|
TRANSURETHRAL WATERJET ABLATION OF PROSTATE, INCLUDING CONTROL OF POST-OPERATIVE BLEEDING, INCLUDING ULTRASOUND GUIDANCE, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED WHEN PERFORMED)
|
Facility
|
OP
|
$11,152.93
|
|
|
Service Code
|
CPT 0421T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,966.38 |
| Max. Negotiated Rate |
$11,152.93 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,966.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,152.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,754.61
|
| Rate for Payer: Humana Medicare Advantage |
$7,966.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,559.66
|
|
|
TRANSVAGINAL ULTRASOUND
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$1,072.32 |
| Rate for Payer: Aetna Commercial |
$860.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.26
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cigna Commercial |
$927.11
|
| Rate for Payer: First Health Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial |
$949.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.96
|
| Rate for Payer: Ohio Health Group HMO |
$837.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.27
|
| Rate for Payer: PHCS Commercial |
$1,072.32
|
| Rate for Payer: United Healthcare All Payer |
$982.96
|
|
|
TRANSVAGINAL ULTRASOUND
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$1,117.00 |
| Rate for Payer: Aetna Commercial |
$182.35
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,117.00
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cigna Commercial |
$156.03
|
| Rate for Payer: Healthspan PPO |
$170.86
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$670.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$781.90
|
| Rate for Payer: UHCCP Medicaid |
$390.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
|
|
TRANSVAGINAL ULTRASOUND
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,072.32 |
| Rate for Payer: Aetna Commercial |
$860.09
|
| Rate for Payer: Anthem Medicaid |
$384.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cigna Commercial |
$927.11
|
| Rate for Payer: First Health Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial |
$949.45
|
| Rate for Payer: Humana KY Medicaid |
$384.14
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$388.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.96
|
| Rate for Payer: Ohio Health Group HMO |
$837.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.27
|
| Rate for Payer: PHCS Commercial |
$1,072.32
|
| Rate for Payer: United Healthcare All Payer |
$982.96
|
|
|
TRANSVAGINAL ULTRASOUND(P
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402P0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$182.35 |
| Rate for Payer: Aetna Commercial |
$182.35
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$156.03
|
| Rate for Payer: Healthspan PPO |
$170.86
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.50
|
| Rate for Payer: UHCCP Medicaid |
$54.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
|
|
TRANSVAGINAL ULTRASOUND(T
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402T0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.06 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.22
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
TRANSVAGINAL ULTRASOUND(T
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402T0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem Medicaid |
$330.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Humana KY Medicaid |
$330.83
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$334.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.22
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
OP
|
$11,412.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
48100001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,483.56 |
| Max. Negotiated Rate |
$10,955.52 |
| Rate for Payer: Aetna Commercial |
$8,787.24
|
| Rate for Payer: Anthem Medicaid |
$3,924.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,901.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cigna Commercial |
$9,471.96
|
| Rate for Payer: First Health Commercial |
$10,841.40
|
| Rate for Payer: Humana Commercial |
$9,700.20
|
| Rate for Payer: Humana KY Medicaid |
$3,924.59
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,422.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,042.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,559.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.72
|
| Rate for Payer: PHCS Commercial |
$10,955.52
|
| Rate for Payer: United Healthcare All Payer |
$10,042.56
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
IP
|
$11,412.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
48100001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,483.56 |
| Max. Negotiated Rate |
$10,955.52 |
| Rate for Payer: Aetna Commercial |
$8,787.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,901.36
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cigna Commercial |
$9,471.96
|
| Rate for Payer: First Health Commercial |
$10,841.40
|
| Rate for Payer: Humana Commercial |
$9,700.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,422.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,042.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,559.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.72
|
| Rate for Payer: PHCS Commercial |
$10,955.52
|
| Rate for Payer: United Healthcare All Payer |
$10,042.56
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Professional
|
Both
|
$11,412.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
48100001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$191.91 |
| Max. Negotiated Rate |
$11,412.00 |
| Rate for Payer: Aetna Commercial |
$310.95
|
| Rate for Payer: Anthem Medicaid |
$191.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,412.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cigna Commercial |
$283.81
|
| Rate for Payer: Healthspan PPO |
$305.73
|
| Rate for Payer: Humana Medicaid |
$191.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$255.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.75
|
| Rate for Payer: Molina Healthcare Passport |
$191.91
|
| Rate for Payer: Multiplan PHCS |
$6,847.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,988.40
|
| Rate for Payer: UHCCP Medicaid |
$3,994.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.83
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
IP
|
$11,412.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
45000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,483.56 |
| Max. Negotiated Rate |
$10,955.52 |
| Rate for Payer: Aetna Commercial |
$8,787.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,901.36
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cigna Commercial |
$9,471.96
|
| Rate for Payer: First Health Commercial |
$10,841.40
|
| Rate for Payer: Humana Commercial |
$9,700.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,422.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,042.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,559.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.72
|
| Rate for Payer: PHCS Commercial |
$10,955.52
|
| Rate for Payer: United Healthcare All Payer |
$10,042.56
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
IP
|
$11,042.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
481T0001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,435.46 |
| Max. Negotiated Rate |
$10,600.32 |
| Rate for Payer: Aetna Commercial |
$8,502.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,612.76
|
| Rate for Payer: Cash Price |
$5,521.00
|
| Rate for Payer: Cigna Commercial |
$9,164.86
|
| Rate for Payer: First Health Commercial |
$10,489.90
|
| Rate for Payer: Humana Commercial |
$9,385.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,054.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,149.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,716.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,281.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.02
|
| Rate for Payer: PHCS Commercial |
$10,600.32
|
| Rate for Payer: United Healthcare All Payer |
$9,716.96
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
OP
|
$11,412.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
45000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,483.56 |
| Max. Negotiated Rate |
$10,955.52 |
| Rate for Payer: Aetna Commercial |
$8,787.24
|
| Rate for Payer: Anthem Medicaid |
$3,924.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,901.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cash Price |
$5,706.00
|
| Rate for Payer: Cigna Commercial |
$9,471.96
|
| Rate for Payer: First Health Commercial |
$10,841.40
|
| Rate for Payer: Humana Commercial |
$9,700.20
|
| Rate for Payer: Humana KY Medicaid |
$3,924.59
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,422.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,042.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,559.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.72
|
| Rate for Payer: PHCS Commercial |
$10,955.52
|
| Rate for Payer: United Healthcare All Payer |
$10,042.56
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Facility
|
OP
|
$11,042.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
481T0001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,435.46 |
| Max. Negotiated Rate |
$10,600.32 |
| Rate for Payer: Aetna Commercial |
$8,502.34
|
| Rate for Payer: Anthem Medicaid |
$3,797.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,612.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$5,521.00
|
| Rate for Payer: Cash Price |
$5,521.00
|
| Rate for Payer: Cigna Commercial |
$9,164.86
|
| Rate for Payer: First Health Commercial |
$10,489.90
|
| Rate for Payer: Humana Commercial |
$9,385.70
|
| Rate for Payer: Humana KY Medicaid |
$3,797.34
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,835.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,054.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,149.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,873.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,716.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,281.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.02
|
| Rate for Payer: PHCS Commercial |
$10,600.32
|
| Rate for Payer: United Healthcare All Payer |
$9,716.96
|
|
|
TRANSVEN PACER INSERT/MANAGEM
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
481P0001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$310.95
|
| Rate for Payer: Anthem Medicaid |
$191.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$283.81
|
| Rate for Payer: Healthspan PPO |
$305.73
|
| Rate for Payer: Humana Medicaid |
$191.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$255.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.75
|
| Rate for Payer: Molina Healthcare Passport |
$191.91
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.00
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.83
|
|
|
TRAP 4.5 CATH 5F
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
TRAP 4.5 CATH 5F
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$17,482.96
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$11,863.44 |
| Max. Negotiated Rate |
$17,482.96 |
| Rate for Payer: Anthem Medicaid |
$11,863.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,487.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,482.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,858.57
|
| Rate for Payer: Humana KY Medicaid |
$11,863.44
|
| Rate for Payer: Humana Medicare Advantage |
$12,487.83
|
| Rate for Payer: Kentucky WC Medicaid |
$11,982.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,985.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,100.71
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$10,618.45
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,205.38 |
| Max. Negotiated Rate |
$10,618.45 |
| Rate for Payer: Anthem Medicaid |
$7,205.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,584.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,618.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,239.22
|
| Rate for Payer: Humana KY Medicaid |
$7,205.38
|
| Rate for Payer: Humana Medicare Advantage |
$7,584.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,277.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,101.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,349.49
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$15,407.70
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$10,455.22 |
| Max. Negotiated Rate |
$15,407.70 |
| Rate for Payer: Anthem Medicaid |
$10,455.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,005.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,407.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,857.42
|
| Rate for Payer: Humana KY Medicaid |
$10,455.22
|
| Rate for Payer: Humana Medicare Advantage |
$11,005.50
|
| Rate for Payer: Kentucky WC Medicaid |
$10,559.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,206.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,664.33
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$15,867.43
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$10,767.19 |
| Max. Negotiated Rate |
$15,867.43 |
| Rate for Payer: Anthem Medicaid |
$10,767.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,333.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,867.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,300.74
|
| Rate for Payer: Humana KY Medicaid |
$10,767.19
|
| Rate for Payer: Humana Medicare Advantage |
$11,333.88
|
| Rate for Payer: Kentucky WC Medicaid |
$10,874.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,600.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,982.53
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$26,587.65
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$18,041.62 |
| Max. Negotiated Rate |
$26,587.65 |
| Rate for Payer: Anthem Medicaid |
$18,041.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,991.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,587.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,638.09
|
| Rate for Payer: Humana KY Medicaid |
$18,041.62
|
| Rate for Payer: Humana Medicare Advantage |
$18,991.18
|
| Rate for Payer: Kentucky WC Medicaid |
$18,222.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,789.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,402.45
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$26,652.04
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$18,085.31 |
| Max. Negotiated Rate |
$26,652.04 |
| Rate for Payer: Anthem Medicaid |
$18,085.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,037.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,652.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,700.18
|
| Rate for Payer: Humana KY Medicaid |
$18,085.31
|
| Rate for Payer: Humana Medicare Advantage |
$19,037.17
|
| Rate for Payer: Kentucky WC Medicaid |
$18,266.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,844.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,447.02
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$10,366.94
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,034.71 |
| Max. Negotiated Rate |
$10,366.94 |
| Rate for Payer: Anthem Medicaid |
$7,034.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,404.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,366.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,996.70
|
| Rate for Payer: Humana KY Medicaid |
$7,034.71
|
| Rate for Payer: Humana Medicare Advantage |
$7,404.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,105.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,885.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,175.41
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$10,758.83
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$7,300.64 |
| Max. Negotiated Rate |
$10,758.83 |
| Rate for Payer: Anthem Medicaid |
$7,300.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,684.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,758.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,374.59
|
| Rate for Payer: Humana KY Medicaid |
$7,300.64
|
| Rate for Payer: Humana Medicare Advantage |
$7,684.88
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,221.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,446.65
|
|
