|
VEIN BYPASS GRAFT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35583
|
| Hospital Charge Code |
761P1403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,510.52
|
| Rate for Payer: Anthem Medicaid |
$1,117.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,379.76
|
| Rate for Payer: Healthspan PPO |
$2,468.33
|
| Rate for Payer: Humana Medicaid |
$1,117.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,139.55
|
| Rate for Payer: Molina Healthcare Passport |
$1,117.21
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,128.38
|
|
|
VEIN BYPASS GRAFT(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35372
|
| Hospital Charge Code |
761P1389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$716.15 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,751.15
|
| Rate for Payer: Anthem Medicaid |
$716.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,685.99
|
| Rate for Payer: Healthspan PPO |
$1,721.73
|
| Rate for Payer: Humana Medicaid |
$716.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,348.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$730.47
|
| Rate for Payer: Molina Healthcare Passport |
$716.15
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.31
|
|
|
VEIN HARVEST
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 33508
|
| Hospital Charge Code |
76101296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
VEIN HARVEST
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 33508
|
| Hospital Charge Code |
76101296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
VEIN HARVEST
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 33508
|
| Hospital Charge Code |
76101296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: Anthem Medicaid |
$12.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$26.43
|
| Rate for Payer: Healthspan PPO |
$27.71
|
| Rate for Payer: Humana Medicaid |
$12.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.78
|
| Rate for Payer: Molina Healthcare Passport |
$12.53
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.66
|
|
|
VEIN HARVEST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 33508
|
| Hospital Charge Code |
761P1296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$28.18
|
| Rate for Payer: Anthem Medicaid |
$12.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$26.43
|
| Rate for Payer: Healthspan PPO |
$27.71
|
| Rate for Payer: Humana Medicaid |
$12.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.78
|
| Rate for Payer: Molina Healthcare Passport |
$12.53
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.66
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$33,049.76
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$22,426.62 |
| Max. Negotiated Rate |
$33,049.76 |
| Rate for Payer: Anthem Medicaid |
$22,426.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,606.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33,049.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$31,869.41
|
| Rate for Payer: Humana KY Medicaid |
$22,426.62
|
| Rate for Payer: Humana Medicare Advantage |
$23,606.97
|
| Rate for Payer: Kentucky WC Medicaid |
$22,650.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,328.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,875.15
|
|
|
VEIN MAPPING
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$754.56 |
| Rate for Payer: Aetna Commercial |
$605.22
|
| Rate for Payer: Anthem Medicaid |
$270.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$652.38
|
| Rate for Payer: First Health Commercial |
$746.70
|
| Rate for Payer: Humana Commercial |
$668.10
|
| Rate for Payer: Humana KY Medicaid |
$270.31
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.68
|
| Rate for Payer: Ohio Health Group HMO |
$589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.66
|
| Rate for Payer: PHCS Commercial |
$754.56
|
| Rate for Payer: United Healthcare All Payer |
$691.68
|
|
|
VEIN MAPPING
|
Professional
|
Both
|
$786.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$786.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$471.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$550.20
|
| Rate for Payer: UHCCP Medicaid |
$275.10
|
|
|
VEIN MAPPING
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$754.56 |
| Rate for Payer: Aetna Commercial |
$605.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.08
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$652.38
|
| Rate for Payer: First Health Commercial |
$746.70
|
| Rate for Payer: Humana Commercial |
$668.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.68
|
| Rate for Payer: Ohio Health Group HMO |
$589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.66
|
| Rate for Payer: PHCS Commercial |
$754.56
|
| Rate for Payer: United Healthcare All Payer |
$691.68
|
|
|
VEIN MAPPING(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320P0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
|
|
VEIN MAPPING(T
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320T0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$706.56 |
| Rate for Payer: Aetna Commercial |
$566.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.08
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: First Health Commercial |
$699.20
|
| Rate for Payer: Humana Commercial |
$625.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$603.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$647.68
|
| Rate for Payer: Ohio Health Group HMO |
$552.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.16
|
| Rate for Payer: PHCS Commercial |
$706.56
|
| Rate for Payer: United Healthcare All Payer |
$647.68
|
|
|
VEIN MAPPING(T
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320T0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$706.56 |
| Rate for Payer: Aetna Commercial |
$566.72
|
| Rate for Payer: Anthem Medicaid |
$253.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: First Health Commercial |
$699.20
|
| Rate for Payer: Humana Commercial |
$625.60
|
| Rate for Payer: Humana KY Medicaid |
$253.11
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$255.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$603.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$647.68
|
| Rate for Payer: Ohio Health Group HMO |
$552.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.16
|
| Rate for Payer: PHCS Commercial |
$706.56
|
| Rate for Payer: United Healthcare All Payer |
$647.68
|
|
|
VEIN X-RAY LIVER
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$414.26
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,900.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$676.17
|
| Rate for Payer: Healthspan PPO |
$388.17
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,940.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,430.00
|
| Rate for Payer: UHCCP Medicaid |
$1,715.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
VEIN X-RAY LIVER
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem Medicaid |
$1,685.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| 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 |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Humana KY Medicaid |
$1,685.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
VEIN X-RAY LIVER
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
VEIN X-RAY LIVER (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320P1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$676.17 |
| Rate for Payer: Aetna Commercial |
$414.26
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$676.17
|
| Rate for Payer: Healthspan PPO |
$388.17
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
VEIN X-RAY LIVER (T
|
Facility
|
OP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320T1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem Medicaid |
$1,581.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| 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 |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Humana KY Medicaid |
$1,581.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,613.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
VEIN X-RAY LIVER (T
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320T1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
VEIN X-RAY LIVER W/HEMODYNAM
|
Facility
|
OP
|
$4,147.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
76102440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.11 |
| Max. Negotiated Rate |
$3,981.12 |
| Rate for Payer: Aetna Commercial |
$3,193.19
|
| Rate for Payer: Anthem Medicaid |
$1,426.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,234.66
|
| 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 |
$2,073.50
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cigna Commercial |
$3,442.01
|
| Rate for Payer: First Health Commercial |
$3,939.65
|
| Rate for Payer: Humana Commercial |
$3,524.95
|
| Rate for Payer: Humana KY Medicaid |
$1,426.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,400.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,060.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,649.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.57
|
| Rate for Payer: PHCS Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare All Payer |
$3,649.36
|
|
|
VEIN X-RAY LIVER W/HEMODYNAM
|
Facility
|
IP
|
$4,147.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
76102440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.11 |
| Max. Negotiated Rate |
$3,981.12 |
| Rate for Payer: Aetna Commercial |
$3,193.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,234.66
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cigna Commercial |
$3,442.01
|
| Rate for Payer: First Health Commercial |
$3,939.65
|
| Rate for Payer: Humana Commercial |
$3,524.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,400.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,060.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,649.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.57
|
| Rate for Payer: PHCS Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare All Payer |
$3,649.36
|
|
|
VEIN X-RAY LIVER W/O HEMODYN
|
Facility
|
OP
|
$2,912.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
76102441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.56 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,242.24
|
| Rate for Payer: Anthem Medicaid |
$1,001.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,271.36
|
| 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 |
$1,456.00
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$2,416.96
|
| Rate for Payer: First Health Commercial |
$2,766.40
|
| Rate for Payer: Humana Commercial |
$2,475.20
|
| Rate for Payer: Humana KY Medicaid |
$1,001.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,011.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,387.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,021.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,562.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$902.72
|
| Rate for Payer: PHCS Commercial |
$2,795.52
|
| Rate for Payer: United Healthcare All Payer |
$2,562.56
|
|
|
VEIN X-RAY LIVER W/O HEMODYN
|
Facility
|
IP
|
$2,912.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
76102441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.56 |
| Max. Negotiated Rate |
$2,795.52 |
| Rate for Payer: Aetna Commercial |
$2,242.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,271.36
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$2,416.96
|
| Rate for Payer: First Health Commercial |
$2,766.40
|
| Rate for Payer: Humana Commercial |
$2,475.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,387.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$873.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,562.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$902.72
|
| Rate for Payer: PHCS Commercial |
$2,795.52
|
| Rate for Payer: United Healthcare All Payer |
$2,562.56
|
|
|
VEIN X-RAY NECK
|
Facility
|
IP
|
$4,722.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$613.86 |
| Max. Negotiated Rate |
$4,533.12 |
| Rate for Payer: Aetna Commercial |
$3,635.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,683.16
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cigna Commercial |
$3,919.26
|
| Rate for Payer: First Health Commercial |
$4,485.90
|
| Rate for Payer: Humana Commercial |
$4,013.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,872.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,484.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,155.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,541.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.82
|
| Rate for Payer: PHCS Commercial |
$4,533.12
|
| Rate for Payer: United Healthcare All Payer |
$4,155.36
|
|
|
VEIN X-RAY NECK
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360T1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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 |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
