|
STAB PHLEBECTOMY 10-20 (T
|
Facility
|
OP
|
$6,241.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.24 |
| Max. Negotiated Rate |
$5,991.36 |
| Rate for Payer: Aetna Commercial |
$4,805.57
|
| Rate for Payer: Anthem Medicaid |
$2,146.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,867.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$3,120.50
|
| Rate for Payer: Cash Price |
$3,120.50
|
| Rate for Payer: Cigna Commercial |
$5,180.03
|
| Rate for Payer: First Health Commercial |
$5,928.95
|
| Rate for Payer: Humana Commercial |
$5,304.85
|
| Rate for Payer: Humana KY Medicaid |
$2,146.28
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,168.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,117.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,605.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,189.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,492.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,680.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,934.71
|
| Rate for Payer: PHCS Commercial |
$5,991.36
|
| Rate for Payer: United Healthcare All Payer |
$5,492.08
|
|
|
STAB PHLEBECTOMY 10-20 (T
|
Facility
|
IP
|
$6,241.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.33 |
| Max. Negotiated Rate |
$5,991.36 |
| Rate for Payer: Aetna Commercial |
$4,805.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,867.98
|
| Rate for Payer: Cash Price |
$3,120.50
|
| Rate for Payer: Cigna Commercial |
$5,180.03
|
| Rate for Payer: First Health Commercial |
$5,928.95
|
| Rate for Payer: Humana Commercial |
$5,304.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,117.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,605.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,872.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,492.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,680.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,934.71
|
| Rate for Payer: PHCS Commercial |
$5,991.36
|
| Rate for Payer: United Healthcare All Payer |
$5,492.08
|
|
|
STAB PHLEBECTOMY 1-9
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.31 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$836.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$557.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$863.97
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
STAB PHLEBECTOMY 1-9
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.31 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem Medicaid |
$958.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Humana KY Medicaid |
$958.45
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$968.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$977.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$557.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$863.97
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
STAB PHLEBECTOMY 1-9
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761P2674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
|
|
STAB PHLEBECTOMY 1-9
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.86 |
| Max. Negotiated Rate |
$3,285.12 |
| Rate for Payer: Aetna Commercial |
$2,634.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,669.16
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,840.26
|
| Rate for Payer: First Health Commercial |
$3,250.90
|
| Rate for Payer: Humana Commercial |
$2,908.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,806.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,525.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,011.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$684.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,060.82
|
| Rate for Payer: PHCS Commercial |
$3,285.12
|
| Rate for Payer: United Healthcare All Payer |
$3,011.36
|
|
|
STAB PHLEBECTOMY 1-9
|
Facility
|
OP
|
$3,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.86 |
| Max. Negotiated Rate |
$3,285.12 |
| Rate for Payer: Aetna Commercial |
$2,634.94
|
| Rate for Payer: Anthem Medicaid |
$1,176.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,669.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,840.26
|
| Rate for Payer: First Health Commercial |
$3,250.90
|
| Rate for Payer: Humana Commercial |
$2,908.70
|
| Rate for Payer: Humana KY Medicaid |
$1,176.83
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,188.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,806.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,525.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,200.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,011.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$684.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,060.82
|
| Rate for Payer: PHCS Commercial |
$3,285.12
|
| Rate for Payer: United Healthcare All Payer |
$3,011.36
|
|
|
STAB PHLEBECTOMY 1-9
|
Professional
|
Both
|
$3,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,422.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,422.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,053.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,395.40
|
| Rate for Payer: UHCCP Medicaid |
$1,197.70
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
STAB PHLEB OF VEIN - 10-20
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
76101581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STAB PHLEB OF VEIN - 10-20
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
76101581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.81 |
| Max. Negotiated Rate |
$685.01 |
| Rate for Payer: Aetna Commercial |
$685.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.81
|
| Rate for Payer: Anthem Medicaid |
$340.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$672.62
|
| Rate for Payer: Healthspan PPO |
$547.72
|
| Rate for Payer: Humana Medicaid |
$340.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.81
|
| Rate for Payer: Molina Healthcare Passport |
$340.01
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$289.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.41
|
|
|
STAB PHLEB OF VEIN - 10-20
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
76101581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STAB PHLEB OF VEIN - 10-20(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
761P1581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.81 |
| Max. Negotiated Rate |
$685.01 |
| Rate for Payer: Aetna Commercial |
$685.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.81
|
| Rate for Payer: Anthem Medicaid |
$340.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$672.62
|
| Rate for Payer: Healthspan PPO |
$547.72
|
| Rate for Payer: Humana Medicaid |
$340.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.81
|
| Rate for Payer: Molina Healthcare Passport |
$340.01
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$289.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.41
|
|
|
STAB PHLEB OF VEIN - > 20 INCI
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
76101582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.76 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Aetna Commercial |
$830.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$337.76
|
| Rate for Payer: Anthem Medicaid |
$414.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$812.39
|
| Rate for Payer: Healthspan PPO |
$663.86
|
| Rate for Payer: Humana Medicaid |
$414.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.63
|
| Rate for Payer: Molina Healthcare Passport |
$414.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$354.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.48
|
|
|
STAB PHLEB OF VEIN - > 20 INCI
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
76101582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
STAB PHLEB OF VEIN - > 20 INCI
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
761P1582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.76 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Aetna Commercial |
$830.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$337.76
|
| Rate for Payer: Anthem Medicaid |
$414.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$812.39
|
| Rate for Payer: Healthspan PPO |
$663.86
|
| Rate for Payer: Humana Medicaid |
$414.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.63
|
| Rate for Payer: Molina Healthcare Passport |
$414.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$354.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.48
|
|
|
STAB PHLEB OF VEIN - > 20 INCI
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
76101582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
STAB TIBIAL INSERT 76*51*8.0MM
|
Facility
|
OP
|
$5,211.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.51 |
| Max. Negotiated Rate |
$5,003.12 |
| Rate for Payer: Aetna Commercial |
$4,012.92
|
| Rate for Payer: Anthem Medicaid |
$1,792.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,065.03
|
| Rate for Payer: Cash Price |
$2,605.79
|
| Rate for Payer: Cigna Commercial |
$4,325.61
|
| Rate for Payer: First Health Commercial |
$4,951.00
|
| Rate for Payer: Humana Commercial |
$4,429.84
|
| Rate for Payer: Humana KY Medicaid |
$1,792.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,810.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,273.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,846.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,828.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,586.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,908.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.59
|
| Rate for Payer: PHCS Commercial |
$5,003.12
|
| Rate for Payer: United Healthcare All Payer |
$4,586.19
|
|
|
STAB TIBIAL INSERT 76*51*8.0MM
|
Facility
|
IP
|
$5,211.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.51 |
| Max. Negotiated Rate |
$5,003.12 |
| Rate for Payer: Aetna Commercial |
$4,012.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,065.03
|
| Rate for Payer: Cash Price |
$2,605.79
|
| Rate for Payer: Cigna Commercial |
$4,325.61
|
| Rate for Payer: First Health Commercial |
$4,951.00
|
| Rate for Payer: Humana Commercial |
$4,429.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,273.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,846.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,586.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,908.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.59
|
| Rate for Payer: PHCS Commercial |
$5,003.12
|
| Rate for Payer: United Healthcare All Payer |
$4,586.19
|
|
|
STADOL 1MG (2MG VIAL)
|
Facility
|
IP
|
$82.50
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.35
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cigna Commercial |
$68.48
|
| Rate for Payer: First Health Commercial |
$78.38
|
| Rate for Payer: Humana Commercial |
$70.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.60
|
| Rate for Payer: Ohio Health Group HMO |
$61.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.58
|
| Rate for Payer: PHCS Commercial |
$79.20
|
| Rate for Payer: United Healthcare All Payer |
$72.60
|
|
|
STADOL 1MG (2MG VIAL)
|
Facility
|
OP
|
$82.50
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Anthem Medicaid |
$28.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.35
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cigna Commercial |
$68.48
|
| Rate for Payer: First Health Commercial |
$78.38
|
| Rate for Payer: Humana Commercial |
$70.12
|
| Rate for Payer: Humana KY Medicaid |
$28.37
|
| Rate for Payer: Kentucky WC Medicaid |
$28.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.60
|
| Rate for Payer: Ohio Health Group HMO |
$61.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.58
|
| Rate for Payer: PHCS Commercial |
$79.20
|
| Rate for Payer: United Healthcare All Payer |
$72.60
|
|
|
STADOL (BUTORPHANOL) 1MG/1ML
|
Facility
|
IP
|
$81.13
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$77.88 |
| Rate for Payer: Aetna Commercial |
$62.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.28
|
| Rate for Payer: Cash Price |
$40.56
|
| Rate for Payer: Cigna Commercial |
$67.34
|
| Rate for Payer: First Health Commercial |
$77.07
|
| Rate for Payer: Humana Commercial |
$68.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.39
|
| Rate for Payer: Ohio Health Group HMO |
$60.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.15
|
| Rate for Payer: PHCS Commercial |
$77.88
|
| Rate for Payer: United Healthcare All Payer |
$71.39
|
|
|
STADOL (BUTORPHANOL) 1MG/1ML
|
Facility
|
OP
|
$81.13
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$77.88 |
| Rate for Payer: Aetna Commercial |
$62.47
|
| Rate for Payer: Anthem Medicaid |
$27.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.28
|
| Rate for Payer: Cash Price |
$40.56
|
| Rate for Payer: Cigna Commercial |
$67.34
|
| Rate for Payer: First Health Commercial |
$77.07
|
| Rate for Payer: Humana Commercial |
$68.96
|
| Rate for Payer: Humana KY Medicaid |
$27.90
|
| Rate for Payer: Kentucky WC Medicaid |
$28.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.39
|
| Rate for Payer: Ohio Health Group HMO |
$60.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.15
|
| Rate for Payer: PHCS Commercial |
$77.88
|
| Rate for Payer: United Healthcare All Payer |
$71.39
|
|
|
STAGE ONE CEMENT SPACER MOLD
|
Facility
|
OP
|
$12,746.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.01 |
| Max. Negotiated Rate |
$12,236.35 |
| Rate for Payer: Aetna Commercial |
$9,814.57
|
| Rate for Payer: Anthem Medicaid |
$4,383.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,942.04
|
| Rate for Payer: Cash Price |
$6,373.10
|
| Rate for Payer: Cigna Commercial |
$10,579.35
|
| Rate for Payer: First Health Commercial |
$12,108.89
|
| Rate for Payer: Humana Commercial |
$10,834.27
|
| Rate for Payer: Humana KY Medicaid |
$4,383.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,451.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,406.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,823.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,471.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,216.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,559.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,549.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.32
|
| Rate for Payer: PHCS Commercial |
$12,236.35
|
| Rate for Payer: United Healthcare All Payer |
$11,216.66
|
|
