|
CATHETER 8F 50CM
|
Facility
|
OP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem Medicaid |
$4,598.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Humana KY Medicaid |
$4,598.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,645.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,691.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
|
CATHETER C-CAE-19.0-83
|
Facility
|
OP
|
$1,499.82
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.95 |
| Max. Negotiated Rate |
$1,439.83 |
| Rate for Payer: Aetna Commercial |
$1,154.86
|
| Rate for Payer: Anthem Medicaid |
$515.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.86
|
| Rate for Payer: Cash Price |
$749.91
|
| Rate for Payer: Cigna Commercial |
$1,244.85
|
| Rate for Payer: First Health Commercial |
$1,424.83
|
| Rate for Payer: Humana Commercial |
$1,274.85
|
| Rate for Payer: Humana KY Medicaid |
$515.79
|
| Rate for Payer: Kentucky WC Medicaid |
$521.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.88
|
| Rate for Payer: PHCS Commercial |
$1,439.83
|
| Rate for Payer: United Healthcare All Payer |
$1,319.84
|
|
|
CATHETER C-CAE-19.0-83
|
Facility
|
IP
|
$1,499.82
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.95 |
| Max. Negotiated Rate |
$1,439.83 |
| Rate for Payer: Aetna Commercial |
$1,154.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.86
|
| Rate for Payer: Cash Price |
$749.91
|
| Rate for Payer: Cigna Commercial |
$1,244.85
|
| Rate for Payer: First Health Commercial |
$1,424.83
|
| Rate for Payer: Humana Commercial |
$1,274.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.88
|
| Rate for Payer: PHCS Commercial |
$1,439.83
|
| Rate for Payer: United Healthcare All Payer |
$1,319.84
|
|
|
CATHETER CCOMBO/SVO2 8FR
|
Facility
|
OP
|
$3,586.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.88 |
| Max. Negotiated Rate |
$3,442.80 |
| Rate for Payer: Aetna Commercial |
$2,761.41
|
| Rate for Payer: Anthem Medicaid |
$1,233.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,797.28
|
| Rate for Payer: Cash Price |
$1,793.12
|
| Rate for Payer: Cigna Commercial |
$2,976.59
|
| Rate for Payer: First Health Commercial |
$3,406.94
|
| Rate for Payer: Humana Commercial |
$3,048.31
|
| Rate for Payer: Humana KY Medicaid |
$1,233.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,940.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,646.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,258.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,155.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,689.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,869.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,120.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,474.51
|
| Rate for Payer: PHCS Commercial |
$3,442.80
|
| Rate for Payer: United Healthcare All Payer |
$3,155.90
|
|
|
CATHETER CCOMBO/SVO2 8FR
|
Facility
|
IP
|
$3,586.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.88 |
| Max. Negotiated Rate |
$3,442.80 |
| Rate for Payer: Aetna Commercial |
$2,761.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,797.28
|
| Rate for Payer: Cash Price |
$1,793.12
|
| Rate for Payer: Cigna Commercial |
$2,976.59
|
| Rate for Payer: First Health Commercial |
$3,406.94
|
| Rate for Payer: Humana Commercial |
$3,048.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,940.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,646.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,155.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,689.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,869.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,120.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,474.51
|
| Rate for Payer: PHCS Commercial |
$3,442.80
|
| Rate for Payer: United Healthcare All Payer |
$3,155.90
|
|
|
CATHETER CHARTIS
|
Facility
|
IP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
CATHETER CHARTIS
|
Facility
|
OP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem Medicaid |
$2,381.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Humana KY Medicaid |
$2,381.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,405.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
CATHETER COMMAND 6250V-MB2
|
Facility
|
OP
|
$2,105.60
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
CATHETER COMMAND 6250V-MB2
|
Facility
|
IP
|
$2,105.60
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
CATHETER DIALYSIS 12.5 CM PC
|
Facility
|
IP
|
$1,750.32
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.10 |
| Max. Negotiated Rate |
$1,680.31 |
| Rate for Payer: Aetna Commercial |
$1,347.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.25
|
| Rate for Payer: Cash Price |
$875.16
|
| Rate for Payer: Cigna Commercial |
$1,452.77
|
| Rate for Payer: First Health Commercial |
$1,662.80
|
| Rate for Payer: Humana Commercial |
$1,487.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.72
|
| Rate for Payer: PHCS Commercial |
$1,680.31
|
| Rate for Payer: United Healthcare All Payer |
$1,540.28
|
|
|
CATHETER DIALYSIS 12.5 CM PC
|
Facility
|
OP
|
$1,750.32
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.10 |
| Max. Negotiated Rate |
$1,680.31 |
| Rate for Payer: Aetna Commercial |
$1,347.75
|
| Rate for Payer: Anthem Medicaid |
$601.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.25
|
| Rate for Payer: Cash Price |
$875.16
|
| Rate for Payer: Cigna Commercial |
$1,452.77
|
| Rate for Payer: First Health Commercial |
$1,662.80
|
| Rate for Payer: Humana Commercial |
$1,487.77
|
| Rate for Payer: Humana KY Medicaid |
$601.94
|
| Rate for Payer: Kentucky WC Medicaid |
$608.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.72
|
| Rate for Payer: PHCS Commercial |
$1,680.31
|
| Rate for Payer: United Healthcare All Payer |
$1,540.28
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.30 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.69
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.40 |
| Max. Negotiated Rate |
$1,284.48 |
| Rate for Payer: Aetna Commercial |
$1,030.26
|
| Rate for Payer: Anthem Medicaid |
$460.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,043.64
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$1,110.54
|
| Rate for Payer: First Health Commercial |
$1,271.10
|
| Rate for Payer: Humana Commercial |
$1,137.30
|
| Rate for Payer: Humana KY Medicaid |
$460.14
|
| Rate for Payer: Kentucky WC Medicaid |
$464.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,097.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$987.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$469.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,177.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,003.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.22
|
| Rate for Payer: PHCS Commercial |
$1,284.48
|
| Rate for Payer: United Healthcare All Payer |
$1,177.44
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Ambetter Exchange |
$54.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.63
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$802.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.10
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.69
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.40 |
| Max. Negotiated Rate |
$1,284.48 |
| Rate for Payer: Aetna Commercial |
$1,030.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,043.64
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$1,110.54
|
| Rate for Payer: First Health Commercial |
$1,271.10
|
| Rate for Payer: Humana Commercial |
$1,137.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,097.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$987.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,177.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,003.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.22
|
| Rate for Payer: PHCS Commercial |
$1,284.48
|
| Rate for Payer: United Healthcare All Payer |
$1,177.44
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.30 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem Medicaid |
$447.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Humana KY Medicaid |
$447.41
|
| Rate for Payer: Kentucky WC Medicaid |
$451.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.69
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$780.60 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Ambetter Exchange |
$54.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.63
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$780.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.10
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.69
|
|
|
CATHETER FOR HYSTEROGRAPHY(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
320P1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Ambetter Exchange |
$54.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.63
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.10
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.69
|
|
|
CATHETER FOR HYSTEROGRAPHY(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
761P2223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Ambetter Exchange |
$54.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.63
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.10
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.69
|
|
|
CATHETER FOR HYSTEROGRAPHY(T
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
761T2223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.90 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$464.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$470.34
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$500.49
|
| Rate for Payer: First Health Commercial |
$572.85
|
| Rate for Payer: Humana Commercial |
$512.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$494.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$530.64
|
| Rate for Payer: Ohio Health Group HMO |
$452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.07
|
| Rate for Payer: PHCS Commercial |
$578.88
|
| Rate for Payer: United Healthcare All Payer |
$530.64
|
|
|
CATHETER FOR HYSTEROGRAPHY(T
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
320T1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.80 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$194.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$194.65
|
| Rate for Payer: Kentucky WC Medicaid |
$196.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.54
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
CATHETER FOR HYSTEROGRAPHY(T
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
761T2223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.90 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$464.31
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$470.34
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$500.49
|
| Rate for Payer: First Health Commercial |
$572.85
|
| Rate for Payer: Humana Commercial |
$512.55
|
| Rate for Payer: Humana KY Medicaid |
$207.37
|
| Rate for Payer: Kentucky WC Medicaid |
$209.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$494.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$530.64
|
| Rate for Payer: Ohio Health Group HMO |
$452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$482.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.07
|
| Rate for Payer: PHCS Commercial |
$578.88
|
| Rate for Payer: United Healthcare All Payer |
$530.64
|
|
|
CATHETER FOR HYSTEROGRAPHY(T
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
320T1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.80 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.54
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
CATHETER PATENCY
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32000003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$643.80 |
| Rate for Payer: Aetna Commercial |
$93.38
|
| Rate for Payer: Ambetter Exchange |
$33.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.85
|
| Rate for Payer: Anthem Medicaid |
$90.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.61
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$154.88
|
| Rate for Payer: Healthspan PPO |
$135.00
|
| Rate for Payer: Humana Medicaid |
$90.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.79
|
| Rate for Payer: Molina Healthcare Passport |
$90.97
|
| Rate for Payer: Multiplan PHCS |
$643.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.91
|
| Rate for Payer: UHCCP Medicaid |
$29.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.01
|
|
|
CATHETER PATENCY
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32000003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.90 |
| Max. Negotiated Rate |
$1,030.08 |
| Rate for Payer: Aetna Commercial |
$826.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.94
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$890.59
|
| Rate for Payer: First Health Commercial |
$1,019.35
|
| Rate for Payer: Humana Commercial |
$912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.24
|
| Rate for Payer: Ohio Health Group HMO |
$804.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$740.37
|
| Rate for Payer: PHCS Commercial |
$1,030.08
|
| Rate for Payer: United Healthcare All Payer |
$944.24
|
|
