|
BX SOFT TISSUE - LEG OR ANKLE
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.85 |
| Max. Negotiated Rate |
$355.61 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Ambetter Exchange |
$152.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$82.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.20
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$355.61
|
| Rate for Payer: Healthspan PPO |
$309.21
|
| Rate for Payer: Humana Medicaid |
$82.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.26
|
| Rate for Payer: Molina Healthcare Passport |
$82.61
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.47
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.67
|
|
|
BX SOFT TISSUE - LEG OR ANKLE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BX SOFT TISSUE - LEG OR ANKLE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BX SOFT TISSUE - LEG OR ANKL(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
761P0892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.85 |
| Max. Negotiated Rate |
$355.61 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Ambetter Exchange |
$152.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$82.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.20
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$355.61
|
| Rate for Payer: Healthspan PPO |
$309.21
|
| Rate for Payer: Humana Medicaid |
$82.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.26
|
| Rate for Payer: Molina Healthcare Passport |
$82.61
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.47
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.67
|
|
|
BX SOFT TISS UPPER ARM SUPRF
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
76100498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,415.15 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
BX SOFT TISS UPPER ARM SUPRF
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
76100498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
BX SOFT TISS UPPER ARM SUPRF
|
Professional
|
Both
|
$4,115.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
76100498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$2,469.00 |
| Rate for Payer: Aetna Commercial |
$235.03
|
| Rate for Payer: Ambetter Exchange |
$152.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$83.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.42
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$352.08
|
| Rate for Payer: Healthspan PPO |
$310.33
|
| Rate for Payer: Humana Medicaid |
$83.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.85
|
| Rate for Payer: Molina Healthcare Passport |
$83.19
|
| Rate for Payer: Multiplan PHCS |
$2,469.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.71
|
| Rate for Payer: UHCCP Medicaid |
$94.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.85
|
|
|
BX SOFT TISS UPPER ARM SUPRF(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
761P0498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$352.08 |
| Rate for Payer: Aetna Commercial |
$235.03
|
| Rate for Payer: Ambetter Exchange |
$152.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$83.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.42
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$352.08
|
| Rate for Payer: Healthspan PPO |
$310.33
|
| Rate for Payer: Humana Medicaid |
$83.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.85
|
| Rate for Payer: Molina Healthcare Passport |
$83.19
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.71
|
| Rate for Payer: UHCCP Medicaid |
$94.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.85
|
|
|
BX SOFT TISS UPPER ARM SUPRF(T
|
Facility
|
IP
|
$3,665.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
761T0498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,099.50 |
| Max. Negotiated Rate |
$3,518.40 |
| Rate for Payer: Aetna Commercial |
$2,822.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,858.70
|
| Rate for Payer: Cash Price |
$1,832.50
|
| Rate for Payer: Cigna Commercial |
$3,041.95
|
| Rate for Payer: First Health Commercial |
$3,481.75
|
| Rate for Payer: Humana Commercial |
$3,115.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,005.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,704.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,225.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,188.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.85
|
| Rate for Payer: PHCS Commercial |
$3,518.40
|
| Rate for Payer: United Healthcare All Payer |
$3,225.20
|
|
|
BX SOFT TISS UPPER ARM SUPRF(T
|
Facility
|
OP
|
$3,665.00
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
761T0498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.39 |
| Max. Negotiated Rate |
$3,518.40 |
| Rate for Payer: Aetna Commercial |
$2,822.05
|
| Rate for Payer: Anthem Medicaid |
$1,260.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,858.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,832.50
|
| Rate for Payer: Cash Price |
$1,832.50
|
| Rate for Payer: Cigna Commercial |
$3,041.95
|
| Rate for Payer: First Health Commercial |
$3,481.75
|
| Rate for Payer: Humana Commercial |
$3,115.25
|
| Rate for Payer: Humana KY Medicaid |
$1,260.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,273.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,005.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,704.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,285.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,225.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,188.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.85
|
| Rate for Payer: PHCS Commercial |
$3,518.40
|
| Rate for Payer: United Healthcare All Payer |
$3,225.20
|
|
|
BX TONGUE
|
Facility
|
IP
|
$2,074.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
76101651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.20 |
| Max. Negotiated Rate |
$1,991.04 |
| Rate for Payer: Aetna Commercial |
$1,596.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,617.72
|
| Rate for Payer: Cash Price |
$1,037.00
|
| Rate for Payer: Cigna Commercial |
$1,721.42
|
| Rate for Payer: First Health Commercial |
$1,970.30
|
| Rate for Payer: Humana Commercial |
$1,762.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,700.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,530.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,825.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,555.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,804.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.06
|
| Rate for Payer: PHCS Commercial |
$1,991.04
|
| Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
|
BX TONGUE
|
Professional
|
Both
|
$2,074.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
76101651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$1,244.40 |
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Ambetter Exchange |
$100.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.21
|
| Rate for Payer: Anthem Medicaid |
$69.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.03
|
| Rate for Payer: Cash Price |
$1,037.00
|
| Rate for Payer: Cash Price |
$1,037.00
|
| Rate for Payer: Cigna Commercial |
$223.64
|
| Rate for Payer: Healthspan PPO |
$194.48
|
| Rate for Payer: Humana Medicaid |
$69.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.16
|
| Rate for Payer: Molina Healthcare Passport |
$69.76
|
| Rate for Payer: Multiplan PHCS |
$1,244.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.12
|
| Rate for Payer: UHCCP Medicaid |
$80.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.86
|
|
|
BX TONGUE
|
Facility
|
OP
|
$2,074.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
76101651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,991.04 |
| Rate for Payer: Aetna Commercial |
$1,596.98
|
| Rate for Payer: Anthem Medicaid |
$713.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,617.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,037.00
|
| Rate for Payer: Cash Price |
$1,037.00
|
| Rate for Payer: Cigna Commercial |
$1,721.42
|
| Rate for Payer: First Health Commercial |
$1,970.30
|
| Rate for Payer: Humana Commercial |
$1,762.90
|
| Rate for Payer: Humana KY Medicaid |
$713.25
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$720.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,700.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,530.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,825.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,555.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,804.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.06
|
| Rate for Payer: PHCS Commercial |
$1,991.04
|
| Rate for Payer: United Healthcare All Payer |
$1,825.12
|
|
|
BX TONGUE(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
761P1651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$223.64 |
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Ambetter Exchange |
$100.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.21
|
| Rate for Payer: Anthem Medicaid |
$69.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.03
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$223.64
|
| Rate for Payer: Healthspan PPO |
$194.48
|
| Rate for Payer: Humana Medicaid |
$69.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.16
|
| Rate for Payer: Molina Healthcare Passport |
$69.76
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.12
|
| Rate for Payer: UHCCP Medicaid |
$80.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.86
|
|
|
BX TONGUE(T
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
761T1651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.20 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.26
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
BX TONGUE(T
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
761T1651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem Medicaid |
$637.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Humana KY Medicaid |
$637.59
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$644.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.26
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
BYPASS GRAFT; COMPOSITE -
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35681
|
| Hospital Charge Code |
76101416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$144.05
|
| Rate for Payer: Ambetter Exchange |
$74.51
|
| Rate for Payer: Anthem Medicaid |
$601.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.41
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$136.56
|
| Rate for Payer: Healthspan PPO |
$141.63
|
| Rate for Payer: Humana Medicaid |
$601.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.25
|
| Rate for Payer: Molina Healthcare Passport |
$601.23
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.86
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.51
|
|
|
BYPASS GRAFT; COMPOSITE -
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35681
|
| Hospital Charge Code |
76101416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
BYPASS GRAFT; COMPOSITE -
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35681
|
| Hospital Charge Code |
76101416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
BYPASS GRAFT; COMPOSITE -(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35681
|
| Hospital Charge Code |
761P1416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$144.05
|
| Rate for Payer: Ambetter Exchange |
$74.51
|
| Rate for Payer: Anthem Medicaid |
$601.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.41
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$136.56
|
| Rate for Payer: Healthspan PPO |
$141.63
|
| Rate for Payer: Humana Medicaid |
$601.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.25
|
| Rate for Payer: Molina Healthcare Passport |
$601.23
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.86
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.51
|
|
|
BYPASS GRAFT - FEMORAL
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35661
|
| Hospital Charge Code |
76101413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
BYPASS GRAFT - FEMORAL
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35661
|
| Hospital Charge Code |
76101413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
BYPASS GRAFT - FEMORAL
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35661
|
| Hospital Charge Code |
76101413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.01 |
| Max. Negotiated Rate |
$1,920.83 |
| Rate for Payer: Aetna Commercial |
$1,920.83
|
| Rate for Payer: Ambetter Exchange |
$1,014.21
|
| Rate for Payer: Anthem Medicaid |
$832.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,014.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,014.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,217.05
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,844.97
|
| Rate for Payer: Healthspan PPO |
$1,888.55
|
| Rate for Payer: Humana Medicaid |
$832.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,495.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,014.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$848.65
|
| Rate for Payer: Molina Healthcare Passport |
$832.01
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,318.47
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,014.21
|
|
|
BYPASS GRAFT - FEMORAL(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35661
|
| Hospital Charge Code |
761P1413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.01 |
| Max. Negotiated Rate |
$1,920.83 |
| Rate for Payer: Aetna Commercial |
$1,920.83
|
| Rate for Payer: Ambetter Exchange |
$1,014.21
|
| Rate for Payer: Anthem Medicaid |
$832.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,014.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,014.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,217.05
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,844.97
|
| Rate for Payer: Healthspan PPO |
$1,888.55
|
| Rate for Payer: Humana Medicaid |
$832.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,495.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,014.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$848.65
|
| Rate for Payer: Molina Healthcare Passport |
$832.01
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,318.47
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,014.21
|
|
|
BYPASS GRAFT - FEMORAL POPLI(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35656
|
| Hospital Charge Code |
761P1412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$969.73 |
| Max. Negotiated Rate |
$1,922.54 |
| Rate for Payer: Aetna Commercial |
$1,922.54
|
| Rate for Payer: Ambetter Exchange |
$1,004.06
|
| Rate for Payer: Anthem Medicaid |
$969.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,004.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,004.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,204.87
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,841.52
|
| Rate for Payer: Healthspan PPO |
$1,890.23
|
| Rate for Payer: Humana Medicaid |
$969.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,489.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,004.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$989.12
|
| Rate for Payer: Molina Healthcare Passport |
$969.73
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,305.28
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$979.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,004.06
|
|
