|
EXPLORATION - REM. FOREIGN BO
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXPLORATION - REM. FOREIGN BO
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.01 |
| Max. Negotiated Rate |
$859.01 |
| Rate for Payer: Aetna Commercial |
$629.22
|
| Rate for Payer: Anthem Medicaid |
$213.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$859.01
|
| Rate for Payer: Healthspan PPO |
$569.94
|
| Rate for Payer: Humana Medicaid |
$213.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$527.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.27
|
| Rate for Payer: Molina Healthcare Passport |
$213.01
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.14
|
|
|
EXPLORATION - REM. FOREIGN BO
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXPLORATION - REM. FOREIGN B(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
761P0595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.01 |
| Max. Negotiated Rate |
$859.01 |
| Rate for Payer: Aetna Commercial |
$629.22
|
| Rate for Payer: Anthem Medicaid |
$213.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$859.01
|
| Rate for Payer: Healthspan PPO |
$569.94
|
| Rate for Payer: Humana Medicaid |
$213.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$527.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.27
|
| Rate for Payer: Molina Healthcare Passport |
$213.01
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.14
|
|
|
EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 25248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
EXPLORATORY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.94 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,115.90
|
| Rate for Payer: Anthem Medicaid |
$479.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,040.70
|
| Rate for Payer: Healthspan PPO |
$941.06
|
| Rate for Payer: Humana Medicaid |
$479.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$982.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$489.54
|
| Rate for Payer: Molina Healthcare Passport |
$479.94
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.74
|
|
|
EXPLORATORY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLORATORY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLORATORY HEART SURGERY
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.81 |
| Max. Negotiated Rate |
$3,075.00 |
| Rate for Payer: Aetna Commercial |
$1,980.20
|
| Rate for Payer: Anthem Medicaid |
$851.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,075.00
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,889.69
|
| Rate for Payer: Healthspan PPO |
$1,946.92
|
| Rate for Payer: Humana Medicaid |
$851.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,620.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.85
|
| Rate for Payer: Molina Healthcare Passport |
$851.81
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,152.50
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.33
|
|
|
EXPLORATORY HEART SURGERY
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
EXPLORATORY HEART SURGERY
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
EXPLORATORY HEART SURGERY(P
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
761P1283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.81 |
| Max. Negotiated Rate |
$3,075.00 |
| Rate for Payer: Aetna Commercial |
$1,980.20
|
| Rate for Payer: Anthem Medicaid |
$851.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,075.00
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,889.69
|
| Rate for Payer: Healthspan PPO |
$1,946.92
|
| Rate for Payer: Humana Medicaid |
$851.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,620.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.85
|
| Rate for Payer: Molina Healthcare Passport |
$851.81
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,152.50
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.33
|
|
|
EXPLORATORY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
761P1974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.94 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,115.90
|
| Rate for Payer: Anthem Medicaid |
$479.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,040.70
|
| Rate for Payer: Healthspan PPO |
$941.06
|
| Rate for Payer: Humana Medicaid |
$479.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$982.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$489.54
|
| Rate for Payer: Molina Healthcare Passport |
$479.94
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.74
|
|
|
EXPLORE CHEST FREE ADHESION(P
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
761P1177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,524.56 |
| Rate for Payer: Aetna Commercial |
$1,524.56
|
| Rate for Payer: Anthem Medicaid |
$667.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,140.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: Healthspan PPO |
$1,190.34
|
| Rate for Payer: Humana Medicaid |
$667.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.22
|
| Rate for Payer: Molina Healthcare Passport |
$667.86
|
| Rate for Payer: Multiplan PHCS |
$684.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$798.00
|
| Rate for Payer: UHCCP Medicaid |
$399.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.54
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
76101177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.40
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
76101177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,524.56 |
| Rate for Payer: Aetna Commercial |
$1,524.56
|
| Rate for Payer: Anthem Medicaid |
$667.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,140.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: Healthspan PPO |
$1,190.34
|
| Rate for Payer: Humana Medicaid |
$667.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,280.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.22
|
| Rate for Payer: Molina Healthcare Passport |
$667.86
|
| Rate for Payer: Multiplan PHCS |
$684.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$798.00
|
| Rate for Payer: UHCCP Medicaid |
$399.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.54
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
76101177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem Medicaid |
$392.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Humana KY Medicaid |
$392.05
|
| Rate for Payer: Kentucky WC Medicaid |
$396.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.40
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
EXPLORE CHEST VESSELS
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
76101421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.80 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Aetna Commercial |
$2,048.20
|
| Rate for Payer: Anthem Medicaid |
$914.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,074.80
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: First Health Commercial |
$2,527.00
|
| Rate for Payer: Humana Commercial |
$2,261.00
|
| Rate for Payer: Humana KY Medicaid |
$914.77
|
| Rate for Payer: Kentucky WC Medicaid |
$924.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,181.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,963.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$798.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$933.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,340.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.60
|
| Rate for Payer: PHCS Commercial |
$2,553.60
|
| Rate for Payer: United Healthcare All Payer |
$2,340.80
|
|
|
EXPLORE CHEST VESSELS
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
76101421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.80 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Aetna Commercial |
$2,048.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,074.80
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: First Health Commercial |
$2,527.00
|
| Rate for Payer: Humana Commercial |
$2,261.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,181.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,963.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$798.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,340.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.60
|
| Rate for Payer: PHCS Commercial |
$2,553.60
|
| Rate for Payer: United Healthcare All Payer |
$2,340.80
|
|
|
EXPLORE CHEST VESSELS
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
76101421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.74 |
| Max. Negotiated Rate |
$3,150.60 |
| Rate for Payer: Aetna Commercial |
$3,150.60
|
| Rate for Payer: Anthem Medicaid |
$588.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,660.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,766.38
|
| Rate for Payer: Healthspan PPO |
$3,097.66
|
| Rate for Payer: Humana Medicaid |
$588.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,654.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.51
|
| Rate for Payer: Molina Healthcare Passport |
$588.74
|
| Rate for Payer: Multiplan PHCS |
$1,596.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,862.00
|
| Rate for Payer: UHCCP Medicaid |
$931.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.63
|
|
|
EXPLORE CHEST VESSELS(P
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
761P1421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.74 |
| Max. Negotiated Rate |
$3,150.60 |
| Rate for Payer: Aetna Commercial |
$3,150.60
|
| Rate for Payer: Anthem Medicaid |
$588.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,660.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,766.38
|
| Rate for Payer: Healthspan PPO |
$3,097.66
|
| Rate for Payer: Humana Medicaid |
$588.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,654.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.51
|
| Rate for Payer: Molina Healthcare Passport |
$588.74
|
| Rate for Payer: Multiplan PHCS |
$1,596.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,862.00
|
| Rate for Payer: UHCCP Medicaid |
$931.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.63
|
|
|
EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
76102618
|
|
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
|
|
|
EXPLORE LIMB VESSELS
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
761P2618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.00 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$688.84
|
| Rate for Payer: Anthem Medicaid |
$317.00
|
| 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: Cigna Commercial |
$668.82
|
| Rate for Payer: Healthspan PPO |
$677.26
|
| Rate for Payer: Humana Medicaid |
$317.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$549.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$323.34
|
| Rate for Payer: Molina Healthcare Passport |
$317.00
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$320.17
|
|
|
EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
76102618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| 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 |
$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 |
$2,756.39
|
| 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 |
$3,307.67
|
| 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
|
|
|
EXPLORE LIMB VESSELS
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
76102618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.00 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$688.84
|
| Rate for Payer: Anthem Medicaid |
$317.00
|
| 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: Cigna Commercial |
$668.82
|
| Rate for Payer: Healthspan PPO |
$677.26
|
| Rate for Payer: Humana Medicaid |
$317.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$549.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$323.34
|
| Rate for Payer: Molina Healthcare Passport |
$317.00
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$320.17
|
|
