|
TRANSJUGLR LIVER SET ACCES SET
|
Facility
|
OP
|
$3,837.46
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,151.24 |
| Max. Negotiated Rate |
$3,683.96 |
| Rate for Payer: Aetna Commercial |
$2,954.84
|
| Rate for Payer: Anthem Medicaid |
$1,319.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.22
|
| Rate for Payer: Cash Price |
$1,918.73
|
| Rate for Payer: Cigna Commercial |
$3,185.09
|
| Rate for Payer: First Health Commercial |
$3,645.59
|
| Rate for Payer: Humana Commercial |
$3,261.84
|
| Rate for Payer: Humana KY Medicaid |
$1,319.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,376.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,069.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.85
|
| Rate for Payer: PHCS Commercial |
$3,683.96
|
| Rate for Payer: United Healthcare All Payer |
$3,376.96
|
|
|
TRANSJUGLR LIVER SET ACCES SET
|
Facility
|
IP
|
$3,837.46
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,151.24 |
| Max. Negotiated Rate |
$3,683.96 |
| Rate for Payer: Aetna Commercial |
$2,954.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.22
|
| Rate for Payer: Cash Price |
$1,918.73
|
| Rate for Payer: Cigna Commercial |
$3,185.09
|
| Rate for Payer: First Health Commercial |
$3,645.59
|
| Rate for Payer: Humana Commercial |
$3,261.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,376.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,069.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.85
|
| Rate for Payer: PHCS Commercial |
$3,683.96
|
| Rate for Payer: United Healthcare All Payer |
$3,376.96
|
|
|
TRANSLUCENT LEAD
|
Facility
|
IP
|
$503.71
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$151.11 |
| Max. Negotiated Rate |
$483.56 |
| Rate for Payer: Aetna Commercial |
$387.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.89
|
| Rate for Payer: Cash Price |
$251.86
|
| Rate for Payer: Cigna Commercial |
$418.08
|
| Rate for Payer: First Health Commercial |
$478.52
|
| Rate for Payer: Humana Commercial |
$428.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.26
|
| Rate for Payer: Ohio Health Group HMO |
$377.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.56
|
| Rate for Payer: PHCS Commercial |
$483.56
|
| Rate for Payer: United Healthcare All Payer |
$443.26
|
|
|
TRANSLUCENT LEAD
|
Facility
|
OP
|
$503.71
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$151.11 |
| Max. Negotiated Rate |
$483.56 |
| Rate for Payer: Aetna Commercial |
$387.86
|
| Rate for Payer: Anthem Medicaid |
$173.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.89
|
| Rate for Payer: Cash Price |
$251.86
|
| Rate for Payer: Cigna Commercial |
$418.08
|
| Rate for Payer: First Health Commercial |
$478.52
|
| Rate for Payer: Humana Commercial |
$428.15
|
| Rate for Payer: Humana KY Medicaid |
$173.23
|
| Rate for Payer: Kentucky WC Medicaid |
$174.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.26
|
| Rate for Payer: Ohio Health Group HMO |
$377.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.56
|
| Rate for Payer: PHCS Commercial |
$483.56
|
| Rate for Payer: United Healthcare All Payer |
$443.26
|
|
|
TRANSLUM BALL ANGIO ADDL ART
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
32000371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,787.10 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
TRANSLUM BALL ANGIO ADDL ART
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
32000371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,787.10 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
TRANSLUM BALL ANGIO PERI ART
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
32000370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,787.10 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
TRANSLUM BALL ANGIO PERI ART
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
32000370
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,048.61 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN
|
Facility
|
OP
|
$7,375.33
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,268.09 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT LOWER EXTREMITY ARTERY(IES) FOR OCCLUSIVE DISEASE, INTRACRANIAL, CORONARY, PULMONARY, OR DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY; INITIAL ARTERY
|
Facility
|
OP
|
$7,375.33
|
|
|
Service Code
|
CPT 37246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,268.09 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
|
|
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; ABDOMINAL AORTA
|
Facility
|
OP
|
$14,669.84
|
|
|
Service Code
|
CPT 0236T
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,478.46 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
|
|
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; BRACHIOCEPHALIC TRUNK AND BRANCHES, EACH VESSEL
|
Facility
|
OP
|
$14,669.84
|
|
|
Service Code
|
CPT 0237T
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,478.46 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
|
|
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; ILIAC ARTERY, EACH VESSEL
|
Facility
|
OP
|
$23,228.31
|
|
|
Service Code
|
CPT 0238T
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,591.65 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
|
|
TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; ILIAC ARTERY, EACH VESSEL
|
Facility
|
OP
|
$23,228.31
|
|
|
Service Code
|
CPT 0238T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,591.65 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
|
|
TRANSPLANT FOREARM TENDON
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 25312
|
| Hospital Charge Code |
761P2601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,474.58 |
| Rate for Payer: Aetna Commercial |
$1,126.51
|
| Rate for Payer: Ambetter Exchange |
$686.37
|
| Rate for Payer: Anthem Medicaid |
$502.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$823.64
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,474.58
|
| Rate for Payer: Healthspan PPO |
$1,020.38
|
| Rate for Payer: Humana Medicaid |
$502.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$686.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$512.98
|
| Rate for Payer: Molina Healthcare Passport |
$502.92
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.28
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$507.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.37
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 25312
|
| Hospital Charge Code |
76102601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
TRANSPLANT FOREARM TENDON
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
76100605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$1,320.80 |
| Rate for Payer: Aetna Commercial |
$971.06
|
| Rate for Payer: Ambetter Exchange |
$679.39
|
| Rate for Payer: Anthem Medicaid |
$445.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$679.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$679.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.27
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$1,320.80
|
| Rate for Payer: Healthspan PPO |
$879.57
|
| Rate for Payer: Humana Medicaid |
$445.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$794.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$679.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.21
|
| Rate for Payer: Molina Healthcare Passport |
$445.30
|
| Rate for Payer: Multiplan PHCS |
$489.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$883.21
|
| Rate for Payer: UHCCP Medicaid |
$285.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$679.39
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
76100605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.50 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 25312
|
| Hospital Charge Code |
76102601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.67 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| 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 |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
76100605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| 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 |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
TRANSPLANT FOREARM TENDON
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 25312
|
| Hospital Charge Code |
76102601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,474.58 |
| Rate for Payer: Aetna Commercial |
$1,126.51
|
| Rate for Payer: Ambetter Exchange |
$686.37
|
| Rate for Payer: Anthem Medicaid |
$502.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$823.64
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,474.58
|
| Rate for Payer: Healthspan PPO |
$1,020.38
|
| Rate for Payer: Humana Medicaid |
$502.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$686.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$512.98
|
| Rate for Payer: Molina Healthcare Passport |
$502.92
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.28
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$507.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.37
|
|
|
TRANSPLANT FOREARM TENDON(P
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
761P0605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$1,320.80 |
| Rate for Payer: Aetna Commercial |
$971.06
|
| Rate for Payer: Ambetter Exchange |
$679.39
|
| Rate for Payer: Anthem Medicaid |
$445.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$679.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$679.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.27
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$1,320.80
|
| Rate for Payer: Healthspan PPO |
$879.57
|
| Rate for Payer: Humana Medicaid |
$445.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$794.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$679.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.21
|
| Rate for Payer: Molina Healthcare Passport |
$445.30
|
| Rate for Payer: Multiplan PHCS |
$489.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$883.21
|
| Rate for Payer: UHCCP Medicaid |
$285.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$679.39
|
|
|
TRANSPLANT HAND TENDON
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
76100708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.75 |
| Max. Negotiated Rate |
$1,323.87 |
| Rate for Payer: Aetna Commercial |
$1,052.65
|
| Rate for Payer: Ambetter Exchange |
$679.98
|
| Rate for Payer: Anthem Medicaid |
$392.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$679.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$679.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.98
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$1,323.87
|
| Rate for Payer: Healthspan PPO |
$953.48
|
| Rate for Payer: Humana Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$906.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$679.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.41
|
| Rate for Payer: Molina Healthcare Passport |
$392.56
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$883.97
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$396.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$679.98
|
|
|
TRANSPLANT HAND TENDON
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
76100708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.11 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| 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 |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$321.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
TRANSPLANT HAND TENDON
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
76100708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
