|
INJ PARAVERT F JNT C/T 3 LEV
|
Facility
|
IP
|
$1,403.06
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
76102328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$1,346.94 |
| Rate for Payer: Aetna Commercial |
$1,080.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,094.39
|
| Rate for Payer: Cash Price |
$701.53
|
| Rate for Payer: Cigna Commercial |
$1,164.54
|
| Rate for Payer: First Health Commercial |
$1,332.91
|
| Rate for Payer: Humana Commercial |
$1,192.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,150.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,035.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,234.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,052.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.95
|
| Rate for Payer: PHCS Commercial |
$1,346.94
|
| Rate for Payer: United Healthcare All Payer |
$1,234.69
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
761T1429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$866.88 |
| Rate for Payer: Aetna Commercial |
$695.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$704.34
|
| Rate for Payer: Cash Price |
$451.50
|
| Rate for Payer: Cigna Commercial |
$749.49
|
| Rate for Payer: First Health Commercial |
$857.85
|
| Rate for Payer: Humana Commercial |
$767.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$740.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$666.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$794.64
|
| Rate for Payer: Ohio Health Group HMO |
$677.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.93
|
| Rate for Payer: PHCS Commercial |
$866.88
|
| Rate for Payer: United Healthcare All Payer |
$794.64
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
761T1429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$866.88 |
| Rate for Payer: Aetna Commercial |
$695.31
|
| Rate for Payer: Anthem Medicaid |
$310.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$704.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$451.50
|
| Rate for Payer: Cash Price |
$451.50
|
| Rate for Payer: Cigna Commercial |
$749.49
|
| Rate for Payer: First Health Commercial |
$857.85
|
| Rate for Payer: Humana Commercial |
$767.55
|
| Rate for Payer: Humana KY Medicaid |
$310.54
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$313.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$740.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$666.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$316.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$794.64
|
| Rate for Payer: Ohio Health Group HMO |
$677.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.93
|
| Rate for Payer: PHCS Commercial |
$866.88
|
| Rate for Payer: United Healthcare All Payer |
$794.64
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
761P1429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.02
|
| Rate for Payer: Anthem Medicaid |
$84.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$178.56
|
| Rate for Payer: Healthspan PPO |
$271.13
|
| Rate for Payer: Humana Medicaid |
$84.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.69
|
| Rate for Payer: Molina Healthcare Passport |
$84.99
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.84
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
45000233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$323.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Humana KY Medicaid |
$323.95
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
76101429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.39 |
| Max. Negotiated Rate |
$1,154.88 |
| Rate for Payer: Aetna Commercial |
$926.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$938.34
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$998.49
|
| Rate for Payer: First Health Commercial |
$1,142.85
|
| Rate for Payer: Humana Commercial |
$1,022.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$986.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$887.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,058.64
|
| Rate for Payer: Ohio Health Group HMO |
$902.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.93
|
| Rate for Payer: PHCS Commercial |
$1,154.88
|
| Rate for Payer: United Healthcare All Payer |
$1,058.64
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
76101429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.02
|
| Rate for Payer: Anthem Medicaid |
$84.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,203.00
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$178.56
|
| Rate for Payer: Healthspan PPO |
$271.13
|
| Rate for Payer: Humana Medicaid |
$84.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.69
|
| Rate for Payer: Molina Healthcare Passport |
$84.99
|
| Rate for Payer: Multiplan PHCS |
$721.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$842.10
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.84
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
76101429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.39 |
| Max. Negotiated Rate |
$1,154.88 |
| Rate for Payer: Aetna Commercial |
$926.31
|
| Rate for Payer: Anthem Medicaid |
$413.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$938.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$998.49
|
| Rate for Payer: First Health Commercial |
$1,142.85
|
| Rate for Payer: Humana Commercial |
$1,022.55
|
| Rate for Payer: Humana KY Medicaid |
$413.71
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$417.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$986.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$887.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,058.64
|
| Rate for Payer: Ohio Health Group HMO |
$902.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.93
|
| Rate for Payer: PHCS Commercial |
$1,154.88
|
| Rate for Payer: United Healthcare All Payer |
$1,058.64
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
45000233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
INJ PROC CYSTOGRAPHY
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$599.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.00
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$359.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.30
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.69
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem Medicaid |
$206.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Humana KY Medicaid |
$206.00
|
| Rate for Payer: Kentucky WC Medicaid |
$208.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.69
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 0387T
|
| Hospital Charge Code |
76102513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 0387T
|
| Hospital Charge Code |
76102513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INJ PROC CYSTOGRAPHY(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
761P2063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
|
|
INJ PROC CYSTOGRAPHY(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
761T2063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJ PROC CYSTOGRAPHY(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
761T2063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
48100009
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$169.39 |
| Max. Negotiated Rate |
$1,250.88 |
| Rate for Payer: Aetna Commercial |
$1,003.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,016.34
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,081.49
|
| Rate for Payer: First Health Commercial |
$1,237.85
|
| Rate for Payer: Humana Commercial |
$1,107.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,068.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$961.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,146.64
|
| Rate for Payer: Ohio Health Group HMO |
$977.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.93
|
| Rate for Payer: PHCS Commercial |
$1,250.88
|
| Rate for Payer: United Healthcare All Payer |
$1,146.64
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
76101430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$1,713.60 |
| Rate for Payer: Aetna Commercial |
$1,374.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.30
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: Cigna Commercial |
$1,481.55
|
| Rate for Payer: First Health Commercial |
$1,695.75
|
| Rate for Payer: Humana Commercial |
$1,517.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.35
|
| Rate for Payer: PHCS Commercial |
$1,713.60
|
| Rate for Payer: United Healthcare All Payer |
$1,570.80
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
76101430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$1,713.60 |
| Rate for Payer: Aetna Commercial |
$1,374.45
|
| Rate for Payer: Anthem Medicaid |
$613.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.30
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: Cigna Commercial |
$1,481.55
|
| Rate for Payer: First Health Commercial |
$1,695.75
|
| Rate for Payer: Humana Commercial |
$1,517.25
|
| Rate for Payer: Humana KY Medicaid |
$613.86
|
| Rate for Payer: Kentucky WC Medicaid |
$620.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.35
|
| Rate for Payer: PHCS Commercial |
$1,713.60
|
| Rate for Payer: United Healthcare All Payer |
$1,570.80
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
48100009
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$169.39 |
| Max. Negotiated Rate |
$1,250.88 |
| Rate for Payer: Aetna Commercial |
$1,003.31
|
| Rate for Payer: Anthem Medicaid |
$448.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,016.34
|
| Rate for Payer: Cash Price |
$651.50
|
| Rate for Payer: Cigna Commercial |
$1,081.49
|
| Rate for Payer: First Health Commercial |
$1,237.85
|
| Rate for Payer: Humana Commercial |
$1,107.55
|
| Rate for Payer: Humana KY Medicaid |
$448.10
|
| Rate for Payer: Kentucky WC Medicaid |
$452.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,068.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$961.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$457.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,146.64
|
| Rate for Payer: Ohio Health Group HMO |
$977.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.93
|
| Rate for Payer: PHCS Commercial |
$1,250.88
|
| Rate for Payer: United Healthcare All Payer |
$1,146.64
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
76101430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Aetna Commercial |
$84.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$41.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,785.00
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: Cigna Commercial |
$76.81
|
| Rate for Payer: Healthspan PPO |
$520.13
|
| Rate for Payer: Humana Medicaid |
$41.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.28
|
| Rate for Payer: Molina Healthcare Passport |
$41.45
|
| Rate for Payer: Multiplan PHCS |
$1,071.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,249.50
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.86
|
|
|
INJ PROC EXTREM VENOGRAPHY(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
761P1430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$84.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$41.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$76.81
|
| Rate for Payer: Healthspan PPO |
$520.13
|
| Rate for Payer: Humana Medicaid |
$41.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.28
|
| Rate for Payer: Molina Healthcare Passport |
$41.45
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.86
|
|
|
INJ PROC EXTREM VENOGRAPHY(T
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
761T1430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.55 |
| Max. Negotiated Rate |
$1,089.60 |
| Rate for Payer: Aetna Commercial |
$873.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.30
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$942.05
|
| Rate for Payer: First Health Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial |
$964.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.80
|
| Rate for Payer: Ohio Health Group HMO |
$851.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.85
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
|
INJ PROC EXTREM VENOGRAPHY(T
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
761T1430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.55 |
| Max. Negotiated Rate |
$1,089.60 |
| Rate for Payer: Aetna Commercial |
$873.95
|
| Rate for Payer: Anthem Medicaid |
$390.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.30
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$942.05
|
| Rate for Payer: First Health Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial |
$964.75
|
| Rate for Payer: Humana KY Medicaid |
$390.33
|
| Rate for Payer: Kentucky WC Medicaid |
$394.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.80
|
| Rate for Payer: Ohio Health Group HMO |
$851.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.85
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
