|
IR ABLATE LIVER PERCUT RF
|
Professional
|
Both
|
$4,225.00
|
|
|
Service Code
|
HCPCS 47382
|
| Hospital Charge Code |
320P1006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$505.21 |
| Max. Negotiated Rate |
$4,225.00 |
| Rate for Payer: Aetna Commercial |
$1,300.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$505.71
|
| Rate for Payer: Anthem Medicaid |
$505.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,225.00
|
| Rate for Payer: Cash Price |
$2,112.50
|
| Rate for Payer: Cash Price |
$2,112.50
|
| Rate for Payer: Cigna Commercial |
$1,182.37
|
| Rate for Payer: Healthspan PPO |
$1,096.89
|
| Rate for Payer: Humana Medicaid |
$505.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,036.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.31
|
| Rate for Payer: Molina Healthcare Passport |
$505.21
|
| Rate for Payer: Multiplan PHCS |
$2,535.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,957.50
|
| Rate for Payer: UHCCP Medicaid |
$531.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.26
|
|
|
IR ABLATE LUNG PERCUT RF
|
Professional
|
Both
|
$3,505.00
|
|
|
Service Code
|
HCPCS 32998
|
| Hospital Charge Code |
320P1007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$3,505.00 |
| Rate for Payer: Aetna Commercial |
$517.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.51
|
| Rate for Payer: Anthem Medicaid |
$217.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,505.00
|
| Rate for Payer: Cash Price |
$1,752.50
|
| Rate for Payer: Cash Price |
$1,752.50
|
| Rate for Payer: Cigna Commercial |
$456.20
|
| Rate for Payer: Healthspan PPO |
$3,376.85
|
| Rate for Payer: Humana Medicaid |
$217.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.90
|
| Rate for Payer: Molina Healthcare Passport |
$217.55
|
| Rate for Payer: Multiplan PHCS |
$2,103.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,453.50
|
| Rate for Payer: UHCCP Medicaid |
$233.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.73
|
|
|
IR ANGIO MESENTERIC PLEXUS
|
Facility
|
IP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32001018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,070.55 |
| Max. Negotiated Rate |
$7,905.60 |
| Rate for Payer: Aetna Commercial |
$6,340.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$6,835.05
|
| Rate for Payer: First Health Commercial |
$7,823.25
|
| Rate for Payer: Humana Commercial |
$6,999.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.85
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
IR ANGIO MESENTERIC PLEXUS
|
Professional
|
Both
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32001018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$8,235.00 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,235.00
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$685.53
|
| Rate for Payer: Healthspan PPO |
$413.25
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$4,941.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,764.50
|
| Rate for Payer: UHCCP Medicaid |
$2,882.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
IR ANGIO MESENTERIC PLEXUS
|
Facility
|
OP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32001018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,070.55 |
| Max. Negotiated Rate |
$7,905.60 |
| Rate for Payer: Aetna Commercial |
$6,340.95
|
| Rate for Payer: Anthem Medicaid |
$2,832.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$6,835.05
|
| Rate for Payer: First Health Commercial |
$7,823.25
|
| Rate for Payer: Humana Commercial |
$6,999.75
|
| Rate for Payer: Humana KY Medicaid |
$2,832.02
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,860.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,888.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.85
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
IR ANGIO MESENTERIC PLEXUS (P
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320P1018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$685.53 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$685.53
|
| Rate for Payer: Healthspan PPO |
$413.25
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
IR ANGIO MESENTERIC PLEXUS (T
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T1018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
IR ANGIO MESENTERIC PLEXUS (T
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T1018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem Medicaid |
$2,716.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Humana KY Medicaid |
$2,716.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,744.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,771.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
IR EMBOLIZATION ANY METHOD
|
Professional
|
Both
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,728.00
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.78
|
| Rate for Payer: Humana Medicaid |
$708.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.23
|
| Rate for Payer: Molina Healthcare Passport |
$708.07
|
| Rate for Payer: Multiplan PHCS |
$2,836.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,309.60
|
| Rate for Payer: UHCCP Medicaid |
$1,654.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.15
|
|
|
IR EMBOLIZATION ANY METHOD
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.64 |
| Max. Negotiated Rate |
$4,538.88 |
| Rate for Payer: Aetna Commercial |
$3,640.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,687.84
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$3,924.24
|
| Rate for Payer: First Health Commercial |
$4,491.60
|
| Rate for Payer: Humana Commercial |
$4,018.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,876.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,489.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,160.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.68
|
| Rate for Payer: PHCS Commercial |
$4,538.88
|
| Rate for Payer: United Healthcare All Payer |
$4,160.64
|
|
|
IR EMBOLIZATION ANY METHOD
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.64 |
| Max. Negotiated Rate |
$4,538.88 |
| Rate for Payer: Aetna Commercial |
$3,640.56
|
| Rate for Payer: Anthem Medicaid |
$1,625.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,687.84
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$3,924.24
|
| Rate for Payer: First Health Commercial |
$4,491.60
|
| Rate for Payer: Humana Commercial |
$4,018.80
|
| Rate for Payer: Humana KY Medicaid |
$1,625.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,642.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,876.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,489.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,658.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,160.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.68
|
| Rate for Payer: PHCS Commercial |
$4,538.88
|
| Rate for Payer: United Healthcare All Payer |
$4,160.64
|
|
|
IR EMBOLIZATION ANY METHOD (P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320P1020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,466.53 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.78
|
| Rate for Payer: Humana Medicaid |
$708.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.23
|
| Rate for Payer: Molina Healthcare Passport |
$708.07
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.15
|
|
|
IR EMBOLIZATION ANY METHOD (T
|
Facility
|
IP
|
$4,503.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T1020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$585.39 |
| Max. Negotiated Rate |
$4,322.88 |
| Rate for Payer: Aetna Commercial |
$3,467.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,512.34
|
| Rate for Payer: Cash Price |
$2,251.50
|
| Rate for Payer: Cigna Commercial |
$3,737.49
|
| Rate for Payer: First Health Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial |
$3,827.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,692.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,323.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,962.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.93
|
| Rate for Payer: PHCS Commercial |
$4,322.88
|
| Rate for Payer: United Healthcare All Payer |
$3,962.64
|
|
|
IR EMBOLIZATION ANY METHOD (T
|
Facility
|
OP
|
$4,503.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T1020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$585.39 |
| Max. Negotiated Rate |
$4,322.88 |
| Rate for Payer: Aetna Commercial |
$3,467.31
|
| Rate for Payer: Anthem Medicaid |
$1,548.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,512.34
|
| Rate for Payer: Cash Price |
$2,251.50
|
| Rate for Payer: Cigna Commercial |
$3,737.49
|
| Rate for Payer: First Health Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial |
$3,827.55
|
| Rate for Payer: Humana KY Medicaid |
$1,548.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,564.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,692.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,323.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,962.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.93
|
| Rate for Payer: PHCS Commercial |
$4,322.88
|
| Rate for Payer: United Healthcare All Payer |
$3,962.64
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.55 |
| Max. Negotiated Rate |
$2,241.60 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,821.30
|
| Rate for Payer: Cash Price |
$1,167.50
|
| Rate for Payer: Cigna Commercial |
$1,938.05
|
| Rate for Payer: First Health Commercial |
$2,218.25
|
| Rate for Payer: Humana Commercial |
$1,984.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,914.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,054.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,751.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.85
|
| Rate for Payer: PHCS Commercial |
$2,241.60
|
| Rate for Payer: United Healthcare All Payer |
$2,054.80
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.55 |
| Max. Negotiated Rate |
$2,241.60 |
| Rate for Payer: Aetna Commercial |
$1,797.95
|
| Rate for Payer: Anthem Medicaid |
$803.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,821.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,167.50
|
| Rate for Payer: Cash Price |
$1,167.50
|
| Rate for Payer: Cigna Commercial |
$1,938.05
|
| Rate for Payer: First Health Commercial |
$2,218.25
|
| Rate for Payer: Humana Commercial |
$1,984.75
|
| Rate for Payer: Humana KY Medicaid |
$803.01
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$811.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,914.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,723.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$819.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,054.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,751.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.85
|
| Rate for Payer: PHCS Commercial |
$2,241.60
|
| Rate for Payer: United Healthcare All Payer |
$2,054.80
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$2,335.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$76.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,335.00
|
| Rate for Payer: Cash Price |
$1,167.50
|
| Rate for Payer: Cash Price |
$1,167.50
|
| Rate for Payer: Cigna Commercial |
$452.21
|
| Rate for Payer: Humana Medicaid |
$76.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.13
|
| Rate for Payer: Molina Healthcare Passport |
$76.60
|
| Rate for Payer: Multiplan PHCS |
$1,401.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,634.50
|
| Rate for Payer: UHCCP Medicaid |
$48.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.37
|
|
|
IR FNA BX W/FLUOR GDN 1ST (P
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
761P2780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$452.21 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$76.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$452.21
|
| Rate for Payer: Humana Medicaid |
$76.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.13
|
| Rate for Payer: Molina Healthcare Passport |
$76.60
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$48.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.37
|
|
|
IR FNA BX W/FLUOR GDN 1ST (T
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
761T2780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$1,939.20 |
| Rate for Payer: Aetna Commercial |
$1,555.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,676.60
|
| Rate for Payer: First Health Commercial |
$1,919.00
|
| Rate for Payer: Humana Commercial |
$1,717.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,656.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,777.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.20
|
| Rate for Payer: PHCS Commercial |
$1,939.20
|
| Rate for Payer: United Healthcare All Payer |
$1,777.60
|
|
|
IR FNA BX W/FLUOR GDN 1ST (T
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
761T2780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$1,939.20 |
| Rate for Payer: Aetna Commercial |
$1,555.40
|
| Rate for Payer: Anthem Medicaid |
$694.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,575.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,676.60
|
| Rate for Payer: First Health Commercial |
$1,919.00
|
| Rate for Payer: Humana Commercial |
$1,717.00
|
| Rate for Payer: Humana KY Medicaid |
$694.68
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$701.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,656.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,777.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.20
|
| Rate for Payer: PHCS Commercial |
$1,939.20
|
| Rate for Payer: United Healthcare All Payer |
$1,777.60
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.44
|
| Rate for Payer: Anthem Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,079.00
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$255.53
|
| Rate for Payer: Humana Medicaid |
$49.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.94
|
| Rate for Payer: Molina Healthcare Passport |
$49.94
|
| Rate for Payer: Multiplan PHCS |
$647.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$755.30
|
| Rate for Payer: UHCCP Medicaid |
$19.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.44
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.27 |
| Max. Negotiated Rate |
$1,035.84 |
| Rate for Payer: Aetna Commercial |
$830.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$841.62
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$895.57
|
| Rate for Payer: First Health Commercial |
$1,025.05
|
| Rate for Payer: Humana Commercial |
$917.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$796.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$949.52
|
| Rate for Payer: Ohio Health Group HMO |
$809.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.49
|
| Rate for Payer: PHCS Commercial |
$1,035.84
|
| Rate for Payer: United Healthcare All Payer |
$949.52
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.27 |
| Max. Negotiated Rate |
$1,035.84 |
| Rate for Payer: Aetna Commercial |
$830.83
|
| Rate for Payer: Anthem Medicaid |
$371.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$841.62
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$895.57
|
| Rate for Payer: First Health Commercial |
$1,025.05
|
| Rate for Payer: Humana Commercial |
$917.15
|
| Rate for Payer: Humana KY Medicaid |
$371.07
|
| Rate for Payer: Kentucky WC Medicaid |
$374.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$796.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$949.52
|
| Rate for Payer: Ohio Health Group HMO |
$809.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.49
|
| Rate for Payer: PHCS Commercial |
$1,035.84
|
| Rate for Payer: United Healthcare All Payer |
$949.52
|
|
|
IR FNA BX W/FLUOR GDN EA AD (P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761P2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$255.53 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.44
|
| Rate for Payer: Anthem Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$255.53
|
| Rate for Payer: Humana Medicaid |
$49.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.94
|
| Rate for Payer: Molina Healthcare Passport |
$49.94
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$19.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.44
|
|
|
IR FNA BX W/FLUOR GDN EA AD (T
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761T2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem Medicaid |
$307.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Humana KY Medicaid |
$307.45
|
| Rate for Payer: Kentucky WC Medicaid |
$310.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.14
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
