|
LIGATION MAJOR ARTERY EXTREMIT
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
761P1577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.77 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$577.98
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Healthspan PPO |
$462.14
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
LIGATION MAJOR ARTERY EXTREMIT
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
76101577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.77 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$577.98
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Healthspan PPO |
$462.14
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$503.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
LIGATION MAJOR ARTERY EXTREMIT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
76101577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LIGATION MAJOR ARTERY EXTREMIT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
76101577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
LIGATION NECK
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
76101576
|
|
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
|
|
|
LIGATION NECK
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
76101576
|
|
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
|
|
|
LIGATION NECK
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
76101576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.53 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$718.35
|
| Rate for Payer: Anthem Medicaid |
$306.53
|
| 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 |
$673.80
|
| Rate for Payer: Healthspan PPO |
$574.39
|
| Rate for Payer: Humana Medicaid |
$306.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.66
|
| Rate for Payer: Molina Healthcare Passport |
$306.53
|
| 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 |
$309.60
|
|
|
LIGATION NECK(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
761P1576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.53 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$718.35
|
| Rate for Payer: Anthem Medicaid |
$306.53
|
| 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 |
$673.80
|
| Rate for Payer: Healthspan PPO |
$574.39
|
| Rate for Payer: Humana Medicaid |
$306.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.66
|
| Rate for Payer: Molina Healthcare Passport |
$306.53
|
| 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 |
$309.60
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
LIGATION OF HEMORRHOID(S)
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.83
|
| Rate for Payer: Anthem Medicaid |
$52.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$316.31
|
| Rate for Payer: Healthspan PPO |
$281.54
|
| Rate for Payer: Humana Medicaid |
$52.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.80
|
| Rate for Payer: Molina Healthcare Passport |
$52.75
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.00
|
| Rate for Payer: UHCCP Medicaid |
$125.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.28
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem Medicaid |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$240.00
|
| 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: Humana KY Medicaid |
$165.07
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$166.75
|
| 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 |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.38
|
| 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
|
|
|
LIGATION OF HEMORRHOID(S)(P
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
761P1917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.83
|
| Rate for Payer: Anthem Medicaid |
$52.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$316.31
|
| Rate for Payer: Healthspan PPO |
$281.54
|
| Rate for Payer: Humana Medicaid |
$52.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.80
|
| Rate for Payer: Molina Healthcare Passport |
$52.75
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.00
|
| Rate for Payer: UHCCP Medicaid |
$125.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.28
|
|
|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 37607
|
|
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 OR BIOPSY ARTERY
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
76101575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$301.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.69
|
| Rate for Payer: Anthem Medicaid |
$135.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$287.41
|
| Rate for Payer: Healthspan PPO |
$342.63
|
| Rate for Payer: Humana Medicaid |
$135.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.10
|
| Rate for Payer: Molina Healthcare Passport |
$135.39
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$109.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.74
|
|
|
LIGATION OR BIOPSY ARTERY
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
76101575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
LIGATION OR BIOPSY ARTERY
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
76101575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Humana KY Medicaid |
$180.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$182.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
LIGATION OR BIOPSY ARTERY(P
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
761P1575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$301.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.69
|
| Rate for Payer: Anthem Medicaid |
$135.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$287.41
|
| Rate for Payer: Healthspan PPO |
$342.63
|
| Rate for Payer: Humana Medicaid |
$135.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.10
|
| Rate for Payer: Molina Healthcare Passport |
$135.39
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$109.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.74
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
LIGATION PERFORATORS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37760
|
| Hospital Charge Code |
76101580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LIGATION PERFORATORS
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37760
|
| Hospital Charge Code |
76101580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
LIGATION PERFORATORS
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37760
|
| Hospital Charge Code |
76101580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.06 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$980.28
|
| Rate for Payer: Anthem Medicaid |
$528.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$932.41
|
| Rate for Payer: Healthspan PPO |
$783.82
|
| Rate for Payer: Humana Medicaid |
$528.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$849.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$538.62
|
| Rate for Payer: Molina Healthcare Passport |
$528.06
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$533.34
|
|
|
LIGATION PERFORATORS(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37760
|
| Hospital Charge Code |
761P1580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.06 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$980.28
|
| Rate for Payer: Anthem Medicaid |
$528.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$932.41
|
| Rate for Payer: Healthspan PPO |
$783.82
|
| Rate for Payer: Humana Medicaid |
$528.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$849.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$538.62
|
| Rate for Payer: Molina Healthcare Passport |
$528.06
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$533.34
|
|
|
LIGATION VARICO 1 CLUSTR 1 LEG
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
76101583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LIGATION VARICO 1 CLUSTR 1 LEG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
76101583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.99 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$402.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.99
|
| Rate for Payer: Anthem Medicaid |
$135.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$384.40
|
| Rate for Payer: Healthspan PPO |
$421.63
|
| Rate for Payer: Humana Medicaid |
$135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$343.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.82
|
| Rate for Payer: Molina Healthcare Passport |
$135.12
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$137.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.47
|
|
|
LIGATION VARICO 1 CLUSTR 1 LEG
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
76101583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
