|
ILIAC REVASC
|
Facility
|
OP
|
$15,768.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
76101544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,049.88 |
| Max. Negotiated Rate |
$15,137.60 |
| Rate for Payer: Aetna Commercial |
$12,141.61
|
| Rate for Payer: Anthem Medicaid |
$5,422.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,299.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$7,884.16
|
| Rate for Payer: Cash Price |
$7,884.16
|
| Rate for Payer: Cigna Commercial |
$13,087.71
|
| Rate for Payer: First Health Commercial |
$14,979.91
|
| Rate for Payer: Humana Commercial |
$13,403.08
|
| Rate for Payer: Humana KY Medicaid |
$5,422.73
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$5,477.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,930.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,637.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,531.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,876.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,826.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,153.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,049.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.18
|
| Rate for Payer: PHCS Commercial |
$15,137.60
|
| Rate for Payer: United Healthcare All Payer |
$13,876.13
|
|
|
ILIAC REVASC
|
Facility
|
IP
|
$15,768.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
76101544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,049.88 |
| Max. Negotiated Rate |
$15,137.60 |
| Rate for Payer: Aetna Commercial |
$12,141.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,299.30
|
| Rate for Payer: Cash Price |
$7,884.16
|
| Rate for Payer: Cigna Commercial |
$13,087.71
|
| Rate for Payer: First Health Commercial |
$14,979.91
|
| Rate for Payer: Humana Commercial |
$13,403.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,930.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,637.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,730.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,876.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,826.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,153.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,049.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.18
|
| Rate for Payer: PHCS Commercial |
$15,137.60
|
| Rate for Payer: United Healthcare All Payer |
$13,876.13
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$10,289.09
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
76101546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,337.58 |
| Max. Negotiated Rate |
$9,877.53 |
| Rate for Payer: Aetna Commercial |
$7,922.60
|
| Rate for Payer: Anthem Medicaid |
$3,538.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,025.49
|
| Rate for Payer: Cash Price |
$5,144.54
|
| Rate for Payer: Cigna Commercial |
$8,539.94
|
| Rate for Payer: First Health Commercial |
$9,774.64
|
| Rate for Payer: Humana Commercial |
$8,745.73
|
| Rate for Payer: Humana KY Medicaid |
$3,538.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,574.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,086.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,609.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,054.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,716.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,057.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,337.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,189.62
|
| Rate for Payer: PHCS Commercial |
$9,877.53
|
| Rate for Payer: United Healthcare All Payer |
$9,054.40
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$10,289.09
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
76101546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,337.58 |
| Max. Negotiated Rate |
$9,877.53 |
| Rate for Payer: Aetna Commercial |
$7,922.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,025.49
|
| Rate for Payer: Cash Price |
$5,144.54
|
| Rate for Payer: Cigna Commercial |
$8,539.94
|
| Rate for Payer: First Health Commercial |
$9,774.64
|
| Rate for Payer: Humana Commercial |
$8,745.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,086.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,054.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,716.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,057.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,337.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,189.62
|
| Rate for Payer: PHCS Commercial |
$9,877.53
|
| Rate for Payer: United Healthcare All Payer |
$9,054.40
|
|
|
ILIAC REVASC ADD-ON
|
Professional
|
Both
|
$10,289.09
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
76101546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$10,289.09 |
| Rate for Payer: Aetna Commercial |
$323.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.43
|
| Rate for Payer: Anthem Medicaid |
$172.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$10,289.09
|
| Rate for Payer: Cash Price |
$5,144.54
|
| Rate for Payer: Cash Price |
$5,144.54
|
| Rate for Payer: Cigna Commercial |
$366.50
|
| Rate for Payer: Healthspan PPO |
$858.89
|
| Rate for Payer: Humana Medicaid |
$172.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.44
|
| Rate for Payer: Molina Healthcare Passport |
$172.98
|
| Rate for Payer: Multiplan PHCS |
$6,173.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,202.36
|
| Rate for Payer: UHCCP Medicaid |
$102.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.71
|
|
|
ILIAC REVASC ADD-ON(P
|
Professional
|
Both
|
$1,017.59
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
761P1546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$1,017.59 |
| Rate for Payer: Aetna Commercial |
$323.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.43
|
| Rate for Payer: Anthem Medicaid |
$172.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,017.59
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$366.50
|
| Rate for Payer: Healthspan PPO |
$858.89
|
| Rate for Payer: Humana Medicaid |
$172.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.44
|
| Rate for Payer: Molina Healthcare Passport |
$172.98
|
| Rate for Payer: Multiplan PHCS |
$610.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.31
|
| Rate for Payer: UHCCP Medicaid |
$102.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.71
|
|
|
ILIAC REVASC ADD-ON(T
|
Facility
|
OP
|
$9,271.50
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
761T1546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,205.30 |
| Max. Negotiated Rate |
$8,900.64 |
| Rate for Payer: Aetna Commercial |
$7,139.06
|
| Rate for Payer: Anthem Medicaid |
$3,188.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,231.77
|
| Rate for Payer: Cash Price |
$4,635.75
|
| Rate for Payer: Cigna Commercial |
$7,695.34
|
| Rate for Payer: First Health Commercial |
$8,807.92
|
| Rate for Payer: Humana Commercial |
$7,880.78
|
| Rate for Payer: Humana KY Medicaid |
$3,188.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,602.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,842.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,781.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,252.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,158.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,953.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,854.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,874.16
|
| Rate for Payer: PHCS Commercial |
$8,900.64
|
| Rate for Payer: United Healthcare All Payer |
$8,158.92
|
|
|
ILIAC REVASC ADD-ON(T
|
Facility
|
IP
|
$9,271.50
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
761T1546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,205.30 |
| Max. Negotiated Rate |
$8,900.64 |
| Rate for Payer: Aetna Commercial |
$7,139.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,231.77
|
| Rate for Payer: Cash Price |
$4,635.75
|
| Rate for Payer: Cigna Commercial |
$7,695.34
|
| Rate for Payer: First Health Commercial |
$8,807.92
|
| Rate for Payer: Humana Commercial |
$7,880.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,602.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,842.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,781.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,158.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,953.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,854.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,874.16
|
| Rate for Payer: PHCS Commercial |
$8,900.64
|
| Rate for Payer: United Healthcare All Payer |
$8,158.92
|
|
|
ILIAC REVASC(P
|
Professional
|
Both
|
$3,270.00
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
761P1544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.75 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$712.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.75
|
| Rate for Payer: Anthem Medicaid |
$380.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,270.00
|
| Rate for Payer: Cash Price |
$1,635.00
|
| Rate for Payer: Cash Price |
$1,635.00
|
| Rate for Payer: Cigna Commercial |
$806.91
|
| Rate for Payer: Healthspan PPO |
$2,965.58
|
| Rate for Payer: Humana Medicaid |
$380.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$388.58
|
| Rate for Payer: Molina Healthcare Passport |
$380.96
|
| Rate for Payer: Multiplan PHCS |
$1,962.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,289.00
|
| Rate for Payer: UHCCP Medicaid |
$225.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.77
|
|
|
ILIAC REVASC(T
|
Facility
|
OP
|
$12,498.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
761T1544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,624.78 |
| Max. Negotiated Rate |
$11,998.40 |
| Rate for Payer: Aetna Commercial |
$9,623.71
|
| Rate for Payer: Anthem Medicaid |
$4,298.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$6,249.16
|
| Rate for Payer: Cash Price |
$6,249.16
|
| Rate for Payer: Cigna Commercial |
$10,373.61
|
| Rate for Payer: First Health Commercial |
$11,873.41
|
| Rate for Payer: Humana Commercial |
$10,623.58
|
| Rate for Payer: Humana KY Medicaid |
$4,298.18
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.48
|
| Rate for Payer: PHCS Commercial |
$11,998.40
|
| Rate for Payer: United Healthcare All Payer |
$10,998.53
|
|
|
ILIAC REVASC(T
|
Facility
|
IP
|
$12,498.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
761T1544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,624.78 |
| Max. Negotiated Rate |
$11,998.40 |
| Rate for Payer: Aetna Commercial |
$9,623.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.70
|
| Rate for Payer: Cash Price |
$6,249.16
|
| Rate for Payer: Cigna Commercial |
$10,373.61
|
| Rate for Payer: First Health Commercial |
$11,873.41
|
| Rate for Payer: Humana Commercial |
$10,623.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.48
|
| Rate for Payer: PHCS Commercial |
$11,998.40
|
| Rate for Payer: United Healthcare All Payer |
$10,998.53
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
IP
|
$23,068.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
76101545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,998.84 |
| Max. Negotiated Rate |
$22,145.28 |
| Rate for Payer: Aetna Commercial |
$17,762.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,993.04
|
| Rate for Payer: Cash Price |
$11,534.00
|
| Rate for Payer: Cigna Commercial |
$19,146.44
|
| Rate for Payer: First Health Commercial |
$21,914.60
|
| Rate for Payer: Humana Commercial |
$19,607.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,024.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,920.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.84
|
| Rate for Payer: Ohio Health Group HMO |
$17,301.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,151.08
|
| Rate for Payer: PHCS Commercial |
$22,145.28
|
| Rate for Payer: United Healthcare All Payer |
$20,299.84
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
OP
|
$23,068.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
76101545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,998.84 |
| Max. Negotiated Rate |
$22,145.28 |
| Rate for Payer: Aetna Commercial |
$17,762.36
|
| Rate for Payer: Anthem Medicaid |
$7,933.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,993.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$11,534.00
|
| Rate for Payer: Cash Price |
$11,534.00
|
| Rate for Payer: Cigna Commercial |
$19,146.44
|
| Rate for Payer: First Health Commercial |
$21,914.60
|
| Rate for Payer: Humana Commercial |
$19,607.80
|
| Rate for Payer: Humana KY Medicaid |
$7,933.09
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$8,013.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,915.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,024.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,092.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,299.84
|
| Rate for Payer: Ohio Health Group HMO |
$17,301.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,998.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,151.08
|
| Rate for Payer: PHCS Commercial |
$22,145.28
|
| Rate for Payer: United Healthcare All Payer |
$20,299.84
|
|
|
ILIAC REVASC W/STENT
|
Professional
|
Both
|
$23,068.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
76101545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.88 |
| Max. Negotiated Rate |
$23,068.00 |
| Rate for Payer: Aetna Commercial |
$865.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.88
|
| Rate for Payer: Anthem Medicaid |
$463.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$23,068.00
|
| Rate for Payer: Cash Price |
$11,534.00
|
| Rate for Payer: Cash Price |
$11,534.00
|
| Rate for Payer: Cigna Commercial |
$981.73
|
| Rate for Payer: Healthspan PPO |
$4,374.50
|
| Rate for Payer: Humana Medicaid |
$463.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.72
|
| Rate for Payer: Molina Healthcare Passport |
$463.45
|
| Rate for Payer: Multiplan PHCS |
$13,840.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16,147.60
|
| Rate for Payer: UHCCP Medicaid |
$273.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.08
|
|
|
ILIAC REVASC W/STENT ADD-ON
|
Facility
|
OP
|
$14,765.44
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
76101547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,919.51 |
| Max. Negotiated Rate |
$14,174.82 |
| Rate for Payer: Aetna Commercial |
$11,369.39
|
| Rate for Payer: Anthem Medicaid |
$5,077.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,517.04
|
| Rate for Payer: Cash Price |
$7,382.72
|
| Rate for Payer: Cigna Commercial |
$12,255.32
|
| Rate for Payer: First Health Commercial |
$14,027.17
|
| Rate for Payer: Humana Commercial |
$12,550.62
|
| Rate for Payer: Humana KY Medicaid |
$5,077.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,129.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,107.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,896.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,429.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,179.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,993.59
|
| Rate for Payer: Ohio Health Group HMO |
$11,074.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,953.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,577.29
|
| Rate for Payer: PHCS Commercial |
$14,174.82
|
| Rate for Payer: United Healthcare All Payer |
$12,993.59
|
|
|
ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$14,765.44
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
76101547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,919.51 |
| Max. Negotiated Rate |
$14,174.82 |
| Rate for Payer: Aetna Commercial |
$11,369.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,517.04
|
| Rate for Payer: Cash Price |
$7,382.72
|
| Rate for Payer: Cigna Commercial |
$12,255.32
|
| Rate for Payer: First Health Commercial |
$14,027.17
|
| Rate for Payer: Humana Commercial |
$12,550.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,107.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,896.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,429.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,993.59
|
| Rate for Payer: Ohio Health Group HMO |
$11,074.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,953.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,577.29
|
| Rate for Payer: PHCS Commercial |
$14,174.82
|
| Rate for Payer: United Healthcare All Payer |
$12,993.59
|
|
|
ILIAC REVASC W/STENT ADD-ON
|
Professional
|
Both
|
$14,765.44
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
76101547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$14,765.44 |
| Rate for Payer: Aetna Commercial |
$367.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.50
|
| Rate for Payer: Anthem Medicaid |
$196.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$14,765.44
|
| Rate for Payer: Cash Price |
$7,382.72
|
| Rate for Payer: Cash Price |
$7,382.72
|
| Rate for Payer: Cigna Commercial |
$416.19
|
| Rate for Payer: Healthspan PPO |
$4,328.26
|
| Rate for Payer: Humana Medicaid |
$196.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.35
|
| Rate for Payer: Molina Healthcare Passport |
$196.42
|
| Rate for Payer: Multiplan PHCS |
$8,859.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,335.81
|
| Rate for Payer: UHCCP Medicaid |
$116.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.38
|
|
|
ILIAC REVASC W/STENT ADD-ON(P
|
Professional
|
Both
|
$2,568.31
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
761P1547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$4,328.26 |
| Rate for Payer: Aetna Commercial |
$367.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.50
|
| Rate for Payer: Anthem Medicaid |
$196.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,568.31
|
| Rate for Payer: Cash Price |
$1,284.15
|
| Rate for Payer: Cash Price |
$1,284.15
|
| Rate for Payer: Cigna Commercial |
$416.19
|
| Rate for Payer: Healthspan PPO |
$4,328.26
|
| Rate for Payer: Humana Medicaid |
$196.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.35
|
| Rate for Payer: Molina Healthcare Passport |
$196.42
|
| Rate for Payer: Multiplan PHCS |
$1,540.99
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,797.82
|
| Rate for Payer: UHCCP Medicaid |
$116.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.38
|
|
|
ILIAC REVASC W/STENT ADD-ON(T
|
Facility
|
OP
|
$12,197.13
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
761T1547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.63 |
| Max. Negotiated Rate |
$11,709.24 |
| Rate for Payer: Aetna Commercial |
$9,391.79
|
| Rate for Payer: Anthem Medicaid |
$4,194.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.76
|
| Rate for Payer: Cash Price |
$6,098.56
|
| Rate for Payer: Cigna Commercial |
$10,123.62
|
| Rate for Payer: First Health Commercial |
$11,587.27
|
| Rate for Payer: Humana Commercial |
$10,367.56
|
| Rate for Payer: Humana KY Medicaid |
$4,194.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,237.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,659.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,278.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,733.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,439.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,585.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.11
|
| Rate for Payer: PHCS Commercial |
$11,709.24
|
| Rate for Payer: United Healthcare All Payer |
$10,733.47
|
|
|
ILIAC REVASC W/STENT ADD-ON(T
|
Facility
|
IP
|
$12,197.13
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
761T1547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.63 |
| Max. Negotiated Rate |
$11,709.24 |
| Rate for Payer: Aetna Commercial |
$9,391.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.76
|
| Rate for Payer: Cash Price |
$6,098.56
|
| Rate for Payer: Cigna Commercial |
$10,123.62
|
| Rate for Payer: First Health Commercial |
$11,587.27
|
| Rate for Payer: Humana Commercial |
$10,367.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,659.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,733.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,439.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,585.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.11
|
| Rate for Payer: PHCS Commercial |
$11,709.24
|
| Rate for Payer: United Healthcare All Payer |
$10,733.47
|
|
|
ILIAC REVASC W/STENT(P
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
761P1545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.88 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$865.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.88
|
| Rate for Payer: Anthem Medicaid |
$463.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,800.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$981.73
|
| Rate for Payer: Healthspan PPO |
$4,374.50
|
| Rate for Payer: Humana Medicaid |
$463.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.72
|
| Rate for Payer: Molina Healthcare Passport |
$463.45
|
| Rate for Payer: Multiplan PHCS |
$2,880.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,360.00
|
| Rate for Payer: UHCCP Medicaid |
$273.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.08
|
|
|
ILIAC REVASC W/STENT(T
|
Facility
|
IP
|
$18,268.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
761T1545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,374.84 |
| Max. Negotiated Rate |
$17,537.28 |
| Rate for Payer: Aetna Commercial |
$14,066.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,249.04
|
| Rate for Payer: Cash Price |
$9,134.00
|
| Rate for Payer: Cigna Commercial |
$15,162.44
|
| Rate for Payer: First Health Commercial |
$17,354.60
|
| Rate for Payer: Humana Commercial |
$15,527.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,979.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,481.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,480.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,075.84
|
| Rate for Payer: Ohio Health Group HMO |
$13,701.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,653.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,374.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,663.08
|
| Rate for Payer: PHCS Commercial |
$17,537.28
|
| Rate for Payer: United Healthcare All Payer |
$16,075.84
|
|
|
ILIAC REVASC W/STENT(T
|
Facility
|
OP
|
$18,268.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
761T1545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,374.84 |
| Max. Negotiated Rate |
$17,537.28 |
| Rate for Payer: Aetna Commercial |
$14,066.36
|
| Rate for Payer: Anthem Medicaid |
$6,282.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,249.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$9,134.00
|
| Rate for Payer: Cash Price |
$9,134.00
|
| Rate for Payer: Cigna Commercial |
$15,162.44
|
| Rate for Payer: First Health Commercial |
$17,354.60
|
| Rate for Payer: Humana Commercial |
$15,527.80
|
| Rate for Payer: Humana KY Medicaid |
$6,282.37
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,346.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,979.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,481.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,408.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,075.84
|
| Rate for Payer: Ohio Health Group HMO |
$13,701.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,653.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,374.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,663.08
|
| Rate for Payer: PHCS Commercial |
$17,537.28
|
| Rate for Payer: United Healthcare All Payer |
$16,075.84
|
|
|
ILIOINGUINAL NERVE BLOCK
|
Facility
|
OP
|
$1,410.80
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
76102316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$1,354.37 |
| Rate for Payer: Aetna Commercial |
$1,086.32
|
| Rate for Payer: Anthem Medicaid |
$485.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,100.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$705.40
|
| Rate for Payer: Cash Price |
$705.40
|
| Rate for Payer: Cigna Commercial |
$1,170.96
|
| Rate for Payer: First Health Commercial |
$1,340.26
|
| Rate for Payer: Humana Commercial |
$1,199.18
|
| Rate for Payer: Humana KY Medicaid |
$485.17
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$490.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,041.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$494.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,241.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,058.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.35
|
| Rate for Payer: PHCS Commercial |
$1,354.37
|
| Rate for Payer: United Healthcare All Payer |
$1,241.50
|
|
|
ILIOINGUINAL NERVE BLOCK
|
Facility
|
IP
|
$1,410.80
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
76102316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$1,354.37 |
| Rate for Payer: Aetna Commercial |
$1,086.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,100.42
|
| Rate for Payer: Cash Price |
$705.40
|
| Rate for Payer: Cigna Commercial |
$1,170.96
|
| Rate for Payer: First Health Commercial |
$1,340.26
|
| Rate for Payer: Humana Commercial |
$1,199.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,041.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,241.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,058.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.35
|
| Rate for Payer: PHCS Commercial |
$1,354.37
|
| Rate for Payer: United Healthcare All Payer |
$1,241.50
|
|
