|
VENOGRAPHY ADRENAL UNIL SELEC
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75840
|
| Hospital Charge Code |
32000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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: 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 |
$1,340.10
|
| 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 |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VENOUS THROMBOSIS IMAGING
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.40
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
VENOUS THROMBOSIS IMAGING
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Aetna Commercial |
$281.87
|
| Rate for Payer: Ambetter Exchange |
$140.80
|
| Rate for Payer: Anthem Medicaid |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.96
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$233.44
|
| Rate for Payer: Healthspan PPO |
$281.73
|
| Rate for Payer: Humana Medicaid |
$105.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.29
|
| Rate for Payer: Molina Healthcare Passport |
$105.19
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.04
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.80
|
|
|
VENOUS THROMBOSIS IMAGING
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem Medicaid |
$502.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Humana KY Medicaid |
$502.09
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$507.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.40
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
VENOUS THROMBOSIS IMAGING(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761P2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$281.87 |
| Rate for Payer: Aetna Commercial |
$281.87
|
| Rate for Payer: Ambetter Exchange |
$140.80
|
| Rate for Payer: Anthem Medicaid |
$105.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.96
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$233.44
|
| Rate for Payer: Healthspan PPO |
$281.73
|
| Rate for Payer: Humana Medicaid |
$105.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.29
|
| Rate for Payer: Molina Healthcare Passport |
$105.19
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.04
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.80
|
|
|
VENOUS THROMBOSIS IMAGING(T
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761T2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.39 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
VENOUS THROMBOSIS IMAGING(T
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761T2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
VENOUS WALL-STENT 18*60*75
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem Medicaid |
$1,822.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Humana KY Medicaid |
$1,822.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
VENOUS WALL-STENT 18*60*75
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
VENO VENOUS SINUS S&I
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,613.58 |
| Max. Negotiated Rate |
$4,504.32 |
| Rate for Payer: Aetna Commercial |
$3,612.84
|
| Rate for Payer: Anthem Medicaid |
$1,613.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,894.36
|
| Rate for Payer: First Health Commercial |
$4,457.40
|
| Rate for Payer: Humana Commercial |
$3,988.20
|
| Rate for Payer: Humana KY Medicaid |
$1,613.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,847.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,645.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,082.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,237.48
|
| Rate for Payer: PHCS Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare All Payer |
$4,128.96
|
|
|
VENO VENOUS SINUS S&I
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Ambetter Exchange |
$115.44
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.53
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$683.88
|
| Rate for Payer: Healthspan PPO |
$394.02
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$115.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,815.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.07
|
| Rate for Payer: UHCCP Medicaid |
$1,642.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.44
|
|
|
VENO VENOUS SINUS S&I
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,407.60 |
| Max. Negotiated Rate |
$4,504.32 |
| Rate for Payer: Aetna Commercial |
$3,612.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.76
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,894.36
|
| Rate for Payer: First Health Commercial |
$4,457.40
|
| Rate for Payer: Humana Commercial |
$3,988.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,847.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,407.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,082.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,237.48
|
| Rate for Payer: PHCS Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare All Payer |
$4,128.96
|
|
|
VENO VENOUS SINUS S&I(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
320P0172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$683.88 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Ambetter Exchange |
$115.44
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.53
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$683.88
|
| Rate for Payer: Healthspan PPO |
$394.02
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$115.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.07
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.44
|
|
|
VENO VENOUS SINUS S&I(T
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
320T0172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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: 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 |
$1,340.10
|
| 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 |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VENO VENOUS SINUS S&I(T
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
320T0172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,536.20 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VENOVO 10F 16*40*80
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
VENOVO 10F 16*40*80
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
VENOVO 10F 18*100*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 18*100*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 18*40*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 18*40*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 18*80*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 18*80*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*100*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*100*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
