|
REOPERATION - CAROTID
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 35390
|
| Hospital Charge Code |
76101390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REOPERATION - CAROTID
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 35390
|
| Hospital Charge Code |
76101390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REOPERATION - CAROTID
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 35390
|
| Hospital Charge Code |
76101390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$288.04
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$273.03
|
| Rate for Payer: Healthspan PPO |
$283.20
|
| Rate for Payer: Humana Medicaid |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.84
|
| Rate for Payer: Molina Healthcare Passport |
$147.88
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.36
|
|
|
REOPERATION - CAROTID(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 35390
|
| Hospital Charge Code |
761P1390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$288.04
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$273.03
|
| Rate for Payer: Healthspan PPO |
$283.20
|
| Rate for Payer: Humana Medicaid |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.84
|
| Rate for Payer: Molina Healthcare Passport |
$147.88
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.36
|
|
|
REPAIR 2 DIS LIG ANKLE COLTRL
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS 27698
|
| Hospital Charge Code |
76100915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.60
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
REPAIR 2 DIS LIG ANKLE COLTRL
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 27698
|
| Hospital Charge Code |
76100915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$609.90 |
| Max. Negotiated Rate |
$2,060.00 |
| Rate for Payer: Aetna Commercial |
$983.77
|
| Rate for Payer: Anthem Medicaid |
$609.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,060.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,081.76
|
| Rate for Payer: Healthspan PPO |
$891.08
|
| Rate for Payer: Humana Medicaid |
$609.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$805.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.10
|
| Rate for Payer: Molina Healthcare Passport |
$609.90
|
| Rate for Payer: Multiplan PHCS |
$1,236.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,442.00
|
| Rate for Payer: UHCCP Medicaid |
$721.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.00
|
|
|
REPAIR 2 DIS LIG ANKLE COLTRL
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS 27698
|
| Hospital Charge Code |
76100915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.60
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
REPAIR 2 DIS LIG ANKLE COLTR(P
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 27698
|
| Hospital Charge Code |
761P0915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$609.90 |
| Max. Negotiated Rate |
$2,060.00 |
| Rate for Payer: Aetna Commercial |
$983.77
|
| Rate for Payer: Anthem Medicaid |
$609.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,060.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,081.76
|
| Rate for Payer: Healthspan PPO |
$891.08
|
| Rate for Payer: Humana Medicaid |
$609.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$805.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.10
|
| Rate for Payer: Molina Healthcare Passport |
$609.90
|
| Rate for Payer: Multiplan PHCS |
$1,236.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,442.00
|
| Rate for Payer: UHCCP Medicaid |
$721.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.00
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
76100906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
76100906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR ACHILLES TENDON
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
76100906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,002.02
|
| Rate for Payer: Anthem Medicaid |
$541.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,148.57
|
| Rate for Payer: Healthspan PPO |
$907.61
|
| Rate for Payer: Humana Medicaid |
$541.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$827.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.10
|
| Rate for Payer: Molina Healthcare Passport |
$541.27
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.68
|
|
|
REPAIR ACHILLES TENDON(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
761P0906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,002.02
|
| Rate for Payer: Anthem Medicaid |
$541.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,148.57
|
| Rate for Payer: Healthspan PPO |
$907.61
|
| Rate for Payer: Humana Medicaid |
$541.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$827.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.10
|
| Rate for Payer: Molina Healthcare Passport |
$541.27
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.68
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Facility
|
IP
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.54 |
| Max. Negotiated Rate |
$11,708.64 |
| Rate for Payer: Aetna Commercial |
$9,391.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.27
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$10,123.10
|
| Rate for Payer: First Health Commercial |
$11,586.68
|
| Rate for Payer: Humana Commercial |
$10,367.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,658.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,732.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,439.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,585.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,780.92
|
| Rate for Payer: PHCS Commercial |
$11,708.64
|
| Rate for Payer: United Healthcare All Payer |
$10,732.92
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Professional
|
Both
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$12,196.50 |
| Rate for Payer: Aetna Commercial |
$1,299.66
|
| Rate for Payer: Anthem Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$12,196.50
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$1,250.74
|
| Rate for Payer: Healthspan PPO |
$1,277.82
|
| Rate for Payer: Humana Medicaid |
$675.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.81
|
| Rate for Payer: Molina Healthcare Passport |
$675.30
|
| Rate for Payer: Multiplan PHCS |
$7,317.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,537.55
|
| Rate for Payer: UHCCP Medicaid |
$4,268.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$682.05
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Facility
|
OP
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.54 |
| Max. Negotiated Rate |
$11,708.64 |
| Rate for Payer: Aetna Commercial |
$9,391.30
|
| Rate for Payer: Anthem Medicaid |
$4,194.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$10,123.10
|
| Rate for Payer: First Health Commercial |
$11,586.68
|
| Rate for Payer: Humana Commercial |
$10,367.02
|
| Rate for Payer: Humana KY Medicaid |
$4,194.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,237.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,278.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,732.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,439.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,585.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,780.92
|
| Rate for Payer: PHCS Commercial |
$11,708.64
|
| Rate for Payer: United Healthcare All Payer |
$10,732.92
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761P1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,299.66
|
| Rate for Payer: Anthem Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,250.74
|
| Rate for Payer: Healthspan PPO |
$1,277.82
|
| Rate for Payer: Humana Medicaid |
$675.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.81
|
| Rate for Payer: Molina Healthcare Passport |
$675.30
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$682.05
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(T
|
Facility
|
IP
|
$9,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761T1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.54 |
| Max. Negotiated Rate |
$8,828.64 |
| Rate for Payer: Aetna Commercial |
$7,081.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.27
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cigna Commercial |
$7,633.10
|
| Rate for Payer: First Health Commercial |
$8,736.68
|
| Rate for Payer: Humana Commercial |
$7,817.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,758.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,092.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,839.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,850.92
|
| Rate for Payer: PHCS Commercial |
$8,828.64
|
| Rate for Payer: United Healthcare All Payer |
$8,092.92
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(T
|
Facility
|
OP
|
$9,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761T1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.54 |
| Max. Negotiated Rate |
$8,828.64 |
| Rate for Payer: Aetna Commercial |
$7,081.30
|
| Rate for Payer: Anthem Medicaid |
$3,162.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cigna Commercial |
$7,633.10
|
| Rate for Payer: First Health Commercial |
$8,736.68
|
| Rate for Payer: Humana Commercial |
$7,817.02
|
| Rate for Payer: Humana KY Medicaid |
$3,162.68
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,194.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,226.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,092.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,839.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,850.92
|
| Rate for Payer: PHCS Commercial |
$8,828.64
|
| Rate for Payer: United Healthcare All Payer |
$8,092.92
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem Medicaid |
$1,444.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Humana KY Medicaid |
$1,444.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$3,840.92
|
| Rate for Payer: Anthem Medicaid |
$1,571.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,639.18
|
| Rate for Payer: Healthspan PPO |
$3,776.38
|
| Rate for Payer: Humana Medicaid |
$1,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,996.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,603.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,571.70
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,587.42
|
|
|
REPAIR ANEURYSM ABDOMINAL(P
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
761P1359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$3,840.92
|
| Rate for Payer: Anthem Medicaid |
$1,571.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,639.18
|
| Rate for Payer: Healthspan PPO |
$3,776.38
|
| Rate for Payer: Humana Medicaid |
$1,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,996.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,603.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,571.70
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,587.42
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$2,175.29
|
| Rate for Payer: Anthem Medicaid |
$936.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,078.31
|
| Rate for Payer: Healthspan PPO |
$2,138.74
|
| Rate for Payer: Humana Medicaid |
$936.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,700.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$954.95
|
| Rate for Payer: Molina Healthcare Passport |
$936.23
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$945.59
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
