|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
IP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.60 |
| 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 |
$1,049.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.28
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
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 |
$2,683.26 |
| Rate for Payer: Aetna Commercial |
$673.85
|
| Rate for Payer: Ambetter Exchange |
$367.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$304.00
|
| Rate for Payer: Anthem Medicaid |
$2,047.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.60
|
| 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 |
$2,047.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$544.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,088.24
|
| Rate for Payer: Molina Healthcare Passport |
$2,047.29
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.32
|
| Rate for Payer: UHCCP Medicaid |
$319.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,067.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.17
|
|
|
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 |
$930.00 |
| 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 |
$2,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,697.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,139.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
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 |
$1,066.09 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem Medicaid |
$1,066.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| 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 |
$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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$2,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,697.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,139.00
|
| 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 |
761P1528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$2,683.26 |
| Rate for Payer: Aetna Commercial |
$673.85
|
| Rate for Payer: Ambetter Exchange |
$367.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$304.00
|
| Rate for Payer: Anthem Medicaid |
$2,047.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.60
|
| 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 |
$2,047.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$544.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,088.24
|
| Rate for Payer: Molina Healthcare Passport |
$2,047.29
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.32
|
| Rate for Payer: UHCCP Medicaid |
$319.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,067.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.17
|
|
|
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 |
$756.71 |
| Rate for Payer: Aetna Commercial |
$673.14
|
| Rate for Payer: Ambetter Exchange |
$460.33
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$460.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$552.40
|
| 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 |
$609.73
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$460.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.33
|
| 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 |
$598.43
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.33
|
|
|
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 |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$756.71 |
| Rate for Payer: Aetna Commercial |
$673.14
|
| Rate for Payer: Ambetter Exchange |
$460.33
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$460.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$552.40
|
| 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 |
$609.73
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$460.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.33
|
| 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 |
$598.43
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.33
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
76102294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$876.95 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| 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 |
$876.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| 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 |
$2,165.18
|
| 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 |
$2,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,218.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.50
|
| 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 |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$870.03
|
| Rate for Payer: Ambetter Exchange |
$564.25
|
| Rate for Payer: Anthem Medicaid |
$372.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$564.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.25
|
| 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 |
$733.52
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.25
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62287
|
| Hospital Charge Code |
76102294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.00 |
| 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 |
$2,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,218.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
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 |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$870.03
|
| Rate for Payer: Ambetter Exchange |
$564.25
|
| Rate for Payer: Anthem Medicaid |
$372.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$564.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.25
|
| 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 |
$733.52
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.25
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$8,489.59
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,063.99 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$8,489.59
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,063.99 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$11,961.85
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,544.18 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; SIMPLE (EG, STONE[S] UP TO 2 CM IN SINGLE LOCATION OF KIDNEY OR RENAL PELVIS, NONBRANCHING STONES)
|
Facility
|
OP
|
$11,961.85
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,544.18 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 28406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS CIRCUIT
|
Facility
|
OP
|
$23,228.31
|
|
|
Service Code
|
CPT 36906
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,591.65 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
|
