|
REPR BLD VESSEL LOWER EXTREM
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.02 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,647.93
|
| Rate for Payer: Ambetter Exchange |
$869.47
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$869.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$869.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,043.36
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,587.72
|
| Rate for Payer: Healthspan PPO |
$1,620.24
|
| Rate for Payer: Humana Medicaid |
$687.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$869.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$869.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.76
|
| Rate for Payer: Molina Healthcare Passport |
$687.02
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,130.31
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$869.47
|
|
|
REPR BLD VESSEL LOWER EXTREM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR BLD VESSEL LOWER EXTREM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
76101378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,100.48 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR BLD VESSEL LOWER EXTREM(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35286
|
| Hospital Charge Code |
761P1378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.02 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,647.93
|
| Rate for Payer: Ambetter Exchange |
$869.47
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$869.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$869.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,043.36
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,587.72
|
| Rate for Payer: Healthspan PPO |
$1,620.24
|
| Rate for Payer: Humana Medicaid |
$687.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$869.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$869.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.76
|
| Rate for Payer: Molina Healthcare Passport |
$687.02
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,130.31
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$869.47
|
|
|
REPR CAROTID W GRFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| 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: Humana KY Medicaid |
$1,100.48
|
| 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 |
$960.00
|
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR CAROTID W GRFT
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR CAROTID W GRFT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.74 |
| Max. Negotiated Rate |
$2,108.22 |
| Rate for Payer: Aetna Commercial |
$2,108.22
|
| Rate for Payer: Ambetter Exchange |
$1,071.90
|
| Rate for Payer: Anthem Medicaid |
$967.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,071.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,071.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,286.28
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,013.85
|
| Rate for Payer: Healthspan PPO |
$2,072.79
|
| Rate for Payer: Humana Medicaid |
$967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,578.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,071.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.09
|
| Rate for Payer: Molina Healthcare Passport |
$967.74
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,393.47
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,071.90
|
|
|
REPR CAROTID W GRFT(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
761P1355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.74 |
| Max. Negotiated Rate |
$2,108.22 |
| Rate for Payer: Aetna Commercial |
$2,108.22
|
| Rate for Payer: Ambetter Exchange |
$1,071.90
|
| Rate for Payer: Anthem Medicaid |
$967.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,071.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,071.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,286.28
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,013.85
|
| Rate for Payer: Healthspan PPO |
$2,072.79
|
| Rate for Payer: Humana Medicaid |
$967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,578.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,071.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.09
|
| Rate for Payer: Molina Healthcare Passport |
$967.74
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,393.47
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,071.90
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Aetna Commercial |
$213.36
|
| Rate for Payer: Ambetter Exchange |
$129.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.46
|
| Rate for Payer: Anthem Medicaid |
$106.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$201.16
|
| Rate for Payer: Healthspan PPO |
$210.83
|
| Rate for Payer: Humana Medicaid |
$106.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.18
|
| Rate for Payer: Molina Healthcare Passport |
$106.06
|
| Rate for Payer: Multiplan PHCS |
$1,359.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.92
|
| Rate for Payer: UHCCP Medicaid |
$75.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.17
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Facility
|
OP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.50 |
| Max. Negotiated Rate |
$2,174.40 |
| Rate for Payer: Aetna Commercial |
$1,744.05
|
| Rate for Payer: Anthem Medicaid |
$778.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,766.70
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$1,879.95
|
| Rate for Payer: First Health Commercial |
$2,151.75
|
| Rate for Payer: Humana Commercial |
$1,925.25
|
| Rate for Payer: Humana KY Medicaid |
$778.93
|
| Rate for Payer: Kentucky WC Medicaid |
$786.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,857.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,671.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$794.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,993.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,698.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,970.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,562.85
|
| Rate for Payer: PHCS Commercial |
$2,174.40
|
| Rate for Payer: United Healthcare All Payer |
$1,993.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Facility
|
IP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.50 |
| Max. Negotiated Rate |
$2,174.40 |
| Rate for Payer: Aetna Commercial |
$1,744.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,766.70
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$1,879.95
|
| Rate for Payer: First Health Commercial |
$2,151.75
|
| Rate for Payer: Humana Commercial |
$1,925.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,857.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,671.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,993.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,698.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,970.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,562.85
|
| Rate for Payer: PHCS Commercial |
$2,174.40
|
| Rate for Payer: United Healthcare All Payer |
$1,993.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761P0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$213.36
|
| Rate for Payer: Ambetter Exchange |
$129.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.46
|
| Rate for Payer: Anthem Medicaid |
$106.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$201.16
|
| Rate for Payer: Healthspan PPO |
$210.83
|
| Rate for Payer: Humana Medicaid |
$106.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.18
|
| Rate for Payer: Molina Healthcare Passport |
$106.06
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.92
|
| Rate for Payer: UHCCP Medicaid |
$75.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.17
|
|
|
REPR - COMPLEX EACH ADD 5 CM(T
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761T0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.50 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.85
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM(T
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761T0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.50 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem Medicaid |
$435.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Humana KY Medicaid |
$435.03
|
| Rate for Payer: Kentucky WC Medicaid |
$439.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$443.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.85
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
REPR ELBOW LAT LIGMNT W/TIS(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
761P0522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.35 |
| Max. Negotiated Rate |
$1,122.74 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Ambetter Exchange |
$684.12
|
| Rate for Payer: Anthem Medicaid |
$483.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$684.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$820.94
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,122.74
|
| Rate for Payer: Healthspan PPO |
$922.48
|
| Rate for Payer: Humana Medicaid |
$483.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$684.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.02
|
| Rate for Payer: Molina Healthcare Passport |
$483.35
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.36
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$684.12
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.35 |
| Max. Negotiated Rate |
$1,122.74 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Ambetter Exchange |
$684.12
|
| Rate for Payer: Anthem Medicaid |
$483.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$684.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$820.94
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,122.74
|
| Rate for Payer: Healthspan PPO |
$922.48
|
| Rate for Payer: Humana Medicaid |
$483.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$684.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.02
|
| Rate for Payer: Molina Healthcare Passport |
$483.35
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.36
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$684.12
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.04 |
| Max. Negotiated Rate |
$738.57 |
| Rate for Payer: Aetna Commercial |
$738.57
|
| Rate for Payer: Ambetter Exchange |
$500.48
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$500.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$600.58
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Healthspan PPO |
$622.85
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$500.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$650.62
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$500.48
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REPR INIT INGIN HERNIA > 5YR(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
761P2012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.04 |
| Max. Negotiated Rate |
$738.57 |
| Rate for Payer: Aetna Commercial |
$738.57
|
| Rate for Payer: Ambetter Exchange |
$500.48
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$500.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$600.58
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Healthspan PPO |
$622.85
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$500.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$650.62
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$500.48
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
761P0143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$335.48 |
| Rate for Payer: Aetna Commercial |
$256.47
|
| Rate for Payer: Ambetter Exchange |
$158.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.48
|
| Rate for Payer: Anthem Medicaid |
$100.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$158.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$158.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.77
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$335.48
|
| Rate for Payer: Healthspan PPO |
$292.38
|
| Rate for Payer: Humana Medicaid |
$100.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$158.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.54
|
| Rate for Payer: Molina Healthcare Passport |
$100.53
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.58
|
| Rate for Payer: UHCCP Medicaid |
$89.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.14
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.30 |
| Max. Negotiated Rate |
$941.76 |
| Rate for Payer: Aetna Commercial |
$755.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.18
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$814.23
|
| Rate for Payer: First Health Commercial |
$931.95
|
| Rate for Payer: Humana Commercial |
$833.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$804.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$863.28
|
| Rate for Payer: Ohio Health Group HMO |
$735.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.89
|
| Rate for Payer: PHCS Commercial |
$941.76
|
| Rate for Payer: United Healthcare All Payer |
$863.28
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
761T0143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
