|
OPEN/PERQ PLACE STENT 1ST
|
Professional
|
Both
|
$5,375.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
76101560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.33 |
| Max. Negotiated Rate |
$3,428.17 |
| Rate for Payer: Ambetter Exchange |
$412.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$365.33
|
| Rate for Payer: Anthem Medicaid |
$2,096.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$412.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$412.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$494.77
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$852.94
|
| Rate for Payer: Healthspan PPO |
$3,428.17
|
| Rate for Payer: Humana Medicaid |
$2,096.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$614.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$412.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,138.86
|
| Rate for Payer: Molina Healthcare Passport |
$2,096.92
|
| Rate for Payer: Multiplan PHCS |
$3,225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$536.00
|
| Rate for Payer: UHCCP Medicaid |
$383.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,117.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$412.31
|
|
|
OPEN/PERQ PLACE STENT 1ST(P
|
Professional
|
Both
|
$5,375.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
761P1560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.33 |
| Max. Negotiated Rate |
$3,428.17 |
| Rate for Payer: Ambetter Exchange |
$412.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$365.33
|
| Rate for Payer: Anthem Medicaid |
$2,096.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$412.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$412.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$494.77
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$852.94
|
| Rate for Payer: Healthspan PPO |
$3,428.17
|
| Rate for Payer: Humana Medicaid |
$2,096.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$614.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$412.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,138.86
|
| Rate for Payer: Molina Healthcare Passport |
$2,096.92
|
| Rate for Payer: Multiplan PHCS |
$3,225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$536.00
|
| Rate for Payer: UHCCP Medicaid |
$383.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,117.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$412.31
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 37239
|
| Hospital Charge Code |
76101563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 37237
|
| Hospital Charge Code |
76101561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 37239
|
| Hospital Charge Code |
76101563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$2,473.56 |
| Rate for Payer: Ambetter Exchange |
$141.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.39
|
| Rate for Payer: Anthem Medicaid |
$1,512.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.39
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$278.38
|
| Rate for Payer: Healthspan PPO |
$2,473.56
|
| Rate for Payer: Humana Medicaid |
$1,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$141.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,542.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,512.31
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.51
|
| Rate for Payer: UHCCP Medicaid |
$125.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,527.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.16
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 37239
|
| Hospital Charge Code |
76101563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 37237
|
| Hospital Charge Code |
76101561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.04 |
| Max. Negotiated Rate |
$1,491.14 |
| Rate for Payer: Ambetter Exchange |
$197.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.04
|
| Rate for Payer: Anthem Medicaid |
$911.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.36
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$398.84
|
| Rate for Payer: Healthspan PPO |
$1,491.14
|
| Rate for Payer: Humana Medicaid |
$911.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$930.08
|
| Rate for Payer: Molina Healthcare Passport |
$911.84
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.14
|
| Rate for Payer: UHCCP Medicaid |
$179.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$920.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.80
|
|
|
OPEN/PERQ PLACE STENT EA ADD
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 37237
|
| Hospital Charge Code |
76101561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
OPEN/PERQ PLACE STENT EA AD(P
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 37237
|
| Hospital Charge Code |
761P1561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.04 |
| Max. Negotiated Rate |
$1,491.14 |
| Rate for Payer: Ambetter Exchange |
$197.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.04
|
| Rate for Payer: Anthem Medicaid |
$911.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.36
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$398.84
|
| Rate for Payer: Healthspan PPO |
$1,491.14
|
| Rate for Payer: Humana Medicaid |
$911.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$930.08
|
| Rate for Payer: Molina Healthcare Passport |
$911.84
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.14
|
| Rate for Payer: UHCCP Medicaid |
$179.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$920.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.80
|
|
|
OPEN/PERQ PLACE STENT EA AD(P
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 37239
|
| Hospital Charge Code |
761P1563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$2,473.56 |
| Rate for Payer: Ambetter Exchange |
$141.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.39
|
| Rate for Payer: Anthem Medicaid |
$1,512.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.39
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$278.38
|
| Rate for Payer: Healthspan PPO |
$2,473.56
|
| Rate for Payer: Humana Medicaid |
$1,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$141.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,542.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,512.31
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.51
|
| Rate for Payer: UHCCP Medicaid |
$125.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,527.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.16
|
|
|
OPEN/PERQ PLACE STENT SAME
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
76101562
|
|
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
|
|
|
OPEN/PERQ PLACE STENT SAME
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
76101562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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
|
|
|
OPEN/PERQ PLACE STENT SAME
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
76101562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.89 |
| Max. Negotiated Rate |
$4,977.64 |
| Rate for Payer: Ambetter Exchange |
$286.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.89
|
| Rate for Payer: Anthem Medicaid |
$3,043.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.99
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$597.49
|
| Rate for Payer: Healthspan PPO |
$4,977.64
|
| Rate for Payer: Humana Medicaid |
$3,043.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,104.65
|
| Rate for Payer: Molina Healthcare Passport |
$3,043.77
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.66
|
| Rate for Payer: UHCCP Medicaid |
$268.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,074.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.66
|
|
|
OPEN/PERQ PLACE STENT SAME(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 37238
|
| Hospital Charge Code |
761P1562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.89 |
| Max. Negotiated Rate |
$4,977.64 |
| Rate for Payer: Ambetter Exchange |
$286.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.89
|
| Rate for Payer: Anthem Medicaid |
$3,043.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.99
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$597.49
|
| Rate for Payer: Healthspan PPO |
$4,977.64
|
| Rate for Payer: Humana Medicaid |
$3,043.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,104.65
|
| Rate for Payer: Molina Healthcare Passport |
$3,043.77
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.66
|
| Rate for Payer: UHCCP Medicaid |
$268.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,074.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.66
|
|
|
OPEN PROX HUM FX PROSTH RPLCMT
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 23616
|
| Hospital Charge Code |
76100481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.82 |
| Max. Negotiated Rate |
$23,788.86 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,992.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,788.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,939.25
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$16,992.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,390.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
OPEN PROX HUM FX PROSTH RPLCMT
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 23616
|
| Hospital Charge Code |
76100481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,172.03 |
| Max. Negotiated Rate |
$2,380.63 |
| Rate for Payer: Aetna Commercial |
$1,940.67
|
| Rate for Payer: Ambetter Exchange |
$1,172.03
|
| Rate for Payer: Anthem Medicaid |
$1,268.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,172.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,172.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,406.44
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,380.63
|
| Rate for Payer: Healthspan PPO |
$1,757.84
|
| Rate for Payer: Humana Medicaid |
$1,268.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,568.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,172.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,293.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,268.03
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,523.64
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,280.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,172.03
|
|
|
OPEN PROX HUM FX PROSTH RPLCMT
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 23616
|
| Hospital Charge Code |
76100481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
OPEN PROX HUM FX PROSTH RPLCMT
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 23616
|
| Hospital Charge Code |
761P0481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,172.03 |
| Max. Negotiated Rate |
$2,380.63 |
| Rate for Payer: Aetna Commercial |
$1,940.67
|
| Rate for Payer: Ambetter Exchange |
$1,172.03
|
| Rate for Payer: Anthem Medicaid |
$1,268.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,172.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,172.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,406.44
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,380.63
|
| Rate for Payer: Healthspan PPO |
$1,757.84
|
| Rate for Payer: Humana Medicaid |
$1,268.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,568.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,172.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,293.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,268.03
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,523.64
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,280.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,172.03
|
|
|
OPEN REPAIR RT HIP ABD TENDON
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76102903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
OPEN REPAIR RT HIP ABD TENDON
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76102903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,295.00 |
| Rate for Payer: Anthem Medicaid |
$1,040.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$1,040.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,060.80
|
| Rate for Payer: Molina Healthcare Passport |
$1,040.00
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,050.40
|
|
|
OPEN REPAIR RT HIP ABD TENDON
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76102903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
OPEN TREAT DEPRESS ARCH FRAC(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21356
|
| Hospital Charge Code |
761P0386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$614.79 |
| Rate for Payer: Aetna Commercial |
$530.48
|
| Rate for Payer: Ambetter Exchange |
$379.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$268.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$379.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$379.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$455.09
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$586.67
|
| Rate for Payer: Healthspan PPO |
$614.79
|
| Rate for Payer: Humana Medicaid |
$268.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$379.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.89
|
| Rate for Payer: Molina Healthcare Passport |
$268.52
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$493.01
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$379.24
|
|
|
OPEN TREAT DEPRESS ARCH FRAC(T
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS 21356
|
| Hospital Charge Code |
761T0386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,373.00 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,881.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,457.90
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
OPEN TREAT DEPRESS ARCH FRAC(T
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS 21356
|
| Hospital Charge Code |
761T0386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,720.25 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,881.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,457.90
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
OPEN TREAT DEPRESS ARCH FRACT
|
Professional
|
Both
|
$8,910.00
|
|
|
Service Code
|
HCPCS 21356
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$5,346.00 |
| Rate for Payer: Aetna Commercial |
$530.48
|
| Rate for Payer: Ambetter Exchange |
$379.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$268.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$379.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$379.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$455.09
|
| Rate for Payer: Cash Price |
$4,455.00
|
| Rate for Payer: Cash Price |
$4,455.00
|
| Rate for Payer: Cigna Commercial |
$586.67
|
| Rate for Payer: Healthspan PPO |
$614.79
|
| Rate for Payer: Humana Medicaid |
$268.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$379.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.89
|
| Rate for Payer: Molina Healthcare Passport |
$268.52
|
| Rate for Payer: Multiplan PHCS |
$5,346.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$493.01
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$379.24
|
|
