|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF FOREIGN BODY(S) OR STENT(S) FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$2,303.66
|
|
|
Service Code
|
CPT 43275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.47 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
|
Facility
|
OP
|
$4,636.52
|
|
|
Service Code
|
CPT 43262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,311.80 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
|
|
ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD), INCLUDING ENDOSCOPY OR COLONOSCOPY, MUCOSAL CLOSURE, WHEN PERFORMED
|
Facility
|
OP
|
$4,636.52
|
|
|
Service Code
|
CPT C9779
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,311.80 |
| Max. Negotiated Rate |
$4,636.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
| Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
|
|
ENDOSCOPY MAXILLARY SINUS
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
76101156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$491.34
|
| Rate for Payer: Anthem Medicaid |
$320.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$496.31
|
| Rate for Payer: Healthspan PPO |
$414.36
|
| Rate for Payer: Humana Medicaid |
$320.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$415.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.58
|
| Rate for Payer: Molina Healthcare Passport |
$320.18
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.38
|
|
|
ENDOSCOPY MAXILLARY SINUS
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
76101156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$8,286.08 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,918.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,286.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,990.15
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$5,918.63
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,102.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
ENDOSCOPY MAXILLARY SINUS
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
76101156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
ENDOSCOPY MAXILLARY SINUS(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
761P1156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$491.34
|
| Rate for Payer: Anthem Medicaid |
$320.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$496.31
|
| Rate for Payer: Healthspan PPO |
$414.36
|
| Rate for Payer: Humana Medicaid |
$320.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$415.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.58
|
| Rate for Payer: Molina Healthcare Passport |
$320.18
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.38
|
|
|
ENDOTRACHEAL TUBE EXCHANGE
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 31599
|
| Hospital Charge Code |
76102737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$361.59 |
| Rate for Payer: Anthem Medicaid |
$354.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$354.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$361.59
|
| Rate for Payer: Molina Healthcare Passport |
$354.50
|
| Rate for Payer: Multiplan PHCS |
$130.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.60
|
| Rate for Payer: UHCCP Medicaid |
$76.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.04
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,068.16
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$49,581.96 |
| Max. Negotiated Rate |
$73,068.16 |
| Rate for Payer: Anthem Medicaid |
$49,581.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52,191.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$73,068.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$70,458.58
|
| Rate for Payer: Humana KY Medicaid |
$49,581.96
|
| Rate for Payer: Humana Medicare Advantage |
$52,191.54
|
| Rate for Payer: Kentucky WC Medicaid |
$50,077.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$50,573.60
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$57,089.56
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$38,739.35 |
| Max. Negotiated Rate |
$57,089.56 |
| Rate for Payer: Anthem Medicaid |
$38,739.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40,778.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57,089.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$55,050.65
|
| Rate for Payer: Humana KY Medicaid |
$38,739.35
|
| Rate for Payer: Humana Medicare Advantage |
$40,778.26
|
| Rate for Payer: Kentucky WC Medicaid |
$39,126.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48,933.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,514.13
|
|
|
ENDOVASC VISC AORTA 1 GRAFT
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 34841
|
| Hospital Charge Code |
76101353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ENDOVASC VISC AORTA 1 GRAFT
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 34841
|
| Hospital Charge Code |
76101353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,515.61
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
|
|
ENDOVASC VISC AORTA 1 GRAFT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 34841
|
| Hospital Charge Code |
76101353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ENDOVASC VISC AORTA 1 GRAFT(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 34841
|
| Hospital Charge Code |
761P1353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,515.61
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
|
|
ENDOVENOUS 1ST VEIN
|
Facility
|
OP
|
$9,643.50
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
76101464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,253.66 |
| Max. Negotiated Rate |
$9,257.76 |
| Rate for Payer: Aetna Commercial |
$7,425.50
|
| Rate for Payer: Anthem Medicaid |
$3,316.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,521.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,821.75
|
| Rate for Payer: Cash Price |
$4,821.75
|
| Rate for Payer: Cigna Commercial |
$8,004.10
|
| Rate for Payer: First Health Commercial |
$9,161.32
|
| Rate for Payer: Humana Commercial |
$8,196.98
|
| Rate for Payer: Humana KY Medicaid |
$3,316.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,907.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,116.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,382.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,486.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,232.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.48
|
| Rate for Payer: PHCS Commercial |
$9,257.76
|
| Rate for Payer: United Healthcare All Payer |
$8,486.28
|
|
|
ENDOVENOUS 1ST VEIN
|
Professional
|
Both
|
$9,643.50
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
76101464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$9,643.50 |
| Rate for Payer: Aetna Commercial |
$532.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$271.17
|
| Rate for Payer: Anthem Medicaid |
$273.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,643.50
|
| Rate for Payer: Cash Price |
$4,821.75
|
| Rate for Payer: Cash Price |
$4,821.75
|
| Rate for Payer: Cigna Commercial |
$3,000.73
|
| Rate for Payer: Healthspan PPO |
$2,043.51
|
| Rate for Payer: Humana Medicaid |
$273.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.91
|
| Rate for Payer: Molina Healthcare Passport |
$273.44
|
| Rate for Payer: Multiplan PHCS |
$5,786.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,750.45
|
| Rate for Payer: UHCCP Medicaid |
$284.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.17
|
|
|
ENDOVENOUS 1ST VEIN
|
Facility
|
IP
|
$9,643.50
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
76101464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,253.66 |
| Max. Negotiated Rate |
$9,257.76 |
| Rate for Payer: Aetna Commercial |
$7,425.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,521.93
|
| Rate for Payer: Cash Price |
$4,821.75
|
| Rate for Payer: Cigna Commercial |
$8,004.10
|
| Rate for Payer: First Health Commercial |
$9,161.32
|
| Rate for Payer: Humana Commercial |
$8,196.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,907.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,116.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,486.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,232.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.48
|
| Rate for Payer: PHCS Commercial |
$9,257.76
|
| Rate for Payer: United Healthcare All Payer |
$8,486.28
|
|
|
ENDOVENOUS 1ST VEIN(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
761P1464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$3,000.73 |
| Rate for Payer: Aetna Commercial |
$532.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$271.17
|
| Rate for Payer: Anthem Medicaid |
$273.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$3,000.73
|
| Rate for Payer: Healthspan PPO |
$2,043.51
|
| Rate for Payer: Humana Medicaid |
$273.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.91
|
| Rate for Payer: Molina Healthcare Passport |
$273.44
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$284.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.17
|
|
|
ENDOVENOUS 1ST VEIN(T
|
Facility
|
IP
|
$6,643.50
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
761T1464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$863.66 |
| Max. Negotiated Rate |
$6,377.76 |
| Rate for Payer: Aetna Commercial |
$5,115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.93
|
| Rate for Payer: Cash Price |
$3,321.75
|
| Rate for Payer: Cigna Commercial |
$5,514.10
|
| Rate for Payer: First Health Commercial |
$6,311.32
|
| Rate for Payer: Humana Commercial |
$5,646.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,993.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,846.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.48
|
| Rate for Payer: PHCS Commercial |
$6,377.76
|
| Rate for Payer: United Healthcare All Payer |
$5,846.28
|
|
|
ENDOVENOUS 1ST VEIN(T
|
Facility
|
OP
|
$6,643.50
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
761T1464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$863.66 |
| Max. Negotiated Rate |
$6,377.76 |
| Rate for Payer: Aetna Commercial |
$5,115.50
|
| Rate for Payer: Anthem Medicaid |
$2,284.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,321.75
|
| Rate for Payer: Cash Price |
$3,321.75
|
| Rate for Payer: Cigna Commercial |
$5,514.10
|
| Rate for Payer: First Health Commercial |
$6,311.32
|
| Rate for Payer: Humana Commercial |
$5,646.98
|
| Rate for Payer: Humana KY Medicaid |
$2,284.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,307.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,330.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,846.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.48
|
| Rate for Payer: PHCS Commercial |
$6,377.76
|
| Rate for Payer: United Healthcare All Payer |
$5,846.28
|
|
|
ENDOVENOUS ABLATION
|
Facility
|
OP
|
$4,307.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
76101465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,135.22 |
| Rate for Payer: Aetna Commercial |
$3,316.79
|
| Rate for Payer: Anthem Medicaid |
$1,481.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,359.87
|
| Rate for Payer: Cash Price |
$2,153.76
|
| Rate for Payer: Cigna Commercial |
$3,575.24
|
| Rate for Payer: First Health Commercial |
$4,092.14
|
| Rate for Payer: Humana Commercial |
$3,661.39
|
| Rate for Payer: Humana KY Medicaid |
$1,481.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,496.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,532.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,178.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,511.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,790.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,230.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.33
|
| Rate for Payer: PHCS Commercial |
$4,135.22
|
| Rate for Payer: United Healthcare All Payer |
$3,790.62
|
|
|
ENDOVENOUS ABLATION
|
Professional
|
Both
|
$4,307.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
76101465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$4,307.52 |
| Rate for Payer: Aetna Commercial |
$260.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.27
|
| Rate for Payer: Anthem Medicaid |
$134.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,307.52
|
| Rate for Payer: Cash Price |
$2,153.76
|
| Rate for Payer: Cash Price |
$2,153.76
|
| Rate for Payer: Cigna Commercial |
$597.19
|
| Rate for Payer: Healthspan PPO |
$447.44
|
| Rate for Payer: Humana Medicaid |
$134.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.72
|
| Rate for Payer: Molina Healthcare Passport |
$134.04
|
| Rate for Payer: Multiplan PHCS |
$2,584.51
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,015.26
|
| Rate for Payer: UHCCP Medicaid |
$132.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.38
|
|
|
ENDOVENOUS ABLATION
|
Facility
|
IP
|
$4,307.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
76101465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$4,135.22 |
| Rate for Payer: Aetna Commercial |
$3,316.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,359.87
|
| Rate for Payer: Cash Price |
$2,153.76
|
| Rate for Payer: Cigna Commercial |
$3,575.24
|
| Rate for Payer: First Health Commercial |
$4,092.14
|
| Rate for Payer: Humana Commercial |
$3,661.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,532.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,178.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,790.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,230.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.33
|
| Rate for Payer: PHCS Commercial |
$4,135.22
|
| Rate for Payer: United Healthcare All Payer |
$3,790.62
|
|
|
ENDOVENOUS ABLATION(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761P1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: UHCCP Medicaid |
$132.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.38
|
| Rate for Payer: Aetna Commercial |
$260.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.27
|
| Rate for Payer: Anthem Medicaid |
$134.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$597.19
|
| Rate for Payer: Healthspan PPO |
$447.44
|
| Rate for Payer: Humana Medicaid |
$134.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.72
|
| Rate for Payer: Molina Healthcare Passport |
$134.04
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
|
|
ENDOVENOUS ABLATION(T
|
Facility
|
OP
|
$3,657.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761T1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.48 |
| Max. Negotiated Rate |
$3,511.22 |
| Rate for Payer: Aetna Commercial |
$2,816.29
|
| Rate for Payer: Anthem Medicaid |
$1,257.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,852.87
|
| Rate for Payer: Cash Price |
$1,828.76
|
| Rate for Payer: Cigna Commercial |
$3,035.74
|
| Rate for Payer: First Health Commercial |
$3,474.64
|
| Rate for Payer: Humana Commercial |
$3,108.89
|
| Rate for Payer: Humana KY Medicaid |
$1,257.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,218.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.83
|
| Rate for Payer: PHCS Commercial |
$3,511.22
|
| Rate for Payer: United Healthcare All Payer |
$3,218.62
|
|
