|
IP/OBS CONSLTJ NEW/EST SF 35
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 99252
|
| Hospital Charge Code |
51000333
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$120.30 |
| Rate for Payer: Aetna Commercial |
$120.30
|
| Rate for Payer: Anthem Medicaid |
$55.73
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$112.37
|
| Rate for Payer: Healthspan PPO |
$89.43
|
| Rate for Payer: Humana Medicaid |
$55.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.84
|
| Rate for Payer: Molina Healthcare Passport |
$55.73
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.29
|
|
|
IP/OBS CONSLTJ NEW/EST SF 35(P
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 99252
|
| Hospital Charge Code |
510P0333
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$120.30 |
| Rate for Payer: Aetna Commercial |
$120.30
|
| Rate for Payer: Anthem Medicaid |
$55.73
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$112.37
|
| Rate for Payer: Healthspan PPO |
$89.43
|
| Rate for Payer: Humana Medicaid |
$55.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.84
|
| Rate for Payer: Molina Healthcare Passport |
$55.73
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.29
|
|
|
IPS FACILITY CHARGE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000315
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
IPS FACILITY CHARGE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000315
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
IPS FACILITY CHARGE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000315
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
IPS FACILITY CHARGE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000315
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
IR ABLATE BONE PERCUT RF
|
Professional
|
Both
|
$3,900.00
|
|
|
Service Code
|
HCPCS 20982
|
| Hospital Charge Code |
320P1008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.81 |
| Max. Negotiated Rate |
$4,620.02 |
| Rate for Payer: Aetna Commercial |
$624.58
|
| Rate for Payer: Ambetter Exchange |
$346.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$298.81
|
| Rate for Payer: Anthem Medicaid |
$2,957.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.51
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$656.47
|
| Rate for Payer: Healthspan PPO |
$4,620.02
|
| Rate for Payer: Humana Medicaid |
$2,957.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$484.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$346.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,016.47
|
| Rate for Payer: Molina Healthcare Passport |
$2,957.32
|
| Rate for Payer: Multiplan PHCS |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.14
|
| Rate for Payer: UHCCP Medicaid |
$313.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,986.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.26
|
|
|
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 |
$2,535.00 |
| Rate for Payer: Aetna Commercial |
$1,300.68
|
| Rate for Payer: Ambetter Exchange |
$689.62
|
| 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 Individual/Medicaid |
$689.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$827.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$689.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.62
|
| 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 |
$896.51
|
| Rate for Payer: UHCCP Medicaid |
$531.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.62
|
|
|
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 |
$222.51 |
| Max. Negotiated Rate |
$3,376.85 |
| Rate for Payer: Aetna Commercial |
$517.71
|
| Rate for Payer: Ambetter Exchange |
$409.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.51
|
| Rate for Payer: Anthem Medicaid |
$1,913.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.10
|
| 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 |
$1,913.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,952.17
|
| Rate for Payer: Molina Healthcare Passport |
$1,913.89
|
| Rate for Payer: Multiplan PHCS |
$2,103.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.02
|
| Rate for Payer: UHCCP Medicaid |
$233.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,933.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.25
|
|
|
IR ANGIO MESENTERIC PLEXUS
|
Facility
|
IP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32001018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,470.50 |
| 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 |
$6,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.15
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
IR ANGIO MESENTERIC PLEXUS
|
Facility
|
OP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32001018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,832.02 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.15
|
| 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 |
$4,941.00 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Ambetter Exchange |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.49
|
| 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 |
$204.74
|
| Rate for Payer: UHCCP Medicaid |
$2,882.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.49
|
|
|
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: Ambetter Exchange |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.49
|
| 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 |
$204.74
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.49
|
|
|
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 |
$2,716.81 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,873.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,451.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
IR ANGIO MESENTERIC PLEXUS (T
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T1018
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,370.00 |
| 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 |
$6,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,873.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,451.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
IR EMBOLIZATION ANY METHOD
|
Facility
|
OP
|
$4,859.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,457.70 |
| Max. Negotiated Rate |
$4,664.64 |
| Rate for Payer: Aetna Commercial |
$3,741.43
|
| Rate for Payer: Anthem Medicaid |
$1,671.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.02
|
| Rate for Payer: Cash Price |
$2,429.50
|
| Rate for Payer: Cigna Commercial |
$4,032.97
|
| Rate for Payer: First Health Commercial |
$4,616.05
|
| Rate for Payer: Humana Commercial |
$4,130.15
|
| Rate for Payer: Humana KY Medicaid |
$1,671.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,984.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,585.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,275.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,227.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,352.71
|
| Rate for Payer: PHCS Commercial |
$4,664.64
|
| Rate for Payer: United Healthcare All Payer |
$4,275.92
|
|
|
IR EMBOLIZATION ANY METHOD
|
Professional
|
Both
|
$4,859.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$3,401.30 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| Rate for Payer: Cash Price |
$2,429.50
|
| Rate for Payer: Cash Price |
$2,429.50
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.77
|
| 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 |
$2,915.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,401.30
|
| Rate for Payer: UHCCP Medicaid |
$1,700.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.15
|
|
|
IR EMBOLIZATION ANY METHOD
|
Facility
|
IP
|
$4,859.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32001020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,457.70 |
| Max. Negotiated Rate |
$4,664.64 |
| Rate for Payer: Aetna Commercial |
$3,741.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.02
|
| Rate for Payer: Cash Price |
$2,429.50
|
| Rate for Payer: Cigna Commercial |
$4,032.97
|
| Rate for Payer: First Health Commercial |
$4,616.05
|
| Rate for Payer: Humana Commercial |
$4,130.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,984.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,585.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,275.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,227.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,352.71
|
| Rate for Payer: PHCS Commercial |
$4,664.64
|
| Rate for Payer: United Healthcare All Payer |
$4,275.92
|
|
|
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: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.77
|
| 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
|
$4,634.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T1020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,390.20 |
| Max. Negotiated Rate |
$4,448.64 |
| Rate for Payer: Aetna Commercial |
$3,568.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.52
|
| Rate for Payer: Cash Price |
$2,317.00
|
| Rate for Payer: Cigna Commercial |
$3,846.22
|
| Rate for Payer: First Health Commercial |
$4,402.30
|
| Rate for Payer: Humana Commercial |
$3,938.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,031.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,197.46
|
| Rate for Payer: PHCS Commercial |
$4,448.64
|
| Rate for Payer: United Healthcare All Payer |
$4,077.92
|
|
|
IR EMBOLIZATION ANY METHOD (T
|
Facility
|
OP
|
$4,634.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T1020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,390.20 |
| Max. Negotiated Rate |
$4,448.64 |
| Rate for Payer: Aetna Commercial |
$3,568.18
|
| Rate for Payer: Anthem Medicaid |
$1,593.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.52
|
| Rate for Payer: Cash Price |
$2,317.00
|
| Rate for Payer: Cigna Commercial |
$3,846.22
|
| Rate for Payer: First Health Commercial |
$4,402.30
|
| Rate for Payer: Humana Commercial |
$3,938.90
|
| Rate for Payer: Humana KY Medicaid |
$1,593.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,031.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,197.46
|
| Rate for Payer: PHCS Commercial |
$4,448.64
|
| Rate for Payer: United Healthcare All Payer |
$4,077.92
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
OP
|
$2,406.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,309.76 |
| Rate for Payer: Aetna Commercial |
$1,852.62
|
| Rate for Payer: Anthem Medicaid |
$827.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,876.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cigna Commercial |
$1,996.98
|
| Rate for Payer: First Health Commercial |
$2,285.70
|
| Rate for Payer: Humana Commercial |
$2,045.10
|
| Rate for Payer: Humana KY Medicaid |
$827.42
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$835.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,972.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,775.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$844.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,117.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,804.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,660.14
|
| Rate for Payer: PHCS Commercial |
$2,309.76
|
| Rate for Payer: United Healthcare All Payer |
$2,117.28
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Facility
|
IP
|
$2,406.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.80 |
| Max. Negotiated Rate |
$2,309.76 |
| Rate for Payer: Aetna Commercial |
$1,852.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,876.68
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cigna Commercial |
$1,996.98
|
| Rate for Payer: First Health Commercial |
$2,285.70
|
| Rate for Payer: Humana Commercial |
$2,045.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,972.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,775.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$721.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,117.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,804.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,660.14
|
| Rate for Payer: PHCS Commercial |
$2,309.76
|
| Rate for Payer: United Healthcare All Payer |
$2,117.28
|
|
|
IR FNA BX W/FLUOR GDN 1ST LES
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
76102780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$1,443.60 |
| Rate for Payer: Ambetter Exchange |
$84.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$217.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$84.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$84.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$101.40
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cash Price |
$1,203.00
|
| Rate for Payer: Cigna Commercial |
$452.21
|
| Rate for Payer: Humana Medicaid |
$217.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$84.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.68
|
| Rate for Payer: Molina Healthcare Passport |
$217.33
|
| Rate for Payer: Multiplan PHCS |
$1,443.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.85
|
| Rate for Payer: UHCCP Medicaid |
$48.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$84.50
|
|
|
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: Ambetter Exchange |
$84.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$217.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$84.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$84.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$101.40
|
| 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 |
$217.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$84.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.68
|
| Rate for Payer: Molina Healthcare Passport |
$217.33
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.85
|
| Rate for Payer: UHCCP Medicaid |
$48.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$84.50
|
|
