|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
IP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
45000241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,241.40 |
| 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 |
$3,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,600.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,855.22
|
| 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 |
$660.00 |
| Rate for Payer: Aetna Commercial |
$590.19
|
| Rate for Payer: Ambetter Exchange |
$350.88
|
| Rate for Payer: Anthem Medicaid |
$270.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$350.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.88
|
| 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 |
$456.14
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.88
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
76101574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
76101574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
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 |
$660.00 |
| Rate for Payer: Aetna Commercial |
$590.19
|
| Rate for Payer: Ambetter Exchange |
$350.88
|
| Rate for Payer: Anthem Medicaid |
$270.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$350.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.88
|
| 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 |
$456.14
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.88
|
|
|
LIGAT BAND ANGIOACES ARTVNFIST
|
Facility
|
OP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
45000241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,423.06 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem Medicaid |
$1,423.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,600.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,855.22
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
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 |
$453.95 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem Medicaid |
$453.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$910.80
|
| 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 |
$792.00 |
| Rate for Payer: Aetna Commercial |
$739.63
|
| Rate for Payer: Ambetter Exchange |
$431.55
|
| Rate for Payer: Anthem Medicaid |
$366.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$431.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.55
|
| 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 |
$561.01
|
| Rate for Payer: UHCCP Medicaid |
$462.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.55
|
|
|
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 |
$396.00 |
| 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 |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$910.80
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
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 |
$792.00 |
| Rate for Payer: Aetna Commercial |
$739.63
|
| Rate for Payer: Ambetter Exchange |
$431.55
|
| Rate for Payer: Anthem Medicaid |
$366.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$431.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.55
|
| 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 |
$561.01
|
| Rate for Payer: UHCCP Medicaid |
$462.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.55
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
LIGATION ARTERIES INTERNAL MAX
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 30920
|
| Hospital Charge Code |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| 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 |
76101142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.86 |
| Max. Negotiated Rate |
$1,178.11 |
| Rate for Payer: Aetna Commercial |
$1,178.11
|
| Rate for Payer: Ambetter Exchange |
$808.71
|
| Rate for Payer: Anthem Medicaid |
$506.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$808.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$808.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$970.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$808.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.71
|
| 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 |
$1,051.32
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$808.71
|
|
|
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 |
$1,178.11 |
| Rate for Payer: Aetna Commercial |
$1,178.11
|
| Rate for Payer: Ambetter Exchange |
$808.71
|
| Rate for Payer: Anthem Medicaid |
$506.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$808.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$808.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$970.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$808.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.71
|
| 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 |
$1,051.32
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$808.71
|
|
|
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 |
$840.00 |
| 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 |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| 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 |
$1,960.00 |
| 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
|
|
|
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 |
$571.26 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
LIGATION MAJOR ARTERY EXTREMIT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
76101577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| 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 |
$390.00 |
| 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 |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
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 |
$780.00 |
| Rate for Payer: Aetna Commercial |
$577.98
|
| Rate for Payer: Ambetter Exchange |
$368.28
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$368.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$368.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$368.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$368.28
|
| 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 |
$478.76
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$368.28
|
|
|
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 |
$780.00 |
| Rate for Payer: Aetna Commercial |
$577.98
|
| Rate for Payer: Ambetter Exchange |
$368.28
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$368.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$368.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$368.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$368.28
|
| 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 |
$478.76
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$368.28
|
|
|
LIGATION NECK
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
76101576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LIGATION NECK
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 37615
|
| Hospital Charge Code |
76101576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| 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 |
$718.35 |
| Rate for Payer: Aetna Commercial |
$718.35
|
| Rate for Payer: Ambetter Exchange |
$486.30
|
| Rate for Payer: Anthem Medicaid |
$306.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$486.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$486.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$583.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$486.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.30
|
| 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 |
$632.19
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$486.30
|
|
