|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
45000233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.83 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.78
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
761T1429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.83 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.78
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
76101429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$757.20 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Ambetter Exchange |
$97.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.02
|
| Rate for Payer: Anthem Medicaid |
$134.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.70
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$178.56
|
| Rate for Payer: Healthspan PPO |
$271.13
|
| Rate for Payer: Humana Medicaid |
$134.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.25
|
| Rate for Payer: Molina Healthcare Passport |
$134.56
|
| Rate for Payer: Multiplan PHCS |
$757.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.42
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.25
|
|
|
INJ PERCTX EXTRM PSEUDANEURYSM
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
45000233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.60 |
| 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 |
$769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.78
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
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 |
$271.13 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Ambetter Exchange |
$97.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.02
|
| Rate for Payer: Anthem Medicaid |
$134.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.70
|
| 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 |
$134.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.25
|
| Rate for Payer: Molina Healthcare Passport |
$134.56
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.42
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.25
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 0387T
|
| Hospital Charge Code |
76102513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| 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 |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$584.64 |
| Rate for Payer: Aetna Commercial |
$468.93
|
| Rate for Payer: Anthem Medicaid |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.02
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$505.47
|
| Rate for Payer: First Health Commercial |
$578.55
|
| Rate for Payer: Humana Commercial |
$517.65
|
| Rate for Payer: Humana KY Medicaid |
$209.44
|
| Rate for Payer: Kentucky WC Medicaid |
$211.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$499.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$449.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$535.92
|
| Rate for Payer: Ohio Health Group HMO |
$456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.21
|
| Rate for Payer: PHCS Commercial |
$584.64
|
| Rate for Payer: United Healthcare All Payer |
$535.92
|
|
|
INJ PROC CYSTOGRAPHY
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$584.64 |
| Rate for Payer: Aetna Commercial |
$468.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.02
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$505.47
|
| Rate for Payer: First Health Commercial |
$578.55
|
| Rate for Payer: Humana Commercial |
$517.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$499.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$449.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$535.92
|
| Rate for Payer: Ohio Health Group HMO |
$456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.21
|
| Rate for Payer: PHCS Commercial |
$584.64
|
| Rate for Payer: United Healthcare All Payer |
$535.92
|
|
|
INJ PROC CYSTOGRAPHY
|
Professional
|
Both
|
$609.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
76102063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$40.57
|
| 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 Individual/Medicaid |
$40.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.68
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$40.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$365.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.74
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.57
|
|
|
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 |
$234.05 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$40.57
|
| 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 Individual/Medicaid |
$40.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$40.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.57
|
| 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 |
$52.74
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.57
|
|
|
INJ PROC CYSTOGRAPHY(T
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
761T2063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.16
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
INJ PROC CYSTOGRAPHY(T
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
761T2063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$125.18
|
| Rate for Payer: Kentucky WC Medicaid |
$126.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.16
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
48100009
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$957.72
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
48100009
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem Medicaid |
$477.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Humana KY Medicaid |
$477.33
|
| Rate for Payer: Kentucky WC Medicaid |
$482.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$486.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$957.72
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
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 |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$84.48
|
| Rate for Payer: Ambetter Exchange |
$44.62
|
| 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 Individual/Medicaid |
$44.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$44.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.62
|
| 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 |
$58.01
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.62
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
76101430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.50 |
| 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 |
$1,428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.65
|
| Rate for Payer: PHCS Commercial |
$1,713.60
|
| Rate for Payer: United Healthcare All Payer |
$1,570.80
|
|
|
INJ PROC EXTREM VENOGRAPHY
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
76101430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.50 |
| 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 |
$1,428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.65
|
| Rate for Payer: PHCS Commercial |
$1,713.60
|
| Rate for Payer: United Healthcare All Payer |
$1,570.80
|
|
|
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 |
$520.13 |
| Rate for Payer: Aetna Commercial |
$84.48
|
| Rate for Payer: Ambetter Exchange |
$44.62
|
| 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 Individual/Medicaid |
$44.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$44.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.62
|
| 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 |
$58.01
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.62
|
|
|
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 |
$340.50 |
| 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 |
$908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.15
|
| 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 |
$340.50 |
| 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 |
$908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.15
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
|
INJ PROC; LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$3,177.60 |
| Rate for Payer: Aetna Commercial |
$2,548.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.80
|
| Rate for Payer: Cash Price |
$1,655.00
|
| Rate for Payer: Cigna Commercial |
$2,747.30
|
| Rate for Payer: First Health Commercial |
$3,144.50
|
| Rate for Payer: Humana Commercial |
$2,813.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,714.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.90
|
| Rate for Payer: PHCS Commercial |
$3,177.60
|
| Rate for Payer: United Healthcare All Payer |
$2,912.80
|
|
|
INJ PROC; LYMPHANGIOGRAPHY
|
Professional
|
Both
|
$3,310.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.29 |
| Max. Negotiated Rate |
$1,986.00 |
| Rate for Payer: Aetna Commercial |
$124.40
|
| Rate for Payer: Ambetter Exchange |
$77.29
|
| Rate for Payer: Anthem Medicaid |
$86.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.75
|
| Rate for Payer: Cash Price |
$1,655.00
|
| Rate for Payer: Cash Price |
$1,655.00
|
| Rate for Payer: Cigna Commercial |
$117.21
|
| Rate for Payer: Healthspan PPO |
$99.47
|
| Rate for Payer: Humana Medicaid |
$86.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.19
|
| Rate for Payer: Molina Healthcare Passport |
$86.46
|
| Rate for Payer: Multiplan PHCS |
$1,986.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.48
|
| Rate for Payer: UHCCP Medicaid |
$1,158.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.29
|
|
|
INJ PROC; LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$3,177.60 |
| Rate for Payer: Aetna Commercial |
$2,548.70
|
| Rate for Payer: Anthem Medicaid |
$1,138.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.80
|
| Rate for Payer: Cash Price |
$1,655.00
|
| Rate for Payer: Cigna Commercial |
$2,747.30
|
| Rate for Payer: First Health Commercial |
$3,144.50
|
| Rate for Payer: Humana Commercial |
$2,813.50
|
| Rate for Payer: Humana KY Medicaid |
$1,138.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,714.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,161.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.90
|
| Rate for Payer: PHCS Commercial |
$3,177.60
|
| Rate for Payer: United Healthcare All Payer |
$2,912.80
|
|
|
INJ PROC; LYMPHANGIOGRAPHY(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761P1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.29 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$124.40
|
| Rate for Payer: Ambetter Exchange |
$77.29
|
| Rate for Payer: Anthem Medicaid |
$86.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.75
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$117.21
|
| Rate for Payer: Healthspan PPO |
$99.47
|
| Rate for Payer: Humana Medicaid |
$86.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.19
|
| Rate for Payer: Molina Healthcare Passport |
$86.46
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.48
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.29
|
|
