|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ANGIO-SEAL VAS CLOSURE 6F
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
ANGIO-SEAL VAS CLOSURE 6F
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
ANGIO THROUGH EXISTING CATH
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$530.70 |
| 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 |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| 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 |
$608.36 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem Medicaid |
$608.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
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 |
$1,238.30 |
| Rate for Payer: Aetna Commercial |
$198.71
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| 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(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 |
$268.26 |
| Rate for Payer: Aetna Commercial |
$198.71
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| 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
|
IP
|
$1,469.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
320T0177
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$440.70 |
| 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 |
$1,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,278.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.61
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
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 |
$505.19 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,131.13
|
| Rate for Payer: Anthem Medicaid |
$505.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$1,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,278.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.61
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
ANGLED PIG 125CM
|
Facility
|
OP
|
$171.52
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$164.66 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: Anthem Medicaid |
$58.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.79
|
| Rate for Payer: Cash Price |
$85.76
|
| Rate for Payer: Cigna Commercial |
$142.36
|
| Rate for Payer: First Health Commercial |
$162.94
|
| Rate for Payer: Humana Commercial |
$145.79
|
| Rate for Payer: Humana KY Medicaid |
$58.99
|
| Rate for Payer: Kentucky WC Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.94
|
| Rate for Payer: Ohio Health Group HMO |
$128.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.35
|
| Rate for Payer: PHCS Commercial |
$164.66
|
| Rate for Payer: United Healthcare All Payer |
$150.94
|
|
|
ANGLED PIG 125CM
|
Facility
|
IP
|
$171.52
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$164.66 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.79
|
| Rate for Payer: Cash Price |
$85.76
|
| Rate for Payer: Cigna Commercial |
$142.36
|
| Rate for Payer: First Health Commercial |
$162.94
|
| Rate for Payer: Humana Commercial |
$145.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.94
|
| Rate for Payer: Ohio Health Group HMO |
$128.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.35
|
| Rate for Payer: PHCS Commercial |
$164.66
|
| Rate for Payer: United Healthcare All Payer |
$150.94
|
|
|
ANGLED QUICK CROSS GC 0.014
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
ANGLED QUICK CROSS GC 0.014
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem Medicaid |
$662.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Humana KY Medicaid |
$662.70
|
| Rate for Payer: Kentucky WC Medicaid |
$669.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
ANKLE 2V
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ANKLE 2V
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ANKLE 2V
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
32000106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Ambetter Exchange |
$28.83
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.60
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$28.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
|
|
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 |
$40.28 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Ambetter Exchange |
$28.83
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$28.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.83
|
| 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 |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
|
|
ANKLE 2V(T
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
320T0106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$117.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$117.27
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$118.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
ANKLE 2V(T
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
320T0106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
ANKLE MIN OF 3V
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Ambetter Exchange |
$32.69
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.23
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$44.19
|
| Rate for Payer: Healthspan PPO |
$43.29
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.50
|
| Rate for Payer: UHCCP Medicaid |
$177.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.69
|
|
|
ANKLE MIN OF 3V
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Humana KY Medicaid |
$174.70
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
ANKLE MIN OF 3V
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
ANKLE MIN OF 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320P0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Ambetter Exchange |
$32.69
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.23
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$44.19
|
| Rate for Payer: Healthspan PPO |
$43.29
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.50
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.69
|
|
