|
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 |
$450.00 |
| Rate for Payer: Aetna Commercial |
$377.31
|
| Rate for Payer: Ambetter Exchange |
$271.94
|
| 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 Individual/Medicaid |
$271.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$271.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$326.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$271.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.94
|
| 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 |
$353.52
|
| Rate for Payer: UHCCP Medicaid |
$153.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$271.94
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Facility
|
OP
|
$5,208.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
761T0073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,791.03 |
| Max. Negotiated Rate |
$4,999.69 |
| Rate for Payer: Aetna Commercial |
$4,010.17
|
| Rate for Payer: Anthem Medicaid |
$1,791.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,062.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,604.00
|
| Rate for Payer: Cash Price |
$2,604.00
|
| Rate for Payer: Cigna Commercial |
$4,322.65
|
| Rate for Payer: First Health Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial |
$4,426.81
|
| Rate for Payer: Humana KY Medicaid |
$1,791.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,270.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,843.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,826.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,166.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,530.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,593.53
|
| Rate for Payer: PHCS Commercial |
$4,999.69
|
| Rate for Payer: United Healthcare All Payer |
$4,583.05
|
|
|
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 |
$464.68 |
| Rate for Payer: Aetna Commercial |
$347.78
|
| Rate for Payer: Ambetter Exchange |
$237.98
|
| 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 Individual/Medicaid |
$237.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.98
|
| 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 |
$309.37
|
| Rate for Payer: UHCCP Medicaid |
$139.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.98
|
|
|
EXC SOFT TISSUE LESION
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
76102408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| 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 |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| 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 |
$189.15 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
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 |
$464.68 |
| Rate for Payer: Aetna Commercial |
$347.78
|
| Rate for Payer: Ambetter Exchange |
$237.98
|
| 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 Individual/Medicaid |
$237.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.98
|
| 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 |
$309.37
|
| Rate for Payer: UHCCP Medicaid |
$139.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.98
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Facility
|
IP
|
$4,835.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,450.50 |
| Max. Negotiated Rate |
$4,641.60 |
| Rate for Payer: Aetna Commercial |
$3,722.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,771.30
|
| Rate for Payer: Cash Price |
$2,417.50
|
| Rate for Payer: Cigna Commercial |
$4,013.05
|
| Rate for Payer: First Health Commercial |
$4,593.25
|
| Rate for Payer: Humana Commercial |
$4,109.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,964.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,568.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,450.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,254.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.15
|
| Rate for Payer: PHCS Commercial |
$4,641.60
|
| Rate for Payer: United Healthcare All Payer |
$4,254.80
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Professional
|
Both
|
$4,835.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Ambetter Exchange |
$313.55
|
| 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 Individual/Medicaid |
$313.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.26
|
| Rate for Payer: Cash Price |
$2,417.50
|
| Rate for Payer: Cash Price |
$2,417.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$313.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.19
|
| Rate for Payer: Molina Healthcare Passport |
$120.77
|
| Rate for Payer: Multiplan PHCS |
$2,901.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.62
|
| Rate for Payer: UHCCP Medicaid |
$178.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.55
|
|
|
EXC. SOFT TIS. TUMOR - SHOULD
|
Facility
|
OP
|
$4,835.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
76100439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,641.60 |
| Rate for Payer: Aetna Commercial |
$3,722.95
|
| Rate for Payer: Anthem Medicaid |
$1,662.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,771.30
|
| 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 |
$2,417.50
|
| Rate for Payer: Cash Price |
$2,417.50
|
| Rate for Payer: Cigna Commercial |
$4,013.05
|
| Rate for Payer: First Health Commercial |
$4,593.25
|
| Rate for Payer: Humana Commercial |
$4,109.75
|
| Rate for Payer: Humana KY Medicaid |
$1,662.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,679.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,964.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,568.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,696.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,254.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.15
|
| Rate for Payer: PHCS Commercial |
$4,641.60
|
| Rate for Payer: United Healthcare All Payer |
$4,254.80
|
|
|
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 |
$407.62 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Ambetter Exchange |
$313.55
|
| 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 Individual/Medicaid |
$313.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$313.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.55
|
| 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 |
$407.62
|
| Rate for Payer: UHCCP Medicaid |
$178.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.55
|
|
|
EXC. SOFT TIS. TUMOR - SHOUL(T
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
761T0439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,257.60 |
| Rate for Payer: Aetna Commercial |
$3,414.95
|
| Rate for Payer: Anthem Medicaid |
$1,525.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.30
|
| 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 |
$2,217.50
|
| Rate for Payer: Cash Price |
$2,217.50
|
| Rate for Payer: Cigna Commercial |
$3,681.05
|
| Rate for Payer: First Health Commercial |
$4,213.25
|
| Rate for Payer: Humana Commercial |
$3,769.75
|
| Rate for Payer: Humana KY Medicaid |
$1,525.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,273.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,060.15
|
| Rate for Payer: PHCS Commercial |
$4,257.60
|
| Rate for Payer: United Healthcare All Payer |
$3,902.80
|
|
|
EXC. SOFT TIS. TUMOR - SHOUL(T
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
761T0439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,330.50 |
| Max. Negotiated Rate |
$4,257.60 |
| Rate for Payer: Aetna Commercial |
$3,414.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.30
|
| Rate for Payer: Cash Price |
$2,217.50
|
| Rate for Payer: Cigna Commercial |
$3,681.05
|
| Rate for Payer: First Health Commercial |
$4,213.25
|
| Rate for Payer: Humana Commercial |
$3,769.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,273.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,060.15
|
| Rate for Payer: PHCS Commercial |
$4,257.60
|
| Rate for Payer: United Healthcare All Payer |
$3,902.80
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Professional
|
Both
|
$5,932.99
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.46 |
| Max. Negotiated Rate |
$3,559.79 |
| Rate for Payer: Aetna Commercial |
$643.13
|
| Rate for Payer: Ambetter Exchange |
$401.67
|
| Rate for Payer: Anthem Medicaid |
$302.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.00
|
| Rate for Payer: Cash Price |
$2,966.50
|
| Rate for Payer: Cash Price |
$2,966.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$401.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.51
|
| Rate for Payer: Molina Healthcare Passport |
$302.46
|
| Rate for Payer: Multiplan PHCS |
$3,559.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.17
|
| Rate for Payer: UHCCP Medicaid |
$2,076.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
OP
|
$5,932.99
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,040.36 |
| Max. Negotiated Rate |
$5,695.67 |
| Rate for Payer: Aetna Commercial |
$4,568.40
|
| Rate for Payer: Anthem Medicaid |
$2,040.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,627.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,966.50
|
| Rate for Payer: Cash Price |
$2,966.50
|
| Rate for Payer: Cigna Commercial |
$4,924.38
|
| Rate for Payer: First Health Commercial |
$5,636.34
|
| Rate for Payer: Humana Commercial |
$5,043.04
|
| Rate for Payer: Humana KY Medicaid |
$2,040.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,061.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,865.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,378.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,081.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,221.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,449.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,746.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,161.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,093.76
|
| Rate for Payer: PHCS Commercial |
$5,695.67
|
| Rate for Payer: United Healthcare All Payer |
$5,221.03
|
|
|
EXC THIGH/KNEE LES SC 3 CM/>
|
Facility
|
IP
|
$5,932.99
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
76100818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,779.90 |
| Max. Negotiated Rate |
$5,695.67 |
| Rate for Payer: Aetna Commercial |
$4,568.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,627.73
|
| Rate for Payer: Cash Price |
$2,966.50
|
| Rate for Payer: Cigna Commercial |
$4,924.38
|
| Rate for Payer: First Health Commercial |
$5,636.34
|
| Rate for Payer: Humana Commercial |
$5,043.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,865.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,378.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,779.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,221.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,449.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,746.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,161.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,093.76
|
| Rate for Payer: PHCS Commercial |
$5,695.67
|
| Rate for Payer: United Healthcare All Payer |
$5,221.03
|
|
|
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 |
$732.51 |
| Rate for Payer: Aetna Commercial |
$643.13
|
| Rate for Payer: Ambetter Exchange |
$401.67
|
| Rate for Payer: Anthem Medicaid |
$302.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$401.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.67
|
| 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 |
$522.17
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.67
|
|
|
EXC THIGH/KNEE LES SC 3 CM/(T
|
Facility
|
IP
|
$5,182.99
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
761T0818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.90 |
| Max. Negotiated Rate |
$4,975.67 |
| Rate for Payer: Aetna Commercial |
$3,990.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,042.73
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cigna Commercial |
$4,301.88
|
| Rate for Payer: First Health Commercial |
$4,923.84
|
| Rate for Payer: Humana Commercial |
$4,405.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,250.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,825.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,561.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,887.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,509.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,576.26
|
| Rate for Payer: PHCS Commercial |
$4,975.67
|
| Rate for Payer: United Healthcare All Payer |
$4,561.03
|
|
|
EXC THIGH/KNEE LES SC 3 CM/(T
|
Facility
|
OP
|
$5,182.99
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
761T0818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,782.43 |
| Max. Negotiated Rate |
$4,975.67 |
| Rate for Payer: Aetna Commercial |
$3,990.90
|
| Rate for Payer: Anthem Medicaid |
$1,782.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,042.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cigna Commercial |
$4,301.88
|
| Rate for Payer: First Health Commercial |
$4,923.84
|
| Rate for Payer: Humana Commercial |
$4,405.54
|
| Rate for Payer: Humana KY Medicaid |
$1,782.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,800.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,250.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,825.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,818.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,561.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,887.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,509.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,576.26
|
| Rate for Payer: PHCS Commercial |
$4,975.67
|
| Rate for Payer: United Healthcare All Payer |
$4,561.03
|
|
|
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 |
$1,321.59 |
| Rate for Payer: Aetna Commercial |
$1,161.57
|
| Rate for Payer: Ambetter Exchange |
$720.17
|
| Rate for Payer: Anthem Medicaid |
$545.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$720.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$864.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$720.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.17
|
| 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 |
$936.22
|
| Rate for Payer: UHCCP Medicaid |
$672.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$720.17
|
|
|
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 |
$660.29 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,478.40
|
| Rate for Payer: Anthem Medicaid |
$660.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$1,536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.80
|
| Rate for Payer: PHCS Commercial |
$1,843.20
|
| Rate for Payer: United Healthcare All Payer |
$1,689.60
|
|
|
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 |
$576.00 |
| 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 |
$1,536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.80
|
| 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 |
$1,321.59 |
| Rate for Payer: Aetna Commercial |
$1,161.57
|
| Rate for Payer: Ambetter Exchange |
$720.17
|
| Rate for Payer: Anthem Medicaid |
$545.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$720.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$864.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$720.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.17
|
| 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 |
$936.22
|
| Rate for Payer: UHCCP Medicaid |
$672.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$720.17
|
|
|
EXC THROMBOSED CEPHALIC VEIN
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.25 |
| 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 |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| 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 |
$571.26
|
| 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 |
$685.51
|
| 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 |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| 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 |
$745.50 |
| 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
|
|
|
EXC THROMBOSED CEPHALIC VEIN
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.50 |
| 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 |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
