|
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 |
$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
|
|
|
LIGATION OF HEMORRHOID(S)
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Ambetter Exchange |
$181.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.83
|
| Rate for Payer: Anthem Medicaid |
$61.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.14
|
| 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 |
$61.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.83
|
| Rate for Payer: Molina Healthcare Passport |
$61.60
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.31
|
| Rate for Payer: UHCCP Medicaid |
$125.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.78
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.00 |
| 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 |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.20
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
76101917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem Medicaid |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| 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 |
$842.40
|
| 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 |
$1,010.88
|
| 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 |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.20
|
| 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 |
$61.60 |
| Max. Negotiated Rate |
$316.31 |
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Ambetter Exchange |
$181.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.83
|
| Rate for Payer: Anthem Medicaid |
$61.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.14
|
| 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 |
$61.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.83
|
| Rate for Payer: Molina Healthcare Passport |
$61.60
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.31
|
| Rate for Payer: UHCCP Medicaid |
$125.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.78
|
|
|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 37607
|
|
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 OR BIOPSY ARTERY
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
76101575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| 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 |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| 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 |
$180.55 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| 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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
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 |
$342.63 |
| Rate for Payer: Aetna Commercial |
$301.13
|
| Rate for Payer: Ambetter Exchange |
$191.06
|
| 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 Individual/Medicaid |
$191.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.27
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.06
|
| 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 |
$248.38
|
| Rate for Payer: UHCCP Medicaid |
$109.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.06
|
|
|
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 |
$342.63 |
| Rate for Payer: Aetna Commercial |
$301.13
|
| Rate for Payer: Ambetter Exchange |
$191.06
|
| 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 Individual/Medicaid |
$191.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.27
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.06
|
| 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 |
$248.38
|
| Rate for Payer: UHCCP Medicaid |
$109.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.06
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
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 |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$980.28
|
| Rate for Payer: Ambetter Exchange |
$543.92
|
| Rate for Payer: Anthem Medicaid |
$528.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$543.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$543.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$652.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$543.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.92
|
| 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 |
$707.10
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$533.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$543.92
|
|
|
LIGATION PERFORATORS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37760
|
| Hospital Charge Code |
76101580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| 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 |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
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 |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$980.28
|
| Rate for Payer: Ambetter Exchange |
$543.92
|
| Rate for Payer: Anthem Medicaid |
$528.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$543.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$543.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$652.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$543.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.92
|
| 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 |
$707.10
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$533.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$543.92
|
|
|
LIGATION VARICO 1 CLUSTR 1 LEG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
761P1583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.99 |
| Max. Negotiated Rate |
$421.63 |
| Rate for Payer: Aetna Commercial |
$402.61
|
| Rate for Payer: Ambetter Exchange |
$236.07
|
| 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 Individual/Medicaid |
$236.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$236.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.07
|
| 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 |
$306.89
|
| Rate for Payer: UHCCP Medicaid |
$137.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.07
|
|
|
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 |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| 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 |
$421.63 |
| Rate for Payer: Aetna Commercial |
$402.61
|
| Rate for Payer: Ambetter Exchange |
$236.07
|
| 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 Individual/Medicaid |
$236.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$236.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.07
|
| 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 |
$306.89
|
| Rate for Payer: UHCCP Medicaid |
$137.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.07
|
|
|
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 |
$206.34 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
LIG DIV SAPHENOFEM JUNC
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
76101578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$389.66
|
| Rate for Payer: Ambetter Exchange |
$229.82
|
| Rate for Payer: Anthem Medicaid |
$218.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.78
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$378.49
|
| Rate for Payer: Healthspan PPO |
$311.56
|
| Rate for Payer: Humana Medicaid |
$218.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$332.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.03
|
| Rate for Payer: Molina Healthcare Passport |
$218.66
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$298.77
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.82
|
|
|
LIG DIV SAPHENOFEM JUNC(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37700
|
| Hospital Charge Code |
761P1578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$389.66
|
| Rate for Payer: Ambetter Exchange |
$229.82
|
| Rate for Payer: Anthem Medicaid |
$218.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.78
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$378.49
|
| Rate for Payer: Healthspan PPO |
$311.56
|
| Rate for Payer: Humana Medicaid |
$218.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$332.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.03
|
| Rate for Payer: Molina Healthcare Passport |
$218.66
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$298.77
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.82
|
|
|
LILETTA 24HR IUD
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna Commercial |
$1,155.98
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,222.39
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
|
|
LILETTA 24HR IUD
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
