67 |
Rate for Payer: Aetna Commercial |
$1,531.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.61
|
Rate for Payer: Cash Price |
$994.62
|
Rate for Payer: Cigna Commercial |
$1,651.07
|
Rate for Payer: First Health Commercial |
$1,889.78
|
Rate for Payer: Humana Commercial |
$1,690.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,468.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$596.77
|
Rate for Payer: Ohio Health Choice Commercial |
$1,750.53
|
Rate for Payer: Ohio Health Group HMO |
$1,491.93
|
Rate for Payer: Ohio Health Group PPO Differential |
$397.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$258.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.66
|
Rate for Payer: PHCS Commercial |
$1,909.67
|
Rate for Payer: United Healthcare All Payer |
$1,750.53
|
|
SEL CATH PLCMNT 1ST ORDER(T
|
Facility
|
OP
|
$1,989.24
|
|
Service Code
|
HCPCS 36011
|
Hospital Charge Code |
761T1432
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$258.60 |
Max. Negotiated Rate |
$1,909.67 |
Rate for Payer: Aetna Commercial |
$1,531.71
|
Rate for Payer: Anthem Medicaid |
$684.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.61
|
Rate for Payer: Cash Price |
$994.62
|
Rate for Payer: Cigna Commercial |
$1,651.07
|
Rate for Payer: First Health Commercial |
$1,889.78
|
Rate for Payer: Humana Commercial |
$1,690.85
|
Rate for Payer: Humana KY Medicaid |
$684.10
|
Rate for Payer: Kentucky WC Medicaid |
$691.06
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,468.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$596.77
|
Rate for Payer: Molina Healthcare Medicaid |
$697.83
|
Rate for Payer: Ohio Health Choice Commercial |
$1,750.53
|
Rate for Payer: Ohio Health Group HMO |
$1,491.93
|
Rate for Payer: Ohio Health Group PPO Differential |
$397.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$258.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.66
|
Rate for Payer: PHCS Commercial |
$1,909.67
|
Rate for Payer: United Healthcare All Payer |
$1,750.53
|
|
SEL CATH PLCMNT 3RD ORDER
|
Facility
|
OP
|
$2,879.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
76101434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$374.27 |
Max. Negotiated Rate |
$2,763.84 |
Rate for Payer: Aetna Commercial |
$2,216.83
|
Rate for Payer: Anthem Medicaid |
$990.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,245.62
|
Rate for Payer: Cash Price |
$1,439.50
|
Rate for Payer: Cigna Commercial |
$2,389.57
|
Rate for Payer: First Health Commercial |
$2,735.05
|
Rate for Payer: Humana Commercial |
$2,447.15
|
Rate for Payer: Humana KY Medicaid |
$990.09
|
Rate for Payer: Kentucky WC Medicaid |
$1,000.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,360.78
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,124.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$863.70
|
Rate for Payer: Molina Healthcare Medicaid |
$1,009.95
|
Rate for Payer: Ohio Health Choice Commercial |
$2,533.52
|
Rate for Payer: Ohio Health Group HMO |
$2,159.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$575.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$374.27
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.49
|
Rate for Payer: PHCS Commercial |
$2,763.84
|
Rate for Payer: United Healthcare All Payer |
$2,533.52
|
|
SEL CATH PLCMNT 3RD ORDER
|
Facility
|
IP
|
$2,879.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
76101434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$374.27 |
Max. Negotiated Rate |
$2,763.84 |
Rate for Payer: Aetna Commercial |
$2,216.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,245.62
|
Rate for Payer: Cash Price |
$1,439.50
|
Rate for Payer: Cigna Commercial |
$2,389.57
|
Rate for Payer: First Health Commercial |
$2,735.05
|
Rate for Payer: Humana Commercial |
$2,447.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,360.78
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,124.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$863.70
|
Rate for Payer: Ohio Health Choice Commercial |
$2,533.52
|
Rate for Payer: Ohio Health Group HMO |
$2,159.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$575.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$374.27
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.49
|
Rate for Payer: PHCS Commercial |
$2,763.84
|
Rate for Payer: United Healthcare All Payer |
$2,533.52
|
|
SEL CATH PLCMNT 3RD ORDER
|
Professional
|
Both
|
$2,879.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
76101434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$94.53 |
Max. Negotiated Rate |
$2,879.00 |
Rate for Payer: Aetna Commercial |
$227.23
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.53
|
Rate for Payer: Anthem Medicaid |
$138.07
|
Rate for Payer: Buckeye Medicare Advantage |
$2,879.00
|
Rate for Payer: Cash Price |
$1,439.50
|
Rate for Payer: Cash Price |
$1,439.50
|
Rate for Payer: Cigna Commercial |
$206.62
|
Rate for Payer: Healthspan PPO |
$1,241.37
|
Rate for Payer: Humana Medicaid |
$138.07
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.46
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.83
|
Rate for Payer: Molina Healthcare Passport |
$138.07
|
Rate for Payer: Multiplan PHCS |
$1,727.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,015.30
|
Rate for Payer: UHCCP Medicaid |
$99.26
|
Rate for Payer: Wellcare CHIP/Medicaid |
$139.45
|
|
SEL CATH PLCMNT 3RD ORDER(P
|
Professional
|
Both
|
$1,246.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
761P1434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$94.53 |
Max. Negotiated Rate |
$1,246.00 |
Rate for Payer: Aetna Commercial |
$227.23
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.53
|
Rate for Payer: Anthem Medicaid |
$138.07
|
Rate for Payer: Buckeye Medicare Advantage |
$1,246.00
|
Rate for Payer: Cash Price |
$623.00
|
Rate for Payer: Cash Price |
$623.00
|
Rate for Payer: Cigna Commercial |
$206.62
|
Rate for Payer: Healthspan PPO |
$1,241.37
|
Rate for Payer: Humana Medicaid |
$138.07
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.46
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.83
|
Rate for Payer: Molina Healthcare Passport |
$138.07
|
Rate for Payer: Multiplan PHCS |
$747.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$872.20
|
Rate for Payer: UHCCP Medicaid |
$99.26
|
Rate for Payer: Wellcare CHIP/Medicaid |
$139.45
|
|
SEL CATH PLCMNT 3RD ORDER(T
|
Facility
|
OP
|
$1,633.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
761T1434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$212.29 |
Max. Negotiated Rate |
$1,567.68 |
Rate for Payer: Aetna Commercial |
$1,257.41
|
Rate for Payer: Anthem Medicaid |
$561.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
Rate for Payer: Cash Price |
$816.50
|
Rate for Payer: Cigna Commercial |
$1,355.39
|
Rate for Payer: First Health Commercial |
$1,551.35
|
Rate for Payer: Humana Commercial |
$1,388.05
|
Rate for Payer: Humana KY Medicaid |
$561.59
|
Rate for Payer: Kentucky WC Medicaid |
$567.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$489.90
|
Rate for Payer: Molina Healthcare Medicaid |
$572.86
|
Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$326.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$212.29
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.23
|
Rate for Payer: PHCS Commercial |
$1,567.68
|
Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
SEL CATH PLCMNT 3RD ORDER(T
|
Facility
|
IP
|
$1,633.00
|
|
Service Code
|
HCPCS 36013
|
Hospital Charge Code |
761T1434
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$212.29 |
Max. Negotiated Rate |
$1,567.68 |
Rate for Payer: Aetna Commercial |
$1,257.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
Rate for Payer: Cash Price |
$816.50
|
Rate for Payer: Cigna Commercial |
$1,355.39
|
Rate for Payer: First Health Commercial |
$1,551.35
|
Rate for Payer: Humana Commercial |
$1,388.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$489.90
|
Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$326.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$212.29
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.23
|
Rate for Payer: PHCS Commercial |
$1,567.68
|
Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
SELCT II ATTAIN CATH 6248V-130
|
Facility
|
IP
|
$1,913.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$248.76 |
Max. Negotiated Rate |
$1,836.96 |
Rate for Payer: Aetna Commercial |
$1,473.40
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,492.53
|
Rate for Payer: Cash Price |
$956.75
|
Rate for Payer: Cigna Commercial |
$1,588.20
|
Rate for Payer: First Health Commercial |
$1,817.82
|
Rate for Payer: Humana Commercial |
$1,626.48
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,569.07
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,412.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$574.05
|
Rate for Payer: Ohio Health Choice Commercial |
$1,683.88
|
Rate for Payer: Ohio Health Group HMO |
$1,435.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.18
|
Rate for Payer: PHCS Commercial |
$1,836.96
|
Rate for Payer: United Healthcare All Payer |
$1,683.88
|
|
SELCT II ATTAIN CATH 6248V-130
|
Facility
|
OP
|
$1,913.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$248.76 |
Max. Negotiated Rate |
$1,836.96 |
Rate for Payer: Aetna Commercial |
$1,473.40
|
Rate for Payer: Anthem Medicaid |
$658.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,492.53
|
Rate for Payer: Cash Price |
$956.75
|
Rate for Payer: Cigna Commercial |
$1,588.20
|
Rate for Payer: First Health Commercial |
$1,817.82
|
Rate for Payer: Humana Commercial |
$1,626.48
|
Rate for Payer: Humana KY Medicaid |
$658.05
|
Rate for Payer: Kentucky WC Medicaid |
$664.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,569.07
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,412.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$574.05
|
Rate for Payer: Molina Healthcare Medicaid |
$671.26
|
Rate for Payer: Ohio Health Choice Commercial |
$1,683.88
|
Rate for Payer: Ohio Health Group HMO |
$1,435.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.70
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.18
|
Rate for Payer: PHCS Commercial |
$1,836.96
|
Rate for Payer: United Healthcare All Payer |
$1,683.88
|
|
SELCT II ATTN CATH 6248V-130P
|
Facility
|
IP
|
$1,962.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$255.12 |
Max. Negotiated Rate |
$1,884.00 |
Rate for Payer: Aetna Commercial |
$1,511.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
Rate for Payer: Cash Price |
$981.25
|
Rate for Payer: Cigna Commercial |
$1,628.88
|
Rate for Payer: First Health Commercial |
$1,864.38
|
Rate for Payer: Humana Commercial |
$1,668.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
Rate for Payer: PHCS Commercial |
$1,884.00
|
Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
SELCT II ATTN CATH 6248V-130P
|
Facility
|
OP
|
$1,962.50
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
27000243
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$255.12 |
Max. Negotiated Rate |
$1,884.00 |
Rate for Payer: Aetna Commercial |
$1,511.12
|
Rate for Payer: Anthem Medicaid |
$674.90
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
Rate for Payer: Cash Price |
$981.25
|
Rate for Payer: Cigna Commercial |
$1,628.88
|
Rate for Payer: First Health Commercial |
$1,864.38
|
Rate for Payer: Humana Commercial |
$1,668.12
|
Rate for Payer: Humana KY Medicaid |
$674.90
|
Rate for Payer: Kentucky WC Medicaid |
$681.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
Rate for Payer: PHCS Commercial |
$1,884.00
|
Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
SELCT PRI PORHUM STEM 11.5*125
|
Facility
|
OP
|
$23,320.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,031.61 |
Max. Negotiated Rate |
$22,387.30 |
Rate for Payer: Aetna Commercial |
$17,956.48
|
Rate for Payer: Anthem Medicaid |
$8,019.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,189.68
|
Rate for Payer: Cash Price |
$11,660.05
|
Rate for Payer: Cigna Commercial |
$19,355.68
|
Rate for Payer: First Health Commercial |
$22,154.10
|
Rate for Payer: Humana Commercial |
$19,822.08
|
Rate for Payer: Humana KY Medicaid |
$8,019.78
|
Rate for Payer: Kentucky WC Medicaid |
$8,101.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,122.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,210.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,996.03
|
Rate for Payer: Molina Healthcare Medicaid |
$8,180.69
|
Rate for Payer: Ohio Health Choice Commercial |
$20,521.69
|
Rate for Payer: Ohio Health Group HMO |
$17,490.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,664.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,031.61
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,229.23
|
Rate for Payer: PHCS Commercial |
$22,387.30
|
Rate for Payer: United Healthcare All Payer |
$20,521.69
|
|