|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Professional
|
Both
|
$5,958.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
76100073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.56 |
| Max. Negotiated Rate |
$5,958.01 |
| Rate for Payer: Aetna Commercial |
$377.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.56
|
| Rate for Payer: Anthem Medicaid |
$176.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,958.01
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$347.60
|
| Rate for Payer: Healthspan PPO |
$420.67
|
| Rate for Payer: Humana Medicaid |
$176.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.99
|
| Rate for Payer: Molina Healthcare Passport |
$176.46
|
| Rate for Payer: Multiplan PHCS |
$3,574.81
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,170.61
|
| Rate for Payer: UHCCP Medicaid |
$153.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.22
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
761P0073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.56 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$377.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.56
|
| Rate for Payer: Anthem Medicaid |
$176.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$347.60
|
| Rate for Payer: Healthspan PPO |
$420.67
|
| Rate for Payer: Humana Medicaid |
$176.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.99
|
| Rate for Payer: Molina Healthcare Passport |
$176.46
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$153.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.22
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Facility
|
IP
|
$5,958.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
76100073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.54 |
| Max. Negotiated Rate |
$5,719.69 |
| Rate for Payer: Aetna Commercial |
$4,587.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,647.25
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,945.15
|
| Rate for Payer: First Health Commercial |
$5,660.11
|
| Rate for Payer: Humana Commercial |
$5,064.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,885.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,397.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,243.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,468.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.98
|
| Rate for Payer: PHCS Commercial |
$5,719.69
|
| Rate for Payer: United Healthcare All Payer |
$5,243.05
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Facility
|
OP
|
$5,958.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
76100073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.54 |
| Max. Negotiated Rate |
$5,719.69 |
| Rate for Payer: Aetna Commercial |
$4,587.67
|
| Rate for Payer: Anthem Medicaid |
$2,048.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,647.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,945.15
|
| Rate for Payer: First Health Commercial |
$5,660.11
|
| Rate for Payer: Humana Commercial |
$5,064.31
|
| Rate for Payer: Humana KY Medicaid |
$2,048.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,885.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,397.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,090.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,243.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,468.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.98
|
| Rate for Payer: PHCS Commercial |
$5,719.69
|
| Rate for Payer: United Healthcare All Payer |
$5,243.05
|
|
|
EXC SOFT TISSUE LESION
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
76102408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
EXC SOFT TISSUE LESION
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
76102408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
EXC SOFT TISSUE LESION
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
76102408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$347.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.72
|
| Rate for Payer: Anthem Medicaid |
$148.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: Healthspan PPO |
$464.68
|
| Rate for Payer: Humana Medicaid |
$148.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.63
|
| Rate for Payer: Molina Healthcare Passport |
$148.66
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$139.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.15
|
|
|
EXC SOFT TISSUE LESION(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
761P2408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$347.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.72
|
| Rate for Payer: Anthem Medicaid |
$148.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: Healthspan PPO |
$464.68
|
| Rate for Payer: Humana Medicaid |
$148.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.63
|
| Rate for Payer: Molina Healthcare Passport |
$148.66
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$139.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.15
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Facility
|
IP
|
$4,564.56
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.39 |
| Max. Negotiated Rate |
$4,381.98 |
| Rate for Payer: Aetna Commercial |
$3,514.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,560.36
|
| Rate for Payer: Cash Price |
$2,282.28
|
| Rate for Payer: Cigna Commercial |
$3,788.58
|
| Rate for Payer: First Health Commercial |
$4,336.33
|
| Rate for Payer: Humana Commercial |
$3,879.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,742.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,368.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,369.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,016.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,423.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.01
|
| Rate for Payer: PHCS Commercial |
$4,381.98
|
| Rate for Payer: United Healthcare All Payer |
$4,016.81
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Professional
|
Both
|
$4,564.56
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$4,564.56 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.75
|
| Rate for Payer: Anthem Medicaid |
$120.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,564.56
|
| Rate for Payer: Cash Price |
$2,282.28
|
| Rate for Payer: Cash Price |
$2,282.28
|
| Rate for Payer: Cigna Commercial |
$276.95
|
| Rate for Payer: Healthspan PPO |
$325.86
|
| Rate for Payer: Humana Medicaid |
$120.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.19
|
| Rate for Payer: Molina Healthcare Passport |
$120.77
|
| Rate for Payer: Multiplan PHCS |
$2,738.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,195.19
|
| Rate for Payer: UHCCP Medicaid |
$178.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.98
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Facility
|
OP
|
$4,564.56
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.39 |
| Max. Negotiated Rate |
$4,381.98 |
| Rate for Payer: Aetna Commercial |
$3,514.71
|
| Rate for Payer: Anthem Medicaid |
$1,569.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,560.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,282.28
|
| Rate for Payer: Cash Price |
$2,282.28
|
| Rate for Payer: Cigna Commercial |
$3,788.58
|
| Rate for Payer: First Health Commercial |
$4,336.33
|
| Rate for Payer: Humana Commercial |
$3,879.88
|
| Rate for Payer: Humana KY Medicaid |
$1,569.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,742.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,368.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,601.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,016.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,423.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.01
|
| Rate for Payer: PHCS Commercial |
$4,381.98
|
| Rate for Payer: United Healthcare All Payer |
$4,016.81
|
|
|
EXC. SOFT TIS. TUMOR - SHOUL(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
761P0439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.75
|
| Rate for Payer: Anthem Medicaid |
$120.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$276.95
|
| Rate for Payer: Healthspan PPO |
$325.86
|
| Rate for Payer: Humana Medicaid |
$120.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.19
|
| Rate for Payer: Molina Healthcare Passport |
$120.77
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$178.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.98
|
|
|
EXC. SOFT TIS. TUMOR - SHOUL(T
|
Facility
|
OP
|
$4,164.56
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
761T0439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.39 |
| Max. Negotiated Rate |
$3,997.98 |
| Rate for Payer: Aetna Commercial |
$3,206.71
|
| Rate for Payer: Anthem Medicaid |
$1,432.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,248.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,082.28
|
| Rate for Payer: Cash Price |
$2,082.28
|
| Rate for Payer: Cigna Commercial |
$3,456.58
|
| Rate for Payer: First Health Commercial |
$3,956.33
|
| Rate for Payer: Humana Commercial |
$3,539.88
|
| Rate for Payer: Humana KY Medicaid |
$1,432.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,446.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,460.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.01
|
| Rate for Payer: PHCS Commercial |
$3,997.98
|
| Rate for Payer: United Healthcare All Payer |
$3,664.81
|
|
|
EXC. SOFT TIS. TUMOR - SHOUL(T
|
Facility
|
IP
|
$4,164.56
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
761T0439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.39 |
| Max. Negotiated Rate |
$3,997.98 |
| Rate for Payer: Aetna Commercial |
$3,206.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,248.36
|
| Rate for Payer: Cash Price |
$2,082.28
|
| Rate for Payer: Cigna Commercial |
$3,456.58
|
| Rate for Payer: First Health Commercial |
$3,956.33
|
| Rate for Payer: Humana Commercial |
$3,539.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.01
|
| Rate for Payer: PHCS Commercial |
$3,997.98
|
| Rate for Payer: United Healthcare All Payer |
$3,664.81
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$643.13
|
| Rate for Payer: Anthem Medicaid |
$302.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$732.51
|
| Rate for Payer: Healthspan PPO |
$458.82
|
| Rate for Payer: Humana Medicaid |
$302.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.51
|
| Rate for Payer: Molina Healthcare Passport |
$302.46
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.48
|
|
|
EXC THIGH/KNEE LES SC 3 CM/(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
761P0818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$643.13
|
| Rate for Payer: Anthem Medicaid |
$302.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$732.51
|
| Rate for Payer: Healthspan PPO |
$458.82
|
| Rate for Payer: Humana Medicaid |
$302.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.51
|
| Rate for Payer: Molina Healthcare Passport |
$302.46
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.48
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
76100819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,478.40
|
| Rate for Payer: Anthem Medicaid |
$660.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cigna Commercial |
$1,593.60
|
| Rate for Payer: First Health Commercial |
$1,824.00
|
| Rate for Payer: Humana Commercial |
$1,632.00
|
| Rate for Payer: Humana KY Medicaid |
$660.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$667.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.20
|
| Rate for Payer: PHCS Commercial |
$1,843.20
|
| Rate for Payer: United Healthcare All Payer |
$1,689.60
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/>
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
76100819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.82 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,161.57
|
| Rate for Payer: Anthem Medicaid |
$545.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,920.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cigna Commercial |
$1,321.59
|
| Rate for Payer: Healthspan PPO |
$828.78
|
| Rate for Payer: Humana Medicaid |
$545.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$556.74
|
| Rate for Payer: Molina Healthcare Passport |
$545.82
|
| Rate for Payer: Multiplan PHCS |
$1,152.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,344.00
|
| Rate for Payer: UHCCP Medicaid |
$672.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.28
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/>
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
76100819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,843.20 |
| Rate for Payer: Aetna Commercial |
$1,478.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.60
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cigna Commercial |
$1,593.60
|
| Rate for Payer: First Health Commercial |
$1,824.00
|
| Rate for Payer: Humana Commercial |
$1,632.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.20
|
| Rate for Payer: PHCS Commercial |
$1,843.20
|
| Rate for Payer: United Healthcare All Payer |
$1,689.60
|
|
|
EXC THIGH/KNEE TUM DEP 5CM/(P
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 27339
|
| Hospital Charge Code |
761P0819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.82 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,161.57
|
| Rate for Payer: Anthem Medicaid |
$545.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,920.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cigna Commercial |
$1,321.59
|
| Rate for Payer: Healthspan PPO |
$828.78
|
| Rate for Payer: Humana Medicaid |
$545.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$556.74
|
| Rate for Payer: Molina Healthcare Passport |
$545.82
|
| Rate for Payer: Multiplan PHCS |
$1,152.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,344.00
|
| Rate for Payer: UHCCP Medicaid |
$672.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.28
|
|
|
EXC THROMBOSED CEPHALIC VEIN
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
EXC THROMBOSED CEPHALIC VEIN
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
EXC THROMBOSED CEPHALIC VEIN
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,065.00
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.50
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
|
