|
ANGIOSCULPT RX PTCA 3.5*15
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT RX PTCA 3.5*15
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT RX PTCA 3.5*6
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
| Rate for Payer: Aetna Commercial |
$3,850.00
|
|
|
ANGIOSCULPT RX PTCA 3.5*6
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT RX PTCA 3*6
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIOSCULPT RX PTCA 3*6
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIO-SEAL VAS CLOSURE 6F
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Aetna Commercial |
$1,605.45
|
| Rate for Payer: Anthem Medicaid |
$717.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
| Rate for Payer: Cash Price |
$1,042.50
|
| Rate for Payer: Cigna Commercial |
$1,730.55
|
| Rate for Payer: First Health Commercial |
$1,980.75
|
| Rate for Payer: Humana Commercial |
$1,772.25
|
| Rate for Payer: Humana KY Medicaid |
$717.03
|
| Rate for Payer: Kentucky WC Medicaid |
$724.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$731.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
| Rate for Payer: PHCS Commercial |
$2,001.60
|
| Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
|
ANGIO-SEAL VAS CLOSURE 6F
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Aetna Commercial |
$1,605.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
| Rate for Payer: Cash Price |
$1,042.50
|
| Rate for Payer: Cigna Commercial |
$1,730.55
|
| Rate for Payer: First Health Commercial |
$1,980.75
|
| Rate for Payer: Humana Commercial |
$1,772.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
| Rate for Payer: PHCS Commercial |
$2,001.60
|
| Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
|
ANGIO THROUGH EXISTING CATH
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: Aetna Commercial |
$198.71
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,769.00
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$183.54
|
| Rate for Payer: Healthspan PPO |
$268.26
|
| Rate for Payer: Humana Medicaid |
$99.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.45
|
| Rate for Payer: Molina Healthcare Passport |
$99.46
|
| Rate for Payer: Multiplan PHCS |
$1,061.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,238.30
|
| Rate for Payer: UHCCP Medicaid |
$619.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.45
|
|
|
ANGIO THROUGH EXISTING CATH
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$229.97 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.39
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
ANGIO THROUGH EXISTING CATH
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$229.97 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem Medicaid |
$608.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Humana KY Medicaid |
$608.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$614.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.39
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
ANGIO THROUGH EXISTING CATH(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
320P0177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$198.71
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$183.54
|
| Rate for Payer: Healthspan PPO |
$268.26
|
| Rate for Payer: Humana Medicaid |
$99.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.45
|
| Rate for Payer: Molina Healthcare Passport |
$99.46
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.45
|
|
|
ANGIO THROUGH EXISTING CATH(T
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
320T0177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$190.97 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,131.13
|
| Rate for Payer: Anthem Medicaid |
$505.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cigna Commercial |
$1,219.27
|
| Rate for Payer: First Health Commercial |
$1,395.55
|
| Rate for Payer: Humana Commercial |
$1,248.65
|
| Rate for Payer: Humana KY Medicaid |
$505.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$510.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,204.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$515.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,292.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.39
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
ANGIO THROUGH EXISTING CATH(T
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
320T0177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$190.97 |
| Max. Negotiated Rate |
$1,410.24 |
| Rate for Payer: Aetna Commercial |
$1,131.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.82
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cigna Commercial |
$1,219.27
|
| Rate for Payer: First Health Commercial |
$1,395.55
|
| Rate for Payer: Humana Commercial |
$1,248.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,204.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,292.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.39
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
ANGLED PIG 125CM
|
Facility
|
IP
|
$165.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.41 |
| Rate for Payer: Aetna Commercial |
$127.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.71
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cigna Commercial |
$136.96
|
| Rate for Payer: First Health Commercial |
$156.76
|
| Rate for Payer: Humana Commercial |
$140.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.21
|
| Rate for Payer: Ohio Health Group HMO |
$123.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.41
|
| Rate for Payer: United Healthcare All Payer |
$145.21
|
|
|
ANGLED PIG 125CM
|
Facility
|
OP
|
$165.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.41 |
| Rate for Payer: Aetna Commercial |
$127.06
|
| Rate for Payer: Anthem Medicaid |
$56.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.71
|
| Rate for Payer: Cash Price |
$82.51
|
| Rate for Payer: Cigna Commercial |
$136.96
|
| Rate for Payer: First Health Commercial |
$156.76
|
| Rate for Payer: Humana Commercial |
$140.26
|
| Rate for Payer: Humana KY Medicaid |
$56.75
|
| Rate for Payer: Kentucky WC Medicaid |
$57.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.21
|
| Rate for Payer: Ohio Health Group HMO |
$123.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.41
|
| Rate for Payer: United Healthcare All Payer |
$145.21
|
|
|
ANGLED QUICK CROSS GC 0.014
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
ANGLED QUICK CROSS GC 0.014
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
ANKLE 2V
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$37.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$229.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$133.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
ANKLE 2V
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
ANKLE 2V
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem Medicaid |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Humana KY Medicaid |
$131.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$132.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
ANKLE 2V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
320P0106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$37.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
ANKLE 2V(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
320T0106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
ANKLE 2V(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
320T0106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
ANKLE MIN OF 3V
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.80
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
