|
REPAIR BLOOD VESSEL LESION
|
Professional
|
Both
|
$3,713.00
|
|
|
Service Code
|
HCPCS 35189
|
| Hospital Charge Code |
76102889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$859.95 |
| Max. Negotiated Rate |
$3,713.00 |
| Rate for Payer: Aetna Commercial |
$2,789.85
|
| Rate for Payer: Anthem Medicaid |
$859.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,713.00
|
| Rate for Payer: Cash Price |
$1,856.50
|
| Rate for Payer: Cash Price |
$1,856.50
|
| Rate for Payer: Cigna Commercial |
$2,658.78
|
| Rate for Payer: Healthspan PPO |
$2,742.97
|
| Rate for Payer: Humana Medicaid |
$859.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,260.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$877.15
|
| Rate for Payer: Molina Healthcare Passport |
$859.95
|
| Rate for Payer: Multiplan PHCS |
$2,227.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,599.10
|
| Rate for Payer: UHCCP Medicaid |
$1,299.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$868.55
|
|
|
REPAIR BLOOD VESSEL LESION
|
Professional
|
Both
|
$4,150.00
|
|
|
Service Code
|
HCPCS 35211
|
| Hospital Charge Code |
76101372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,013.08 |
| Max. Negotiated Rate |
$4,150.00 |
| Rate for Payer: Aetna Commercial |
$2,365.09
|
| Rate for Payer: Anthem Medicaid |
$1,013.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,150.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cigna Commercial |
$2,239.67
|
| Rate for Payer: Healthspan PPO |
$2,325.34
|
| Rate for Payer: Humana Medicaid |
$1,013.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,849.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,033.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,013.08
|
| Rate for Payer: Multiplan PHCS |
$2,490.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,905.00
|
| Rate for Payer: UHCCP Medicaid |
$1,452.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.21
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
OP
|
$4,150.00
|
|
|
Service Code
|
HCPCS 35211
|
| Hospital Charge Code |
76101372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.50 |
| Max. Negotiated Rate |
$3,984.00 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Anthem Medicaid |
$1,427.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cigna Commercial |
$3,444.50
|
| Rate for Payer: First Health Commercial |
$3,942.50
|
| Rate for Payer: Humana Commercial |
$3,527.50
|
| Rate for Payer: Humana KY Medicaid |
$1,427.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.50
|
| Rate for Payer: PHCS Commercial |
$3,984.00
|
| Rate for Payer: United Healthcare All Payer |
$3,652.00
|
|
|
REPAIR BLOOD VESSEL LESION
|
Facility
|
IP
|
$4,150.00
|
|
|
Service Code
|
HCPCS 35211
|
| Hospital Charge Code |
76101372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.50 |
| Max. Negotiated Rate |
$3,984.00 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cigna Commercial |
$3,444.50
|
| Rate for Payer: First Health Commercial |
$3,942.50
|
| Rate for Payer: Humana Commercial |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.50
|
| Rate for Payer: PHCS Commercial |
$3,984.00
|
| Rate for Payer: United Healthcare All Payer |
$3,652.00
|
|
|
REPAIR BLOOD VESSEL LESION(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
761P1370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.70 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,333.59
|
| Rate for Payer: Anthem Medicaid |
$570.70
|
| 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 |
$1,284.89
|
| 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 |
$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 |
$576.41
|
|
|
REPAIR BLOOD VESSEL LESION(P
|
Professional
|
Both
|
$4,150.00
|
|
|
Service Code
|
HCPCS 35211
|
| Hospital Charge Code |
761P1372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,013.08 |
| Max. Negotiated Rate |
$4,150.00 |
| Rate for Payer: Aetna Commercial |
$2,365.09
|
| Rate for Payer: Anthem Medicaid |
$1,013.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,150.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cash Price |
$2,075.00
|
| Rate for Payer: Cigna Commercial |
$2,239.67
|
| Rate for Payer: Healthspan PPO |
$2,325.34
|
| Rate for Payer: Humana Medicaid |
$1,013.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,849.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,033.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,013.08
|
| Rate for Payer: Multiplan PHCS |
$2,490.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,905.00
|
| Rate for Payer: UHCCP Medicaid |
$1,452.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.21
|
|
|
REPAIR BLOOD VESSEL LESION(T
|
Facility
|
IP
|
$5,147.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
761T1370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.11 |
| Max. Negotiated Rate |
$4,941.12 |
| Rate for Payer: Aetna Commercial |
$3,963.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.66
|
| Rate for Payer: Cash Price |
$2,573.50
|
| Rate for Payer: Cigna Commercial |
$4,272.01
|
| Rate for Payer: First Health Commercial |
$4,889.65
|
| Rate for Payer: Humana Commercial |
$4,374.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,220.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,798.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,529.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,860.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.57
|
| Rate for Payer: PHCS Commercial |
$4,941.12
|
| Rate for Payer: United Healthcare All Payer |
$4,529.36
|
|
|
REPAIR BLOOD VESSEL LESION(T
|
Facility
|
OP
|
$5,147.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
761T1370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.11 |
| Max. Negotiated Rate |
$4,941.12 |
| Rate for Payer: Aetna Commercial |
$3,963.19
|
| Rate for Payer: Anthem Medicaid |
$1,770.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.66
|
| 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 |
$2,573.50
|
| Rate for Payer: Cash Price |
$2,573.50
|
| Rate for Payer: Cigna Commercial |
$4,272.01
|
| Rate for Payer: First Health Commercial |
$4,889.65
|
| Rate for Payer: Humana Commercial |
$4,374.95
|
| Rate for Payer: Humana KY Medicaid |
$1,770.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,220.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,798.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,529.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,860.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.57
|
| Rate for Payer: PHCS Commercial |
$4,941.12
|
| Rate for Payer: United Healthcare All Payer |
$4,529.36
|
|
|
REPAIR BLOOD VESSEL(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
761P1375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.85 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,470.84
|
| Rate for Payer: Anthem Medicaid |
$562.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| 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 |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.48
|
|
|
REPAIR BLOOD VESSEL(T
|
Facility
|
OP
|
$1,948.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
761T1375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.32 |
| Max. Negotiated Rate |
$1,870.66 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Anthem Medicaid |
$670.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$974.30
|
| Rate for Payer: Cash Price |
$974.30
|
| Rate for Payer: Cigna Commercial |
$1,617.34
|
| Rate for Payer: First Health Commercial |
$1,851.17
|
| Rate for Payer: Humana Commercial |
$1,656.31
|
| Rate for Payer: Humana KY Medicaid |
$670.12
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$676.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.07
|
| Rate for Payer: PHCS Commercial |
$1,870.66
|
| Rate for Payer: United Healthcare All Payer |
$1,714.77
|
|
|
REPAIR BLOOD VESSEL(T
|
Facility
|
IP
|
$1,948.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
761T1375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.32 |
| Max. Negotiated Rate |
$1,870.66 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.91
|
| Rate for Payer: Cash Price |
$974.30
|
| Rate for Payer: Cigna Commercial |
$1,617.34
|
| Rate for Payer: First Health Commercial |
$1,851.17
|
| Rate for Payer: Humana Commercial |
$1,656.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,597.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.07
|
| Rate for Payer: PHCS Commercial |
$1,870.66
|
| Rate for Payer: United Healthcare All Payer |
$1,714.77
|
|
|
REPAIR BLOOD VESSEL WITH GRAFT
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35266
|
| Hospital Charge Code |
76101377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPAIR BLOOD VESSEL WITH GRAFT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35266
|
| Hospital Charge Code |
761P1377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$635.28 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,503.67
|
| Rate for Payer: Anthem Medicaid |
$635.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,439.10
|
| Rate for Payer: Healthspan PPO |
$1,478.40
|
| Rate for Payer: Humana Medicaid |
$635.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,172.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.99
|
| Rate for Payer: Molina Healthcare Passport |
$635.28
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.63
|
|
|
REPAIR BLOOD VESSEL WITH GRAFT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35266
|
| Hospital Charge Code |
76101377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$635.28 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,503.67
|
| Rate for Payer: Anthem Medicaid |
$635.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,439.10
|
| Rate for Payer: Healthspan PPO |
$1,478.40
|
| Rate for Payer: Humana Medicaid |
$635.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,172.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.99
|
| Rate for Payer: Molina Healthcare Passport |
$635.28
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.63
|
|
|
REPAIR BLOOD VESSEL WITH GRAFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35266
|
| Hospital Charge Code |
76101377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| 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 |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPAIR BLOOD VESSEL WITH VEIN
|
Facility
|
IP
|
$11,957.19
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
76101376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.43 |
| Max. Negotiated Rate |
$11,478.90 |
| Rate for Payer: Aetna Commercial |
$9,207.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,326.61
|
| Rate for Payer: Cash Price |
$5,978.60
|
| Rate for Payer: Cigna Commercial |
$9,924.47
|
| Rate for Payer: First Health Commercial |
$11,359.33
|
| Rate for Payer: Humana Commercial |
$10,163.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,804.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,824.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,587.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,522.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,967.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,706.73
|
| Rate for Payer: PHCS Commercial |
$11,478.90
|
| Rate for Payer: United Healthcare All Payer |
$10,522.33
|
|
|
REPAIR BLOOD VESSEL WITH VEIN
|
Professional
|
Both
|
$11,957.19
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
76101376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.14 |
| Max. Negotiated Rate |
$11,957.19 |
| Rate for Payer: Aetna Commercial |
$1,708.96
|
| Rate for Payer: Anthem Medicaid |
$660.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,957.19
|
| Rate for Payer: Cash Price |
$5,978.60
|
| Rate for Payer: Cash Price |
$5,978.60
|
| Rate for Payer: Cigna Commercial |
$1,637.38
|
| Rate for Payer: Healthspan PPO |
$1,680.25
|
| Rate for Payer: Humana Medicaid |
$660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.34
|
| Rate for Payer: Molina Healthcare Passport |
$660.14
|
| Rate for Payer: Multiplan PHCS |
$7,174.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,370.03
|
| Rate for Payer: UHCCP Medicaid |
$4,185.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$666.74
|
|
|
REPAIR BLOOD VESSEL WITH VEIN
|
Facility
|
OP
|
$11,957.19
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
76101376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.43 |
| Max. Negotiated Rate |
$11,478.90 |
| Rate for Payer: Aetna Commercial |
$9,207.04
|
| Rate for Payer: Anthem Medicaid |
$4,112.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,326.61
|
| 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 |
$5,978.60
|
| Rate for Payer: Cash Price |
$5,978.60
|
| Rate for Payer: Cigna Commercial |
$9,924.47
|
| Rate for Payer: First Health Commercial |
$11,359.33
|
| Rate for Payer: Humana Commercial |
$10,163.61
|
| Rate for Payer: Humana KY Medicaid |
$4,112.08
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,153.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,804.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,824.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,194.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,522.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,967.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,706.73
|
| Rate for Payer: PHCS Commercial |
$11,478.90
|
| Rate for Payer: United Healthcare All Payer |
$10,522.33
|
|
|
REPAIR BLOOD VESSEL WITH VEI(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
761P1376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.14 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$1,708.96
|
| Rate for Payer: Anthem Medicaid |
$660.14
|
| 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 |
$1,637.38
|
| Rate for Payer: Healthspan PPO |
$1,680.25
|
| Rate for Payer: Humana Medicaid |
$660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.34
|
| Rate for Payer: Molina Healthcare Passport |
$660.14
|
| 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 |
$666.74
|
|
|
REPAIR BLOOD VESSEL WITH VEI(T
|
Facility
|
IP
|
$8,457.19
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
761T1376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,099.43 |
| Max. Negotiated Rate |
$8,118.90 |
| Rate for Payer: Aetna Commercial |
$6,512.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.61
|
| Rate for Payer: Cash Price |
$4,228.60
|
| Rate for Payer: Cigna Commercial |
$7,019.47
|
| Rate for Payer: First Health Commercial |
$8,034.33
|
| Rate for Payer: Humana Commercial |
$7,188.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.73
|
| Rate for Payer: PHCS Commercial |
$8,118.90
|
| Rate for Payer: United Healthcare All Payer |
$7,442.33
|
|
|
REPAIR BLOOD VESSEL WITH VEI(T
|
Facility
|
OP
|
$8,457.19
|
|
|
Service Code
|
HCPCS 35236
|
| Hospital Charge Code |
761T1376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,099.43 |
| Max. Negotiated Rate |
$8,118.90 |
| Rate for Payer: Aetna Commercial |
$6,512.04
|
| Rate for Payer: Anthem Medicaid |
$2,908.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.61
|
| 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 |
$4,228.60
|
| Rate for Payer: Cash Price |
$4,228.60
|
| Rate for Payer: Cigna Commercial |
$7,019.47
|
| Rate for Payer: First Health Commercial |
$8,034.33
|
| Rate for Payer: Humana Commercial |
$7,188.61
|
| Rate for Payer: Humana KY Medicaid |
$2,908.43
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.73
|
| Rate for Payer: PHCS Commercial |
$8,118.90
|
| Rate for Payer: United Healthcare All Payer |
$7,442.33
|
|
|
REPAIR BOWEL-BLADDER FISTULA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44661
|
| Hospital Charge Code |
76102644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,299.93 |
| Rate for Payer: Aetna Commercial |
$2,299.93
|
| Rate for Payer: Anthem Medicaid |
$888.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,133.01
|
| Rate for Payer: Healthspan PPO |
$1,939.57
|
| Rate for Payer: Humana Medicaid |
$888.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,999.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$905.96
|
| Rate for Payer: Molina Healthcare Passport |
$888.20
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$897.08
|
|
|
REPAIR BOWEL FISTULA
|
Professional
|
Both
|
$4,070.00
|
|
|
Service Code
|
HCPCS 44650
|
| Hospital Charge Code |
76102661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$635.85 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Aetna Commercial |
$2,127.79
|
| Rate for Payer: Anthem Medicaid |
$635.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,070.00
|
| Rate for Payer: Cash Price |
$2,035.00
|
| Rate for Payer: Cash Price |
$2,035.00
|
| Rate for Payer: Cigna Commercial |
$1,978.69
|
| Rate for Payer: Healthspan PPO |
$1,794.41
|
| Rate for Payer: Humana Medicaid |
$635.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,860.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$648.57
|
| Rate for Payer: Molina Healthcare Passport |
$635.85
|
| Rate for Payer: Multiplan PHCS |
$2,442.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,849.00
|
| Rate for Payer: UHCCP Medicaid |
$1,424.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.21
|
|
|
REPAIR BOWEL-SKIN FISTULA
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44640
|
| Hospital Charge Code |
76101862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR BOWEL-SKIN FISTULA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44640
|
| Hospital Charge Code |
76101862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.66 |
| Max. Negotiated Rate |
$2,044.74 |
| Rate for Payer: Aetna Commercial |
$2,044.74
|
| Rate for Payer: Anthem Medicaid |
$599.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,904.65
|
| Rate for Payer: Healthspan PPO |
$1,724.37
|
| Rate for Payer: Humana Medicaid |
$599.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,796.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.65
|
| Rate for Payer: Molina Healthcare Passport |
$599.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.66
|
|
