|
REPAIR ARTERY RUPTURE - THIG(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35142
|
| Hospital Charge Code |
761P1366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.56 |
| Max. Negotiated Rate |
$2,348.58 |
| Rate for Payer: Aetna Commercial |
$2,348.58
|
| Rate for Payer: Ambetter Exchange |
$1,237.18
|
| Rate for Payer: Anthem Medicaid |
$939.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,237.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,237.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,484.62
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,243.11
|
| Rate for Payer: Healthspan PPO |
$2,309.11
|
| Rate for Payer: Humana Medicaid |
$939.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,820.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,237.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$958.35
|
| Rate for Payer: Molina Healthcare Passport |
$939.56
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,608.33
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,237.18
|
|
|
REPAIR ART INTRAMURAL
|
Professional
|
Both
|
$2,530.00
|
|
|
Service Code
|
HCPCS 33507
|
| Hospital Charge Code |
76101295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.50 |
| Max. Negotiated Rate |
$2,980.89 |
| Rate for Payer: Aetna Commercial |
$2,980.89
|
| Rate for Payer: Ambetter Exchange |
$1,617.99
|
| Rate for Payer: Anthem Medicaid |
$1,344.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,617.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,617.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,941.59
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna Commercial |
$2,849.17
|
| Rate for Payer: Healthspan PPO |
$2,930.80
|
| Rate for Payer: Humana Medicaid |
$1,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,426.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,617.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,617.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,370.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,344.06
|
| Rate for Payer: Multiplan PHCS |
$1,518.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,103.39
|
| Rate for Payer: UHCCP Medicaid |
$885.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,357.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,617.99
|
|
|
REPAIR ART INTRAMURAL
|
Facility
|
OP
|
$2,530.00
|
|
|
Service Code
|
HCPCS 33507
|
| Hospital Charge Code |
76101295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.00 |
| Max. Negotiated Rate |
$2,428.80 |
| Rate for Payer: Aetna Commercial |
$1,948.10
|
| Rate for Payer: Anthem Medicaid |
$870.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,973.40
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna Commercial |
$2,099.90
|
| Rate for Payer: First Health Commercial |
$2,403.50
|
| Rate for Payer: Humana Commercial |
$2,150.50
|
| Rate for Payer: Humana KY Medicaid |
$870.07
|
| Rate for Payer: Kentucky WC Medicaid |
$878.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,074.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,226.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,897.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.70
|
| Rate for Payer: PHCS Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Payer |
$2,226.40
|
|
|
REPAIR ART INTRAMURAL
|
Facility
|
IP
|
$2,530.00
|
|
|
Service Code
|
HCPCS 33507
|
| Hospital Charge Code |
76101295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$759.00 |
| Max. Negotiated Rate |
$2,428.80 |
| Rate for Payer: Aetna Commercial |
$1,948.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,973.40
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna Commercial |
$2,099.90
|
| Rate for Payer: First Health Commercial |
$2,403.50
|
| Rate for Payer: Humana Commercial |
$2,150.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,074.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,226.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,897.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,745.70
|
| Rate for Payer: PHCS Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Payer |
$2,226.40
|
|
|
REPAIR ART INTRAMURAL(P
|
Professional
|
Both
|
$2,530.00
|
|
|
Service Code
|
HCPCS 33507
|
| Hospital Charge Code |
761P1295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.50 |
| Max. Negotiated Rate |
$2,980.89 |
| Rate for Payer: Aetna Commercial |
$2,980.89
|
| Rate for Payer: Ambetter Exchange |
$1,617.99
|
| Rate for Payer: Anthem Medicaid |
$1,344.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,617.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,617.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,941.59
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna Commercial |
$2,849.17
|
| Rate for Payer: Healthspan PPO |
$2,930.80
|
| Rate for Payer: Humana Medicaid |
$1,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,426.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,617.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,617.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,370.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,344.06
|
| Rate for Payer: Multiplan PHCS |
$1,518.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,103.39
|
| Rate for Payer: UHCCP Medicaid |
$885.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,357.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,617.99
|
|
|
REPAIR ATRIAL SEPTAL DEFECT
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 33641
|
| Hospital Charge Code |
76101317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| 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 |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ATRIAL SEPTAL DEFECT
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 33641
|
| Hospital Charge Code |
76101317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| 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 |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ATRIAL SEPTAL DEFECT
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 33641
|
| Hospital Charge Code |
76101317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,387.38 |
| Max. Negotiated Rate |
$2,732.37 |
| Rate for Payer: Aetna Commercial |
$2,732.37
|
| Rate for Payer: Ambetter Exchange |
$1,541.18
|
| Rate for Payer: Anthem Medicaid |
$1,387.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,541.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,541.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,849.42
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,496.69
|
| Rate for Payer: Healthspan PPO |
$2,686.46
|
| Rate for Payer: Humana Medicaid |
$1,387.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,307.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,541.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,541.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,415.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,387.38
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,003.53
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,401.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,541.18
|
|
|
REPAIR ATRIAL SEPTAL DEFECT(P
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 33641
|
| Hospital Charge Code |
761P1317
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,387.38 |
| Max. Negotiated Rate |
$2,732.37 |
| Rate for Payer: Aetna Commercial |
$2,732.37
|
| Rate for Payer: Ambetter Exchange |
$1,541.18
|
| Rate for Payer: Anthem Medicaid |
$1,387.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,541.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,541.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,849.42
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,496.69
|
| Rate for Payer: Healthspan PPO |
$2,686.46
|
| Rate for Payer: Humana Medicaid |
$1,387.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,307.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,541.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,541.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,415.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,387.38
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,003.53
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,401.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,541.18
|
|
|
REPAIR BLADDER DEFECT
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
76102814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,115.58
|
| Rate for Payer: Ambetter Exchange |
$703.55
|
| Rate for Payer: Anthem Medicaid |
$682.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$703.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$844.26
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$1,179.81
|
| Rate for Payer: Healthspan PPO |
$1,080.16
|
| Rate for Payer: Humana Medicaid |
$682.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$922.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$703.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$696.33
|
| Rate for Payer: Molina Healthcare Passport |
$682.68
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$914.62
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$689.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$703.55
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
76102814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
REPAIR BLADDER DEFECT
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
76102814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
REPAIR BLD VESEL DIR HAND FING
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
76101371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,231.20 |
| Max. Negotiated Rate |
$3,939.84 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
REPAIR BLD VESEL DIR HAND FING
|
Facility
|
OP
|
$4,279.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
45000231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,471.55 |
| Max. Negotiated Rate |
$4,107.84 |
| Rate for Payer: Aetna Commercial |
$3,294.83
|
| Rate for Payer: Anthem Medicaid |
$1,471.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,337.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cigna Commercial |
$3,551.57
|
| Rate for Payer: First Health Commercial |
$4,065.05
|
| Rate for Payer: Humana Commercial |
$3,637.15
|
| Rate for Payer: Humana KY Medicaid |
$1,471.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,486.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,508.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,765.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,423.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,722.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,952.51
|
| Rate for Payer: PHCS Commercial |
$4,107.84
|
| Rate for Payer: United Healthcare All Payer |
$3,765.52
|
|
|
REPAIR BLD VESEL DIR HAND FING
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
76101371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,411.37 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem Medicaid |
$1,411.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Humana KY Medicaid |
$1,411.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
REPAIR BLD VESEL DIR HAND FING
|
Professional
|
Both
|
$1,790.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
76101371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.43 |
| Max. Negotiated Rate |
$1,192.67 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Ambetter Exchange |
$716.93
|
| Rate for Payer: Anthem Medicaid |
$602.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$716.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$716.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$860.32
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,148.45
|
| Rate for Payer: Healthspan PPO |
$1,172.63
|
| Rate for Payer: Humana Medicaid |
$602.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$938.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$716.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$716.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$614.48
|
| Rate for Payer: Molina Healthcare Passport |
$602.43
|
| Rate for Payer: Multiplan PHCS |
$1,074.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$932.01
|
| Rate for Payer: UHCCP Medicaid |
$626.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$608.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$716.93
|
|
|
REPAIR BLD VESEL DIR HAND FING
|
Facility
|
IP
|
$4,279.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
45000231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,283.70 |
| Max. Negotiated Rate |
$4,107.84 |
| Rate for Payer: Aetna Commercial |
$3,294.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,337.62
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cigna Commercial |
$3,551.57
|
| Rate for Payer: First Health Commercial |
$4,065.05
|
| Rate for Payer: Humana Commercial |
$3,637.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,508.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,765.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,423.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,722.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,952.51
|
| Rate for Payer: PHCS Commercial |
$4,107.84
|
| Rate for Payer: United Healthcare All Payer |
$3,765.52
|
|
|
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 |
$2,489.16 |
| Rate for Payer: Aetna Commercial |
$1,470.84
|
| Rate for Payer: Ambetter Exchange |
$777.28
|
| Rate for Payer: Anthem Medicaid |
$562.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$932.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$777.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.28
|
| 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 |
$1,010.46
|
| Rate for Payer: UHCCP Medicaid |
$1,452.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$568.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.28
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
OP
|
$4,148.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
76101375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,982.66 |
| Rate for Payer: Aetna Commercial |
$3,194.42
|
| Rate for Payer: Anthem Medicaid |
$1,426.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,235.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$2,074.30
|
| 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: Humana KY Medicaid |
$1,426.70
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.22
|
| 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 |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.33
|
| 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 |
$3,318.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,609.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,862.53
|
| Rate for Payer: PHCS Commercial |
$3,982.66
|
| Rate for Payer: United Healthcare All Payer |
$3,650.77
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
OP
|
$1,948.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
45000232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$650.10 |
| 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 |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,519.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| 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 |
$650.10
|
| 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 |
$780.12
|
| 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 |
$1,558.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,695.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.53
|
| Rate for Payer: PHCS Commercial |
$1,870.66
|
| Rate for Payer: United Healthcare All Payer |
$1,714.77
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
IP
|
$1,948.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
45000232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$584.58 |
| 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 |
$1,558.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,695.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.53
|
| Rate for Payer: PHCS Commercial |
$1,870.66
|
| Rate for Payer: United Healthcare All Payer |
$1,714.77
|
|
|
REPAIR BLOOD VESSEL
|
Facility
|
IP
|
$4,148.60
|
|
|
Service Code
|
HCPCS 35226
|
| Hospital Charge Code |
76101375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,244.58 |
| 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 |
$3,318.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,609.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,862.53
|
| Rate for Payer: PHCS Commercial |
$3,982.66
|
| Rate for Payer: United Healthcare All Payer |
$3,650.77
|
|
|
REPAIR BLOOD VESSEL - DIRECT;
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35216
|
| Hospital Charge Code |
76101373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| 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 |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| 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 |
$1,050.00 |
| 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 |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| 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 |
$3,231.16 |
| Rate for Payer: Aetna Commercial |
$3,231.16
|
| Rate for Payer: Ambetter Exchange |
$1,955.88
|
| Rate for Payer: Anthem Medicaid |
$839.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,955.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,955.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,347.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,955.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,955.88
|
| 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 |
$2,542.64
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$847.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,955.88
|
|
