|
US POPLITEAL UNILTERAL LIMITED
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
40200052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$929.28 |
| Rate for Payer: Aetna Commercial |
$745.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.04
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$803.44
|
| Rate for Payer: First Health Commercial |
$919.60
|
| Rate for Payer: Humana Commercial |
$822.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$793.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$714.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$851.84
|
| Rate for Payer: Ohio Health Group HMO |
$726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.92
|
| Rate for Payer: PHCS Commercial |
$929.28
|
| Rate for Payer: United Healthcare All Payer |
$851.84
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
40200052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$929.28 |
| Rate for Payer: Aetna Commercial |
$745.36
|
| Rate for Payer: Anthem Medicaid |
$332.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$803.44
|
| Rate for Payer: First Health Commercial |
$919.60
|
| Rate for Payer: Humana Commercial |
$822.80
|
| Rate for Payer: Humana KY Medicaid |
$332.90
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$336.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$793.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$714.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$851.84
|
| Rate for Payer: Ohio Health Group HMO |
$726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.92
|
| Rate for Payer: PHCS Commercial |
$929.28
|
| Rate for Payer: United Healthcare All Payer |
$851.84
|
|
|
US PROSTATE TRANSRECTAL
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
40200052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Ambetter Exchange |
$175.71
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.85
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$183.51
|
| Rate for Payer: Healthspan PPO |
$191.43
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$580.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.42
|
| Rate for Payer: UHCCP Medicaid |
$338.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.71
|
|
|
US PROSTATE TRANSRECTAL(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
402P0052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Ambetter Exchange |
$175.71
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.85
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$183.51
|
| Rate for Payer: Healthspan PPO |
$191.43
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.42
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.71
|
|
|
US PROSTATE TRANSRECTAL(T
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
402T0052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.40 |
| Max. Negotiated Rate |
$785.28 |
| Rate for Payer: Aetna Commercial |
$629.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.04
|
| Rate for Payer: Cash Price |
$409.00
|
| Rate for Payer: Cigna Commercial |
$678.94
|
| Rate for Payer: First Health Commercial |
$777.10
|
| Rate for Payer: Humana Commercial |
$695.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.84
|
| Rate for Payer: Ohio Health Group HMO |
$613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.42
|
| Rate for Payer: PHCS Commercial |
$785.28
|
| Rate for Payer: United Healthcare All Payer |
$719.84
|
|
|
US PROSTATE TRANSRECTAL(T
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
402T0052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$785.28 |
| Rate for Payer: Aetna Commercial |
$629.86
|
| Rate for Payer: Anthem Medicaid |
$281.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$638.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$409.00
|
| Rate for Payer: Cash Price |
$409.00
|
| Rate for Payer: Cigna Commercial |
$678.94
|
| Rate for Payer: First Health Commercial |
$777.10
|
| Rate for Payer: Humana Commercial |
$695.30
|
| Rate for Payer: Humana KY Medicaid |
$281.31
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$284.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.84
|
| Rate for Payer: Ohio Health Group HMO |
$613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.42
|
| Rate for Payer: PHCS Commercial |
$785.28
|
| Rate for Payer: United Healthcare All Payer |
$719.84
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Humana KY Medicaid |
$389.98
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$393.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
US RETROPERITONEAL COMPLETE
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.71 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: Ambetter Exchange |
$97.55
|
| Rate for Payer: Anthem Medicaid |
$85.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.06
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: Healthspan PPO |
$186.27
|
| Rate for Payer: Humana Medicaid |
$85.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.10
|
| Rate for Payer: Molina Healthcare Passport |
$85.39
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.81
|
| Rate for Payer: UHCCP Medicaid |
$396.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.55
|
|
|
US RETROPERITONEAL COMPLETE (P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402P0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.71 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: Ambetter Exchange |
$97.55
|
| Rate for Payer: Anthem Medicaid |
$85.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.06
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: Healthspan PPO |
$186.27
|
| Rate for Payer: Humana Medicaid |
$85.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.10
|
| Rate for Payer: Molina Healthcare Passport |
$85.39
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.81
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.55
|
|
|
US RETROPERITONEAL COMPLETE (T
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402T0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$944.64 |
| Rate for Payer: Aetna Commercial |
$757.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$816.72
|
| Rate for Payer: First Health Commercial |
$934.80
|
| Rate for Payer: Humana Commercial |
$836.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.92
|
| Rate for Payer: Ohio Health Group HMO |
$738.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.96
|
| Rate for Payer: PHCS Commercial |
$944.64
|
| Rate for Payer: United Healthcare All Payer |
$865.92
|
|
|
US RETROPERITONEAL COMPLETE (T
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402T0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$944.64 |
| Rate for Payer: Aetna Commercial |
$757.68
|
| Rate for Payer: Anthem Medicaid |
$338.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$816.72
|
| Rate for Payer: First Health Commercial |
$934.80
|
| Rate for Payer: Humana Commercial |
$836.40
|
| Rate for Payer: Humana KY Medicaid |
$338.40
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$341.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.92
|
| Rate for Payer: Ohio Health Group HMO |
$738.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.96
|
| Rate for Payer: PHCS Commercial |
$944.64
|
| Rate for Payer: United Healthcare All Payer |
$865.92
|
|
|
US RETROPERITONEAL RENAL LTD
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
US RETROPERITONEAL RENAL LTD
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
US RETROPERITONEAL RENAL LTD
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$580.20 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$580.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$338.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONEAL RENAL LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402P0029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONEAL RENAL LTD(T
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US RETROPERITONEAL RENAL LTD(T
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402P0028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$580.20 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$580.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$338.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US RETROPERITONL ABD AORTA LTD
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
