|
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 |
$1,980.20 |
| Rate for Payer: Aetna Commercial |
$1,980.20
|
| Rate for Payer: Ambetter Exchange |
$1,097.96
|
| Rate for Payer: Anthem Medicaid |
$851.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,097.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,097.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,317.55
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,097.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.96
|
| 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 |
$1,427.35
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,097.96
|
|
|
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 |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,115.90
|
| Rate for Payer: Ambetter Exchange |
$733.12
|
| Rate for Payer: Anthem Medicaid |
$479.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$733.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$733.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$879.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$733.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.12
|
| 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 |
$953.06
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.12
|
|
|
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: Ambetter Exchange |
$871.31
|
| Rate for Payer: Anthem Medicaid |
$667.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$871.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$871.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,045.57
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$871.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$871.31
|
| 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 |
$1,132.70
|
| Rate for Payer: UHCCP Medicaid |
$399.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$871.31
|
|
|
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: Ambetter Exchange |
$871.31
|
| Rate for Payer: Anthem Medicaid |
$667.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$871.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$871.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,045.57
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$871.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$871.31
|
| 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 |
$1,132.70
|
| Rate for Payer: UHCCP Medicaid |
$399.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$871.31
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
76101177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.00 |
| 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 |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 32124
|
| Hospital Charge Code |
76101177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.00 |
| 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 |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
EXPLORE CHEST VESSELS
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
76101421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.00 |
| 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 |
$2,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,314.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,835.40
|
| Rate for Payer: PHCS Commercial |
$2,553.60
|
| Rate for Payer: United Healthcare All Payer |
$2,340.80
|
|
|
EXPLORE CHEST VESSELS
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35820
|
| Hospital Charge Code |
76101421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.00 |
| 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 |
$2,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,314.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,835.40
|
| 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: Ambetter Exchange |
$1,893.49
|
| Rate for Payer: Anthem Medicaid |
$588.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,893.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,893.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,272.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,893.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,893.49
|
| 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 |
$2,461.54
|
| Rate for Payer: UHCCP Medicaid |
$931.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,893.49
|
|
|
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: Ambetter Exchange |
$1,893.49
|
| Rate for Payer: Anthem Medicaid |
$588.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,893.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,893.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,272.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,893.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,893.49
|
| 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 |
$2,461.54
|
| Rate for Payer: UHCCP Medicaid |
$931.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,893.49
|
|
|
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 |
$1,031.68 |
| Rate for Payer: Aetna Commercial |
$688.84
|
| Rate for Payer: Ambetter Exchange |
$793.60
|
| Rate for Payer: Anthem Medicaid |
$317.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$793.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$793.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$952.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$793.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.60
|
| 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 |
$1,031.68
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$320.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$793.60
|
|
|
EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
76102618
|
|
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
|
|
|
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 |
$1,031.68 |
| Rate for Payer: Aetna Commercial |
$688.84
|
| Rate for Payer: Ambetter Exchange |
$793.60
|
| Rate for Payer: Anthem Medicaid |
$317.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$793.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$793.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$952.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$793.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.60
|
| 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 |
$1,031.68
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$320.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$793.60
|
|
|
EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 35860
|
| Hospital Charge Code |
76102618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.25 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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
|
|
|
EXPLORE NECK VESSELS
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
EXPLORE NECK VESSELS
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
EXPLORE NECK VESSELS
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.42 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$816.36
|
| Rate for Payer: Ambetter Exchange |
$693.03
|
| Rate for Payer: Anthem Medicaid |
$342.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$693.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$693.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.64
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Healthspan PPO |
$802.64
|
| Rate for Payer: Humana Medicaid |
$342.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$693.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$693.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$349.27
|
| Rate for Payer: Molina Healthcare Passport |
$342.42
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.94
|
| Rate for Payer: UHCCP Medicaid |
$654.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$693.03
|
|
|
EXPLORE NECK VESSELS(P
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
761P1420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.42 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$816.36
|
| Rate for Payer: Ambetter Exchange |
$693.03
|
| Rate for Payer: Anthem Medicaid |
$342.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$693.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$693.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.64
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Healthspan PPO |
$802.64
|
| Rate for Payer: Humana Medicaid |
$342.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$693.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$693.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$349.27
|
| Rate for Payer: Molina Healthcare Passport |
$342.42
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.94
|
| Rate for Payer: UHCCP Medicaid |
$654.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$693.03
|
|
|
EXPLORE - REMOVE FOREIGN BOD(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
761P0663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.53 |
| Max. Negotiated Rate |
$598.75 |
| Rate for Payer: Aetna Commercial |
$539.52
|
| Rate for Payer: Ambetter Exchange |
$382.17
|
| Rate for Payer: Anthem Medicaid |
$207.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$458.60
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$488.69
|
| Rate for Payer: Humana Medicaid |
$207.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.68
|
| Rate for Payer: Molina Healthcare Passport |
$207.53
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$496.82
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.17
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.53 |
| Max. Negotiated Rate |
$598.75 |
| Rate for Payer: Aetna Commercial |
$539.52
|
| Rate for Payer: Ambetter Exchange |
$382.17
|
| Rate for Payer: Anthem Medicaid |
$207.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$458.60
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$488.69
|
| Rate for Payer: Humana Medicaid |
$207.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.68
|
| Rate for Payer: Molina Healthcare Passport |
$207.53
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$496.82
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.17
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
76100898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.07 |
| Max. Negotiated Rate |
$1,054.18 |
| Rate for Payer: Aetna Commercial |
$965.53
|
| Rate for Payer: Ambetter Exchange |
$614.45
|
| Rate for Payer: Anthem Medicaid |
$440.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$614.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$737.34
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,054.18
|
| Rate for Payer: Healthspan PPO |
$874.57
|
| Rate for Payer: Humana Medicaid |
$440.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$811.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$614.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.87
|
| Rate for Payer: Molina Healthcare Passport |
$440.07
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$798.78
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$614.45
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem Medicaid |
$581.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Humana KY Medicaid |
$581.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$587.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.10
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
