|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
OP
|
$4,798.26
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
76101440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,439.48 |
| Max. Negotiated Rate |
$4,606.33 |
| Rate for Payer: Aetna Commercial |
$3,694.66
|
| Rate for Payer: Anthem Medicaid |
$1,650.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.64
|
| Rate for Payer: Cash Price |
$2,399.13
|
| Rate for Payer: Cigna Commercial |
$3,982.56
|
| Rate for Payer: First Health Commercial |
$4,558.35
|
| Rate for Payer: Humana Commercial |
$4,078.52
|
| Rate for Payer: Humana KY Medicaid |
$1,650.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,541.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,683.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,222.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,174.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.80
|
| Rate for Payer: PHCS Commercial |
$4,606.33
|
| Rate for Payer: United Healthcare All Payer |
$4,222.47
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
48100012
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
IP
|
$4,252.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
48100023
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,275.60 |
| Max. Negotiated Rate |
$4,081.92 |
| Rate for Payer: Aetna Commercial |
$3,274.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.56
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cigna Commercial |
$3,529.16
|
| Rate for Payer: First Health Commercial |
$4,039.40
|
| Rate for Payer: Humana Commercial |
$3,614.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,137.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,699.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,933.88
|
| Rate for Payer: PHCS Commercial |
$4,081.92
|
| Rate for Payer: United Healthcare All Payer |
$3,741.76
|
|
|
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 |
$3,010.11 |
| Rate for Payer: Aetna Commercial |
$567.10
|
| Rate for Payer: Ambetter Exchange |
$277.96
|
| 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 Individual/Medicaid |
$277.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$277.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$333.55
|
| 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 |
$3,010.11
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$434.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$277.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.96
|
| 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 |
$361.35
|
| Rate for Payer: UHCCP Medicaid |
$221.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$277.96
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
IP
|
$4,149.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
76101453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,244.70 |
| Max. Negotiated Rate |
$3,983.04 |
| Rate for Payer: Aetna Commercial |
$3,194.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.22
|
| Rate for Payer: Cash Price |
$2,074.50
|
| Rate for Payer: Cigna Commercial |
$3,443.67
|
| Rate for Payer: First Health Commercial |
$3,941.55
|
| Rate for Payer: Humana Commercial |
$3,526.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,609.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,862.81
|
| Rate for Payer: PHCS Commercial |
$3,983.04
|
| Rate for Payer: United Healthcare All Payer |
$3,651.12
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
OP
|
$4,149.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
76101453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,244.70 |
| Max. Negotiated Rate |
$3,983.04 |
| Rate for Payer: Aetna Commercial |
$3,194.73
|
| Rate for Payer: Anthem Medicaid |
$1,426.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.22
|
| Rate for Payer: Cash Price |
$2,074.50
|
| Rate for Payer: Cigna Commercial |
$3,443.67
|
| Rate for Payer: First Health Commercial |
$3,941.55
|
| Rate for Payer: Humana Commercial |
$3,526.65
|
| Rate for Payer: Humana KY Medicaid |
$1,426.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,609.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,862.81
|
| Rate for Payer: PHCS Commercial |
$3,983.04
|
| Rate for Payer: United Healthcare All Payer |
$3,651.12
|
|
|
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 |
$3,010.11 |
| Rate for Payer: Aetna Commercial |
$567.10
|
| Rate for Payer: Ambetter Exchange |
$277.96
|
| 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 Individual/Medicaid |
$277.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$277.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$333.55
|
| 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 |
$3,010.11
|
| Rate for Payer: Humana Medicaid |
$297.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$434.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$277.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.96
|
| 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 |
$361.35
|
| Rate for Payer: UHCCP Medicaid |
$221.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$277.96
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
761T1453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
OP
|
$4,252.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
48100023
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,275.60 |
| Max. Negotiated Rate |
$4,081.92 |
| Rate for Payer: Aetna Commercial |
$3,274.04
|
| Rate for Payer: Anthem Medicaid |
$1,462.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.56
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cigna Commercial |
$3,529.16
|
| Rate for Payer: First Health Commercial |
$4,039.40
|
| Rate for Payer: Humana Commercial |
$3,614.20
|
| Rate for Payer: Humana KY Medicaid |
$1,462.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,477.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,137.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,699.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,933.88
|
| Rate for Payer: PHCS Commercial |
$4,081.92
|
| Rate for Payer: United Healthcare All Payer |
$3,741.76
|
|
|
SEL CATH EA 3RD ORDER ABD/PELV
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 36247
|
| Hospital Charge Code |
761T1453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem Medicaid |
$426.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Humana KY Medicaid |
$426.78
|
| Rate for Payer: Kentucky WC Medicaid |
$431.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
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: Ambetter Exchange |
$163.94
|
| 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 Individual/Medicaid |
$163.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.73
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.94
|
| 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 |
$213.12
|
| Rate for Payer: UHCCP Medicaid |
$138.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.94
|
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 36012
|
| Hospital Charge Code |
76101433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.94 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: Ambetter Exchange |
$163.94
|
| 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 Individual/Medicaid |
$163.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.73
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.33
|
| Rate for Payer: Molina Healthcare Passport |
$182.68
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.12
|
| Rate for Payer: UHCCP Medicaid |
$138.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.94
|
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 36012
|
| Hospital Charge Code |
76101433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem Medicaid |
$1,341.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Humana KY Medicaid |
$1,341.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
SEL CATH PLCMNT 1ST/2ND ORDER
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 36012
|
| Hospital Charge Code |
76101433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
SEL CATH PLCMNT 1ST/2ND ORDE(T
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 36012
|
| Hospital Charge Code |
761T1433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem Medicaid |
$927.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Humana KY Medicaid |
$927.15
|
| Rate for Payer: Kentucky WC Medicaid |
$936.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
SEL CATH PLCMNT 1ST/2ND ORDE(T
|
Facility
|
IP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 36012
|
| Hospital Charge Code |
761T1433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
SEL CATH PLCMNT 1ST ORDER
|
Facility
|
OP
|
$3,594.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
76101432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,078.20 |
| Max. Negotiated Rate |
$3,450.24 |
| Rate for Payer: Aetna Commercial |
$2,767.38
|
| Rate for Payer: Anthem Medicaid |
$1,235.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.32
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$2,983.02
|
| Rate for Payer: First Health Commercial |
$3,414.30
|
| Rate for Payer: Humana Commercial |
$3,054.90
|
| Rate for Payer: Humana KY Medicaid |
$1,235.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.86
|
| Rate for Payer: PHCS Commercial |
$3,450.24
|
| Rate for Payer: United Healthcare All Payer |
$3,162.72
|
|
|
SEL CATH PLCMNT 1ST ORDER
|
Facility
|
IP
|
$3,594.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
76101432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,078.20 |
| Max. Negotiated Rate |
$3,450.24 |
| Rate for Payer: Aetna Commercial |
$2,767.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.32
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$2,983.02
|
| Rate for Payer: First Health Commercial |
$3,414.30
|
| Rate for Payer: Humana Commercial |
$3,054.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.86
|
| Rate for Payer: PHCS Commercial |
$3,450.24
|
| Rate for Payer: United Healthcare All Payer |
$3,162.72
|
|
|
SEL CATH PLCMNT 1ST ORDER
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
76101432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$2,156.40 |
| Rate for Payer: Aetna Commercial |
$278.98
|
| Rate for Payer: Ambetter Exchange |
$146.05
|
| 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 Individual/Medicaid |
$146.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.26
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cash Price |
$1,797.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$146.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.42
|
| Rate for Payer: Molina Healthcare Passport |
$148.45
|
| Rate for Payer: Multiplan PHCS |
$2,156.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.87
|
| Rate for Payer: UHCCP Medicaid |
$125.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.05
|
|
|
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 |
$1,429.24 |
| Rate for Payer: Aetna Commercial |
$278.98
|
| Rate for Payer: Ambetter Exchange |
$146.05
|
| 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 Individual/Medicaid |
$146.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$146.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.05
|
| 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 |
$189.87
|
| Rate for Payer: UHCCP Medicaid |
$125.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.05
|
|
|
SEL CATH PLCMNT 1ST ORDER(T
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
761T1432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$1,976.64 |
| Rate for Payer: Aetna Commercial |
$1,585.43
|
| Rate for Payer: Anthem Medicaid |
$708.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.02
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cigna Commercial |
$1,708.97
|
| Rate for Payer: First Health Commercial |
$1,956.05
|
| Rate for Payer: Humana Commercial |
$1,750.15
|
| Rate for Payer: Humana KY Medicaid |
$708.09
|
| Rate for Payer: Kentucky WC Medicaid |
$715.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,791.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.71
|
| Rate for Payer: PHCS Commercial |
$1,976.64
|
| Rate for Payer: United Healthcare All Payer |
$1,811.92
|
|
|
SEL CATH PLCMNT 1ST ORDER(T
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
761T1432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$1,976.64 |
| Rate for Payer: Aetna Commercial |
$1,585.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.02
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cigna Commercial |
$1,708.97
|
| Rate for Payer: First Health Commercial |
$1,956.05
|
| Rate for Payer: Humana Commercial |
$1,750.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,791.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.71
|
| Rate for Payer: PHCS Commercial |
$1,976.64
|
| Rate for Payer: United Healthcare All Payer |
$1,811.92
|
|
|
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 |
$863.70 |
| 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 |
$2,303.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,504.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,986.51
|
| Rate for Payer: PHCS Commercial |
$2,763.84
|
| Rate for Payer: United Healthcare All Payer |
$2,533.52
|
|
|
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 |
$863.70 |
| 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 |
$2,303.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,504.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,986.51
|
| 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 |
$1,727.40 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: Ambetter Exchange |
$117.67
|
| 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 Individual/Medicaid |
$117.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$117.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.67
|
| 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 |
$152.97
|
| Rate for Payer: UHCCP Medicaid |
$99.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.67
|
|
