|
REPAIR BLOOD VESSEL
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
45000232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
REPAIR BLOOD VESSEL
|
Professional
|
Both
|
$4,148.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
76101375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.85 |
| Max. Negotiated Rate |
$4,148.60 |
| Rate for Payer: Aetna Commercial |
$1,470.84
|
| Rate for Payer: Anthem Medicaid |
$562.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,148.60
|
| Rate for Payer: Cash Price |
$2,074.30
|
| Rate for Payer: Cash Price |
$2,074.30
|
| Rate for Payer: Cigna Commercial |
$1,425.53
|
| Rate for Payer: Healthspan PPO |
$1,446.12
|
| Rate for Payer: Humana Medicaid |
$562.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,140.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$574.11
|
| Rate for Payer: Molina Healthcare Passport |
$562.85
|
| Rate for Payer: Multiplan PHCS |
$2,489.16
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,904.02
|
| Rate for Payer: UHCCP Medicaid |
$1,452.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.48
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
45000232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
IP
|
$4,148.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
76101375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.32 |
| Max. Negotiated Rate |
$3,982.66 |
| Rate for Payer: Aetna Commercial |
$3,194.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,235.91
|
| Rate for Payer: Cash Price |
$2,074.30
|
| Rate for Payer: Cigna Commercial |
$3,443.34
|
| Rate for Payer: First Health Commercial |
$3,941.17
|
| Rate for Payer: Humana Commercial |
$3,526.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,401.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,650.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.07
|
| Rate for Payer: PHCS Commercial |
$3,982.66
|
| Rate for Payer: United Healthcare All Payer |
$3,650.77
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35221
|
| Hospital Charge Code |
76101374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35216
|
| Hospital Charge Code |
76101373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$839.36 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$3,231.16
|
| Rate for Payer: Anthem Medicaid |
$839.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,879.50
|
| Rate for Payer: Healthspan PPO |
$3,176.86
|
| Rate for Payer: Humana Medicaid |
$839.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,692.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$856.15
|
| Rate for Payer: Molina Healthcare Passport |
$839.36
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$847.75
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35221
|
| Hospital Charge Code |
76101374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35221
|
| Hospital Charge Code |
76101374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$794.29 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,442.93
|
| Rate for Payer: Anthem Medicaid |
$794.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,313.62
|
| Rate for Payer: Healthspan PPO |
$2,401.88
|
| Rate for Payer: Humana Medicaid |
$794.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,910.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$810.18
|
| Rate for Payer: Molina Healthcare Passport |
$794.29
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$802.23
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35216
|
| Hospital Charge Code |
76101373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35216
|
| Hospital Charge Code |
76101373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REPAIR BLOOD VESSEL - DIRECT(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35221
|
| Hospital Charge Code |
761P1374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$794.29 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,442.93
|
| Rate for Payer: Anthem Medicaid |
$794.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,313.62
|
| Rate for Payer: Healthspan PPO |
$2,401.88
|
| Rate for Payer: Humana Medicaid |
$794.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,910.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$810.18
|
| Rate for Payer: Molina Healthcare Passport |
$794.29
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$802.23
|
|
|
REPAIR BLOOD VESSEL - DIRECT(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35216
|
| Hospital Charge Code |
761P1373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$839.36 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$3,231.16
|
| Rate for Payer: Anthem Medicaid |
$839.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,879.50
|
| Rate for Payer: Healthspan PPO |
$3,176.86
|
| Rate for Payer: Humana Medicaid |
$839.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,692.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$856.15
|
| Rate for Payer: Molina Healthcare Passport |
$839.36
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$847.75
|
|
|
REPAIR BLOOD VESSEL DIR NECK
|
Facility
|
IP
|
$9,383.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
76101369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,219.79 |
| Max. Negotiated Rate |
$9,007.68 |
| Rate for Payer: Aetna Commercial |
$7,224.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,318.74
|
| Rate for Payer: Cash Price |
$4,691.50
|
| Rate for Payer: Cigna Commercial |
$7,787.89
|
| Rate for Payer: First Health Commercial |
$8,913.85
|
| Rate for Payer: Humana Commercial |
$7,975.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,694.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,924.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,257.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,037.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,219.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,908.73
|
| Rate for Payer: PHCS Commercial |
$9,007.68
|
| Rate for Payer: United Healthcare All Payer |
$8,257.04
|
|
|
REPAIR BLOOD VESSEL DIR NECK
|
Professional
|
Both
|
$9,383.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
76101369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.39 |
| Max. Negotiated Rate |
$9,383.00 |
| Rate for Payer: Aetna Commercial |
$1,634.03
|
| Rate for Payer: Anthem Medicaid |
$578.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,383.00
|
| Rate for Payer: Cash Price |
$4,691.50
|
| Rate for Payer: Cash Price |
$4,691.50
|
| Rate for Payer: Cigna Commercial |
$1,571.89
|
| Rate for Payer: Healthspan PPO |
$1,606.57
|
| Rate for Payer: Humana Medicaid |
$578.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$589.96
|
| Rate for Payer: Molina Healthcare Passport |
$578.39
|
| Rate for Payer: Multiplan PHCS |
$5,629.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,568.10
|
| Rate for Payer: UHCCP Medicaid |
$3,284.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.17
|
|
|
REPAIR BLOOD VESSEL DIR NECK
|
Facility
|
OP
|
$9,383.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
76101369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,219.79 |
| Max. Negotiated Rate |
$9,007.68 |
| Rate for Payer: Aetna Commercial |
$7,224.91
|
| Rate for Payer: Anthem Medicaid |
$3,226.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,318.74
|
| 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 |
$4,691.50
|
| Rate for Payer: Cash Price |
$4,691.50
|
| Rate for Payer: Cigna Commercial |
$7,787.89
|
| Rate for Payer: First Health Commercial |
$8,913.85
|
| Rate for Payer: Humana Commercial |
$7,975.55
|
| Rate for Payer: Humana KY Medicaid |
$3,226.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,259.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,694.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,924.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,291.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,257.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,037.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,219.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,908.73
|
| Rate for Payer: PHCS Commercial |
$9,007.68
|
| Rate for Payer: United Healthcare All Payer |
$8,257.04
|
|
|
REPAIR BLOOD VESSEL DIR NECK(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
761P1369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.39 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,634.03
|
| Rate for Payer: Anthem Medicaid |
$578.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,571.89
|
| Rate for Payer: Healthspan PPO |
$1,606.57
|
| Rate for Payer: Humana Medicaid |
$578.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$589.96
|
| Rate for Payer: Molina Healthcare Passport |
$578.39
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.17
|
|
|
REPAIR BLOOD VESSEL DIR NECK(T
|
Facility
|
IP
|
$6,583.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
761T1369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.79 |
| Max. Negotiated Rate |
$6,319.68 |
| Rate for Payer: Aetna Commercial |
$5,068.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,134.74
|
| Rate for Payer: Cash Price |
$3,291.50
|
| Rate for Payer: Cigna Commercial |
$5,463.89
|
| Rate for Payer: First Health Commercial |
$6,253.85
|
| Rate for Payer: Humana Commercial |
$5,595.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,793.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.73
|
| Rate for Payer: PHCS Commercial |
$6,319.68
|
| Rate for Payer: United Healthcare All Payer |
$5,793.04
|
|
|
REPAIR BLOOD VESSEL DIR NECK(T
|
Facility
|
OP
|
$6,583.00
|
|
|
Service Code
|
HCPCS 35201
|
| Hospital Charge Code |
761T1369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.79 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$5,068.91
|
| Rate for Payer: Anthem Medicaid |
$2,263.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,134.74
|
| 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 |
$3,291.50
|
| Rate for Payer: Cash Price |
$3,291.50
|
| Rate for Payer: Cigna Commercial |
$5,463.89
|
| Rate for Payer: First Health Commercial |
$6,253.85
|
| Rate for Payer: Humana Commercial |
$5,595.55
|
| Rate for Payer: Humana KY Medicaid |
$2,263.89
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,286.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,309.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,793.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.73
|
| Rate for Payer: PHCS Commercial |
$6,319.68
|
| Rate for Payer: United Healthcare All Payer |
$5,793.04
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
HCPCS 35189
|
| Hospital Charge Code |
76102889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.69 |
| Max. Negotiated Rate |
$3,564.48 |
| Rate for Payer: Aetna Commercial |
$2,859.01
|
| Rate for Payer: Anthem Medicaid |
$1,276.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,896.14
|
| Rate for Payer: Cash Price |
$1,856.50
|
| Rate for Payer: Cigna Commercial |
$3,081.79
|
| Rate for Payer: First Health Commercial |
$3,527.35
|
| Rate for Payer: Humana Commercial |
$3,156.05
|
| Rate for Payer: Humana KY Medicaid |
$1,276.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,289.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,044.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,740.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,113.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,302.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,267.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,784.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.03
|
| Rate for Payer: PHCS Commercial |
$3,564.48
|
| Rate for Payer: United Healthcare All Payer |
$3,267.44
|
|
|
REPAIR BLOOD VESSEL LESION
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 35256
|
| Hospital Charge Code |
76102718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,800.17 |
| Rate for Payer: Aetna Commercial |
$1,800.17
|
| Rate for Payer: Anthem Medicaid |
$688.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,732.17
|
| Rate for Payer: Healthspan PPO |
$1,769.92
|
| Rate for Payer: Humana Medicaid |
$688.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,389.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$701.97
|
| Rate for Payer: Molina Healthcare Passport |
$688.21
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.09
|
|
|
REPAIR BLOOD VESSEL LESION
|
Professional
|
Both
|
$1,281.56
|
|
|
Service Code
|
HCPCS 35231
|
| Hospital Charge Code |
76102731
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.55 |
| Max. Negotiated Rate |
$2,047.06 |
| Rate for Payer: Aetna Commercial |
$2,047.06
|
| Rate for Payer: Anthem Medicaid |
$756.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,281.56
|
| Rate for Payer: Cash Price |
$640.78
|
| Rate for Payer: Cash Price |
$640.78
|
| Rate for Payer: Cigna Commercial |
$1,949.20
|
| Rate for Payer: Healthspan PPO |
$2,012.66
|
| Rate for Payer: Humana Medicaid |
$756.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,568.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.17
|
| Rate for Payer: Molina Healthcare Passport |
$756.05
|
| Rate for Payer: Multiplan PHCS |
$768.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$897.09
|
| Rate for Payer: UHCCP Medicaid |
$448.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.61
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
OP
|
$7,947.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
76101370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.11 |
| Max. Negotiated Rate |
$7,629.12 |
| Rate for Payer: Aetna Commercial |
$6,119.19
|
| Rate for Payer: Anthem Medicaid |
$2,732.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cigna Commercial |
$6,596.01
|
| Rate for Payer: First Health Commercial |
$7,549.65
|
| Rate for Payer: Humana Commercial |
$6,754.95
|
| Rate for Payer: Humana KY Medicaid |
$2,732.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,993.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,960.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.57
|
| Rate for Payer: PHCS Commercial |
$7,629.12
|
| Rate for Payer: United Healthcare All Payer |
$6,993.36
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
IP
|
$7,947.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
76101370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.11 |
| Max. Negotiated Rate |
$7,629.12 |
| Rate for Payer: Aetna Commercial |
$6,119.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.66
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cigna Commercial |
$6,596.01
|
| Rate for Payer: First Health Commercial |
$7,549.65
|
| Rate for Payer: Humana Commercial |
$6,754.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,384.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,993.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,960.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.57
|
| Rate for Payer: PHCS Commercial |
$7,629.12
|
| Rate for Payer: United Healthcare All Payer |
$6,993.36
|
|
|
REPAIR BLOOD VESSEL LESION
|
Professional
|
Both
|
$7,947.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
76101370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.70 |
| Max. Negotiated Rate |
$7,947.00 |
| Rate for Payer: Aetna Commercial |
$1,333.59
|
| Rate for Payer: Anthem Medicaid |
$570.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,947.00
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cigna Commercial |
$1,284.89
|
| Rate for Payer: Healthspan PPO |
$1,311.18
|
| Rate for Payer: Humana Medicaid |
$570.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,039.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.11
|
| Rate for Payer: Molina Healthcare Passport |
$570.70
|
| Rate for Payer: Multiplan PHCS |
$4,768.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,562.90
|
| Rate for Payer: UHCCP Medicaid |
$2,781.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.41
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
IP
|
$3,713.00
|
|
|
Service Code
|
HCPCS 35189
|
| Hospital Charge Code |
76102889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.69 |
| Max. Negotiated Rate |
$3,564.48 |
| Rate for Payer: Aetna Commercial |
$2,859.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,896.14
|
| Rate for Payer: Cash Price |
$1,856.50
|
| Rate for Payer: Cigna Commercial |
$3,081.79
|
| Rate for Payer: First Health Commercial |
$3,527.35
|
| Rate for Payer: Humana Commercial |
$3,156.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,044.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,740.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,113.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,267.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,784.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.03
|
| Rate for Payer: PHCS Commercial |
$3,564.48
|
| Rate for Payer: United Healthcare All Payer |
$3,267.44
|
|
