|
PERC SKEL FIX HUM EPCNDYLR FX
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
IP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,259.52 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,023.36
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$1,088.96
|
| Rate for Payer: First Health Commercial |
$1,246.40
|
| Rate for Payer: Humana Commercial |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,154.56
|
| Rate for Payer: Ohio Health Group HMO |
$984.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.72
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Anthem Medicaid |
$2.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,312.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$8.07
|
| Rate for Payer: Healthspan PPO |
$10.05
|
| Rate for Payer: Humana Medicaid |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.88
|
| Rate for Payer: Molina Healthcare Passport |
$2.82
|
| Rate for Payer: Multiplan PHCS |
$787.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$918.40
|
| Rate for Payer: UHCCP Medicaid |
$459.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.85
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
OP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,265.78 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Anthem Medicaid |
$451.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$904.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,023.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,265.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,220.58
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$1,088.96
|
| Rate for Payer: First Health Commercial |
$1,246.40
|
| Rate for Payer: Humana Commercial |
$1,115.20
|
| Rate for Payer: Humana KY Medicaid |
$451.20
|
| Rate for Payer: Humana Medicare Advantage |
$904.13
|
| Rate for Payer: Kentucky WC Medicaid |
$455.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,084.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,154.56
|
| Rate for Payer: Ohio Health Group HMO |
$984.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.72
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761P2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Anthem Medicaid |
$2.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.07
|
| Rate for Payer: Healthspan PPO |
$10.05
|
| Rate for Payer: Humana Medicaid |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.88
|
| Rate for Payer: Molina Healthcare Passport |
$2.82
|
| Rate for Payer: Multiplan PHCS |
$6.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.00
|
| Rate for Payer: UHCCP Medicaid |
$3.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.85
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761T2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.26 |
| Max. Negotiated Rate |
$1,265.78 |
| Rate for Payer: Aetna Commercial |
$1,002.54
|
| Rate for Payer: Anthem Medicaid |
$447.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$904.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,015.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,265.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,220.58
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna Commercial |
$1,080.66
|
| Rate for Payer: First Health Commercial |
$1,236.90
|
| Rate for Payer: Humana Commercial |
$1,106.70
|
| Rate for Payer: Humana KY Medicaid |
$447.76
|
| Rate for Payer: Humana Medicare Advantage |
$904.13
|
| Rate for Payer: Kentucky WC Medicaid |
$452.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,067.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,084.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,145.76
|
| Rate for Payer: Ohio Health Group HMO |
$976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.62
|
| Rate for Payer: PHCS Commercial |
$1,249.92
|
| Rate for Payer: United Healthcare All Payer |
$1,145.76
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761T2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.26 |
| Max. Negotiated Rate |
$1,249.92 |
| Rate for Payer: Aetna Commercial |
$1,002.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,015.56
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna Commercial |
$1,080.66
|
| Rate for Payer: First Health Commercial |
$1,236.90
|
| Rate for Payer: Humana Commercial |
$1,106.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,067.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,145.76
|
| Rate for Payer: Ohio Health Group HMO |
$976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.62
|
| Rate for Payer: PHCS Commercial |
$1,249.92
|
| Rate for Payer: United Healthcare All Payer |
$1,145.76
|
|
|
PERC TRANSLUM MECH THROMB VEIN
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
761P1528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$673.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$304.00
|
| Rate for Payer: Anthem Medicaid |
$331.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,100.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$620.61
|
| Rate for Payer: Healthspan PPO |
$2,683.26
|
| Rate for Payer: Humana Medicaid |
$331.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$544.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.48
|
| Rate for Payer: Molina Healthcare Passport |
$331.84
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,170.00
|
| Rate for Payer: UHCCP Medicaid |
$319.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.16
|
|
|
PERC TRANSLUM MECH THROMB VEIN
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
76101528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem Medicaid |
$1,066.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Humana KY Medicaid |
$1,066.09
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,076.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
PERC TRANSLUM MECH THROMB VEIN
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
76101528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$673.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$304.00
|
| Rate for Payer: Anthem Medicaid |
$331.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,100.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$620.61
|
| Rate for Payer: Healthspan PPO |
$2,683.26
|
| Rate for Payer: Humana Medicaid |
$331.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$544.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.48
|
| Rate for Payer: Molina Healthcare Passport |
$331.84
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,170.00
|
| Rate for Payer: UHCCP Medicaid |
$319.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.16
|
|
|
PERC TRANSLUM MECH THROMB VEIN
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37187
|
| Hospital Charge Code |
76101528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
PERCU. SKELE.FIX. OF METACARPA
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 26608
|
| Hospital Charge Code |
76100724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PERCU. SKELE.FIX. OF METACARPA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 26608
|
| Hospital Charge Code |
76100724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PERCU. SKELE.FIX. OF METACARPA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 26608
|
| Hospital Charge Code |
761P0724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$673.14
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$756.71
|
| Rate for Payer: Healthspan PPO |
$609.72
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.50
|
| Rate for Payer: Molina Healthcare Passport |
$259.31
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
|
|
PERCU. SKELE.FIX. OF METACARPA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 26608
|
| Hospital Charge Code |
76100724
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$673.14
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$756.71
|
| Rate for Payer: Healthspan PPO |
$609.72
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.50
|
| Rate for Payer: Molina Healthcare Passport |
$259.31
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,587.89
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$30,934.64 |
| Max. Negotiated Rate |
$45,587.89 |
| Rate for Payer: Anthem Medicaid |
$30,934.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32,562.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45,587.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$43,959.75
|
| Rate for Payer: Humana KY Medicaid |
$30,934.64
|
| Rate for Payer: Humana Medicare Advantage |
$32,562.78
|
| Rate for Payer: Kentucky WC Medicaid |
$31,243.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39,075.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,553.33
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$37,911.54
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$25,725.69 |
| Max. Negotiated Rate |
$37,911.54 |
| Rate for Payer: Anthem Medicaid |
$25,725.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27,079.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,911.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,557.55
|
| Rate for Payer: Humana KY Medicaid |
$25,725.69
|
| Rate for Payer: Humana Medicare Advantage |
$27,079.67
|
| Rate for Payer: Kentucky WC Medicaid |
$25,982.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,495.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,240.20
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$33,628.81
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$22,819.55 |
| Max. Negotiated Rate |
$33,628.81 |
| Rate for Payer: Anthem Medicaid |
$22,819.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,020.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33,628.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$32,427.78
|
| Rate for Payer: Humana KY Medicaid |
$22,819.55
|
| Rate for Payer: Humana Medicare Advantage |
$24,020.58
|
| Rate for Payer: Kentucky WC Medicaid |
$23,047.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,824.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,275.94
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$21,330.50
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$14,474.27 |
| Max. Negotiated Rate |
$21,330.50 |
| Rate for Payer: Anthem Medicaid |
$14,474.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,236.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,330.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,568.69
|
| Rate for Payer: Humana KY Medicaid |
$14,474.27
|
| Rate for Payer: Humana Medicare Advantage |
$15,236.07
|
| Rate for Payer: Kentucky WC Medicaid |
$14,619.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,283.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,763.75
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$27,500.13
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$18,660.80 |
| Max. Negotiated Rate |
$27,500.13 |
| Rate for Payer: Anthem Medicaid |
$18,660.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,642.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27,500.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$26,517.98
|
| Rate for Payer: Humana KY Medicaid |
$18,660.80
|
| Rate for Payer: Humana Medicare Advantage |
$19,642.95
|
| Rate for Payer: Kentucky WC Medicaid |
$18,847.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,571.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,034.02
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$18,563.90
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$12,596.93 |
| Max. Negotiated Rate |
$18,563.90 |
| Rate for Payer: Anthem Medicaid |
$12,596.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,259.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,563.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,900.91
|
| Rate for Payer: Humana KY Medicaid |
$12,596.93
|
| Rate for Payer: Humana Medicare Advantage |
$13,259.93
|
| Rate for Payer: Kentucky WC Medicaid |
$12,722.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,911.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,848.87
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
76102294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Humana KY Medicaid |
$876.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$885.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$894.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
76102294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$765.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
PERCUTANEOUS DISKECTOMY
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
76102294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.26 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$870.03
|
| Rate for Payer: Anthem Medicaid |
$372.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Healthspan PPO |
$679.29
|
| Rate for Payer: Humana Medicaid |
$372.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$698.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.71
|
| Rate for Payer: Molina Healthcare Passport |
$372.26
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.98
|
|
|
PERCUTANEOUS DISKECTOMY(P
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
761P2294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.26 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$870.03
|
| Rate for Payer: Anthem Medicaid |
$372.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Healthspan PPO |
$679.29
|
| Rate for Payer: Humana Medicaid |
$372.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$698.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.71
|
| Rate for Payer: Molina Healthcare Passport |
$372.26
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.98
|
|
