|
LIGAMENT RECON KNEE INTARTIC
|
Facility
|
OP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
76100843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem Medicaid |
$1,215.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Humana KY Medicaid |
$1,215.69
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,228.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,240.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.85
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
LIGAMENT RECON KNEE INTARTIC
|
Facility
|
IP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
76100843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$3,393.60 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.85
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
LIGAMENT RECON KNEE INTARTIC(P
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
761P0843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.89 |
| Max. Negotiated Rate |
$3,535.00 |
| Rate for Payer: Aetna Commercial |
$1,625.81
|
| Rate for Payer: Anthem Medicaid |
$745.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,535.00
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$1,759.85
|
| Rate for Payer: Healthspan PPO |
$1,472.63
|
| Rate for Payer: Humana Medicaid |
$745.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,382.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$760.81
|
| Rate for Payer: Molina Healthcare Passport |
$745.89
|
| Rate for Payer: Multiplan PHCS |
$2,121.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,474.50
|
| Rate for Payer: UHCCP Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$753.35
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$377.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$2,233.00
|
| Rate for Payer: Anthem Medicaid |
$997.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,262.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$2,407.00
|
| Rate for Payer: First Health Commercial |
$2,755.00
|
| Rate for Payer: Humana Commercial |
$2,465.00
|
| Rate for Payer: Humana KY Medicaid |
$997.31
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,007.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,378.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,140.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,017.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,552.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$899.00
|
| Rate for Payer: PHCS Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare All Payer |
$2,552.00
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$377.00 |
| Max. Negotiated Rate |
$2,784.00 |
| Rate for Payer: Aetna Commercial |
$2,233.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,262.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$2,407.00
|
| Rate for Payer: First Health Commercial |
$2,755.00
|
| Rate for Payer: Humana Commercial |
$2,465.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,378.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,140.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,552.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$899.00
|
| Rate for Payer: PHCS Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare All Payer |
$2,552.00
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
761P0842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.63 |
| Max. Negotiated Rate |
$2,900.00 |
| Rate for Payer: Aetna Commercial |
$1,055.85
|
| Rate for Payer: Anthem Medicaid |
$607.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,900.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$1,154.45
|
| Rate for Payer: Healthspan PPO |
$956.38
|
| Rate for Payer: Humana Medicaid |
$607.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$888.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.78
|
| Rate for Payer: Molina Healthcare Passport |
$607.63
|
| Rate for Payer: Multiplan PHCS |
$1,740.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,030.00
|
| Rate for Payer: UHCCP Medicaid |
$1,015.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.71
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.63 |
| Max. Negotiated Rate |
$2,900.00 |
| Rate for Payer: Aetna Commercial |
$1,055.85
|
| Rate for Payer: Anthem Medicaid |
$607.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,900.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$1,154.45
|
| Rate for Payer: Healthspan PPO |
$956.38
|
| Rate for Payer: Humana Medicaid |
$607.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$888.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.78
|
| Rate for Payer: Molina Healthcare Passport |
$607.63
|
| Rate for Payer: Multiplan PHCS |
$1,740.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,030.00
|
| Rate for Payer: UHCCP Medicaid |
$1,015.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.71
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
76101574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
IP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
45000241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
761P1574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.69 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$590.19
|
| Rate for Payer: Anthem Medicaid |
$270.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Healthspan PPO |
$471.91
|
| Rate for Payer: Humana Medicaid |
$270.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.10
|
| Rate for Payer: Molina Healthcare Passport |
$270.69
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.40
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
76101574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
OP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
45000241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem Medicaid |
$1,423.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| 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 |
$2,069.00
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Humana KY Medicaid |
$1,423.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
76101574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.69 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$590.19
|
| Rate for Payer: Anthem Medicaid |
$270.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Healthspan PPO |
$471.91
|
| Rate for Payer: Humana Medicaid |
$270.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.10
|
| Rate for Payer: Molina Healthcare Passport |
$270.69
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.40
|
|
|
LIGATE/STRIP LONG LEG VEIN
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 37722
|
| Hospital Charge Code |
76101579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$1,095.60
|
| Rate for Payer: First Health Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial |
$1,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.20
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
LIGATE/STRIP LONG LEG VEIN
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 37722
|
| Hospital Charge Code |
76101579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem Medicaid |
$453.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| 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 |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$1,095.60
|
| Rate for Payer: First Health Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial |
$1,122.00
|
| Rate for Payer: Humana KY Medicaid |
$453.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$458.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$463.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.20
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
LIGATE/STRIP LONG LEG VEIN
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 37722
|
| Hospital Charge Code |
76101579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.19 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$739.63
|
| Rate for Payer: Anthem Medicaid |
$366.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,320.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$712.33
|
| Rate for Payer: Healthspan PPO |
$591.40
|
| Rate for Payer: Humana Medicaid |
$366.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.51
|
| Rate for Payer: Molina Healthcare Passport |
$366.19
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$924.00
|
| Rate for Payer: UHCCP Medicaid |
$462.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.85
|
|
|
LIGATE/STRIP LONG LEG VEIN(P
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 37722
|
| Hospital Charge Code |
761P1579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.19 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$739.63
|
| Rate for Payer: Anthem Medicaid |
$366.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,320.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$712.33
|
| Rate for Payer: Healthspan PPO |
$591.40
|
| Rate for Payer: Humana Medicaid |
$366.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.51
|
| Rate for Payer: Molina Healthcare Passport |
$366.19
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$924.00
|
| Rate for Payer: UHCCP Medicaid |
$462.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.85
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.86 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,178.11
|
| Rate for Payer: Anthem Medicaid |
$506.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,144.82
|
| Rate for Payer: Healthspan PPO |
$993.52
|
| Rate for Payer: Humana Medicaid |
$506.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,058.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.00
|
| Rate for Payer: Molina Healthcare Passport |
$506.86
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.93
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| 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 |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
761P1142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.86 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,178.11
|
| Rate for Payer: Anthem Medicaid |
$506.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,144.82
|
| Rate for Payer: Healthspan PPO |
$993.52
|
| Rate for Payer: Humana Medicaid |
$506.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,058.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$517.00
|
| Rate for Payer: Molina Healthcare Passport |
$506.86
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.93
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
LIGATION,CEPHALIC VEIN SIDE BR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
LIGATION,CEPHALIC VEIN SIDE BR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
LIGATION,CEPHALIC VEIN SIDE BR
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
|
