|
STAB PHLEBECTOMY 10-20 (P
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761P2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
|
|
STAB PHLEBECTOMY 10-20 (T
|
Facility
|
OP
|
$6,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$6,165.12 |
| Rate for Payer: Aetna Commercial |
$4,944.94
|
| Rate for Payer: Anthem Medicaid |
$2,208.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,009.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$3,211.00
|
| Rate for Payer: Cash Price |
$3,211.00
|
| Rate for Payer: Cigna Commercial |
$5,330.26
|
| Rate for Payer: First Health Commercial |
$6,100.90
|
| Rate for Payer: Humana Commercial |
$5,458.70
|
| Rate for Payer: Humana KY Medicaid |
$2,208.53
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,231.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,266.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,739.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,252.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,651.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,816.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,587.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,431.18
|
| Rate for Payer: PHCS Commercial |
$6,165.12
|
| Rate for Payer: United Healthcare All Payer |
$5,651.36
|
|
|
STAB PHLEBECTOMY 10-20 (T
|
Facility
|
IP
|
$6,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,926.60 |
| Max. Negotiated Rate |
$6,165.12 |
| Rate for Payer: Aetna Commercial |
$4,944.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,009.16
|
| Rate for Payer: Cash Price |
$3,211.00
|
| Rate for Payer: Cigna Commercial |
$5,330.26
|
| Rate for Payer: First Health Commercial |
$6,100.90
|
| Rate for Payer: Humana Commercial |
$5,458.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,266.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,739.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,926.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,651.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,816.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,587.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,431.18
|
| Rate for Payer: PHCS Commercial |
$6,165.12
|
| Rate for Payer: United Healthcare All Payer |
$5,651.36
|
|
|
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 |
$444.50 |
| 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
|
$2,787.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761T2674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.10 |
| 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 |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| 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 |
$571.26 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
STAB PHLEBECTOMY 1-9
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,026.60 |
| 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 |
$2,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,977.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.18
|
| 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 |
$571.26 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,669.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$2,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,977.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.18
|
| 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 |
$2,395.40 |
| 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
|
$4,071.52
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
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 |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
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 |
$206.34 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| 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 |
$252.60 |
| Max. Negotiated Rate |
$685.01 |
| Rate for Payer: Aetna Commercial |
$685.01
|
| Rate for Payer: Ambetter Exchange |
$252.60
|
| 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 Individual/Medicaid |
$252.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$252.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$252.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| 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 |
$328.38
|
| Rate for Payer: UHCCP Medicaid |
$289.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.60
|
|
|
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 |
$252.60 |
| Max. Negotiated Rate |
$685.01 |
| Rate for Payer: Aetna Commercial |
$685.01
|
| Rate for Payer: Ambetter Exchange |
$252.60
|
| 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 Individual/Medicaid |
$252.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$252.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$252.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| 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 |
$328.38
|
| Rate for Payer: UHCCP Medicaid |
$289.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.60
|
|
|
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 |
$257.93 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
76101582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.05 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Aetna Commercial |
$830.25
|
| Rate for Payer: Ambetter Exchange |
$312.05
|
| 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 Individual/Medicaid |
$312.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$312.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.05
|
| 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 |
$405.67
|
| Rate for Payer: UHCCP Medicaid |
$354.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.05
|
|
|
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 |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
$312.05 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Aetna Commercial |
$830.25
|
| Rate for Payer: Ambetter Exchange |
$312.05
|
| 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 Individual/Medicaid |
$312.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$312.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.05
|
| 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 |
$405.67
|
| Rate for Payer: UHCCP Medicaid |
$354.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.05
|
|
|
STAB TIBIAL INSERT 76*51*8.0MM
|
Facility
|
OP
|
$5,226.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.01 |
| Max. Negotiated Rate |
$5,017.62 |
| Rate for Payer: Aetna Commercial |
$4,024.55
|
| Rate for Payer: Anthem Medicaid |
$1,797.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,076.82
|
| Rate for Payer: Cash Price |
$2,613.34
|
| Rate for Payer: Cigna Commercial |
$4,338.15
|
| Rate for Payer: First Health Commercial |
$4,965.36
|
| Rate for Payer: Humana Commercial |
$4,442.69
|
| Rate for Payer: Humana KY Medicaid |
$1,797.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,815.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,285.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,857.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,833.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,599.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,920.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,181.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,606.42
|
| Rate for Payer: PHCS Commercial |
$5,017.62
|
| Rate for Payer: United Healthcare All Payer |
$4,599.49
|
|
|
STAB TIBIAL INSERT 76*51*8.0MM
|
Facility
|
IP
|
$5,226.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.01 |
| Max. Negotiated Rate |
$5,017.62 |
| Rate for Payer: Aetna Commercial |
$4,024.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,076.82
|
| Rate for Payer: Cash Price |
$2,613.34
|
| Rate for Payer: Cigna Commercial |
$4,338.15
|
| Rate for Payer: First Health Commercial |
$4,965.36
|
| Rate for Payer: Humana Commercial |
$4,442.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,285.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,857.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,599.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,920.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,181.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,606.42
|
| Rate for Payer: PHCS Commercial |
$5,017.62
|
| Rate for Payer: United Healthcare All Payer |
$4,599.49
|
|
|
STADOL 1MG (2MG VIAL)
|
Facility
|
IP
|
$82.50
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.75 |
| 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 |
$68.47
|
| 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 |
$66.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.92
|
| 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 |
$24.75 |
| 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 |
$68.47
|
| 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 |
$66.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.92
|
| Rate for Payer: PHCS Commercial |
$79.20
|
| Rate for Payer: United Healthcare All Payer |
$72.60
|
|
|
STADOL (BUTORPHANOL) 1MG/1ML
|
Facility
|
OP
|
$81.13
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.34 |
| 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 |
$64.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.98
|
| Rate for Payer: PHCS Commercial |
$77.88
|
| Rate for Payer: United Healthcare All Payer |
$71.39
|
|
|
STADOL (BUTORPHANOL) 1MG/1ML
|
Facility
|
IP
|
$81.13
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
25001912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.34 |
| 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 |
$64.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.98
|
| Rate for Payer: PHCS Commercial |
$77.88
|
| Rate for Payer: United Healthcare All Payer |
$71.39
|
|
