|
ILEOSTOMY
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
HCPCS 44144
|
| Hospital Charge Code |
76101817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$2,246.40 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,825.20
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna Commercial |
$1,942.20
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial |
$1,989.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,918.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,726.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$702.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,059.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,035.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,614.60
|
| Rate for Payer: PHCS Commercial |
$2,246.40
|
| Rate for Payer: United Healthcare All Payer |
$2,059.20
|
|
|
ILEOSTOMY
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44310
|
| Hospital Charge Code |
76101836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
ILEOSTOMY(P
|
Professional
|
Both
|
$2,340.00
|
|
|
Service Code
|
HCPCS 44144
|
| Hospital Charge Code |
761P1817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$2,495.90 |
| Rate for Payer: Aetna Commercial |
$2,495.90
|
| Rate for Payer: Ambetter Exchange |
$1,671.09
|
| Rate for Payer: Anthem Medicaid |
$825.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,671.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,671.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,005.31
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna Commercial |
$2,286.79
|
| Rate for Payer: Healthspan PPO |
$2,104.84
|
| Rate for Payer: Humana Medicaid |
$825.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,253.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,671.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,671.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$841.60
|
| Rate for Payer: Molina Healthcare Passport |
$825.10
|
| Rate for Payer: Multiplan PHCS |
$1,404.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,172.42
|
| Rate for Payer: UHCCP Medicaid |
$819.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$833.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,671.09
|
|
|
ILEOSTOMY(P
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44310
|
| Hospital Charge Code |
761P1836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.18 |
| Max. Negotiated Rate |
$1,509.94 |
| Rate for Payer: Aetna Commercial |
$1,509.94
|
| Rate for Payer: Ambetter Exchange |
$986.64
|
| Rate for Payer: Anthem Medicaid |
$547.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$986.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$986.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,183.97
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,407.07
|
| Rate for Payer: Healthspan PPO |
$1,273.36
|
| Rate for Payer: Humana Medicaid |
$547.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,330.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$986.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.12
|
| Rate for Payer: Molina Healthcare Passport |
$547.18
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,282.63
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$986.64
|
|
|
ILIAC REVASC
|
Facility
|
IP
|
$15,768.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
76101544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,730.50 |
| 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 |
$12,614.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,718.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,880.15
|
| Rate for Payer: PHCS Commercial |
$15,137.60
|
| Rate for Payer: United Healthcare All Payer |
$13,876.13
|
|
|
ILIAC REVASC
|
Facility
|
OP
|
$15,768.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
76101544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,268.09 |
| 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 |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,299.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$12,614.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,718.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,880.15
|
| Rate for Payer: PHCS Commercial |
$15,137.60
|
| Rate for Payer: United Healthcare All Payer |
$13,876.13
|
|
|
ILIAC REVASC
|
Professional
|
Both
|
$15,768.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
76101544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.75 |
| Max. Negotiated Rate |
$9,461.00 |
| Rate for Payer: Aetna Commercial |
$712.86
|
| Rate for Payer: Ambetter Exchange |
$373.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.75
|
| Rate for Payer: Anthem Medicaid |
$2,769.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.15
|
| Rate for Payer: Cash Price |
$7,884.16
|
| Rate for Payer: Cash Price |
$7,884.16
|
| Rate for Payer: Cigna Commercial |
$806.91
|
| Rate for Payer: Healthspan PPO |
$2,965.58
|
| Rate for Payer: Humana Medicaid |
$2,769.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$373.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,825.08
|
| Rate for Payer: Molina Healthcare Passport |
$2,769.69
|
| Rate for Payer: Multiplan PHCS |
$9,461.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$485.50
|
| Rate for Payer: UHCCP Medicaid |
$225.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,797.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.46
|
|
|
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 |
$6,173.45 |
| Rate for Payer: Aetna Commercial |
$323.77
|
| Rate for Payer: Ambetter Exchange |
$173.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.43
|
| Rate for Payer: Anthem Medicaid |
$798.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$208.43
|
| 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 |
$798.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$814.69
|
| Rate for Payer: Molina Healthcare Passport |
$798.72
|
| Rate for Payer: Multiplan PHCS |
$6,173.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$225.80
|
| Rate for Payer: UHCCP Medicaid |
$102.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$806.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.69
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$10,289.09
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
76101546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,086.73 |
| 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 |
$8,231.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,951.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,099.47
|
| Rate for Payer: PHCS Commercial |
$9,877.53
|
| Rate for Payer: United Healthcare All Payer |
$9,054.40
|
|
|
ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$10,289.09
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
76101546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,086.73 |
| 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 |
$8,231.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,951.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,099.47
|
| Rate for Payer: PHCS Commercial |
$9,877.53
|
| Rate for Payer: United Healthcare All Payer |
$9,054.40
|
|
|
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 |
$858.89 |
| Rate for Payer: Aetna Commercial |
$323.77
|
| Rate for Payer: Ambetter Exchange |
$173.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.43
|
| Rate for Payer: Anthem Medicaid |
$798.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$208.43
|
| 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 |
$798.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$814.69
|
| Rate for Payer: Molina Healthcare Passport |
$798.72
|
| Rate for Payer: Multiplan PHCS |
$610.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$225.80
|
| Rate for Payer: UHCCP Medicaid |
$102.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$806.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.69
|
|
|
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 |
$2,781.45 |
| 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 |
$7,695.35
|
| Rate for Payer: First Health Commercial |
$8,807.92
|
| Rate for Payer: Humana Commercial |
$7,880.77
|
| 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 |
$7,417.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,066.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,397.34
|
| Rate for Payer: PHCS Commercial |
$8,900.64
|
| Rate for Payer: United Healthcare All Payer |
$8,158.92
|
|
|
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 |
$2,781.45 |
| 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 |
$7,695.35
|
| Rate for Payer: First Health Commercial |
$8,807.92
|
| Rate for Payer: Humana Commercial |
$7,880.77
|
| 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 |
$7,417.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,066.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,397.34
|
| 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 |
$2,965.58 |
| Rate for Payer: Aetna Commercial |
$712.86
|
| Rate for Payer: Ambetter Exchange |
$373.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.75
|
| Rate for Payer: Anthem Medicaid |
$2,769.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.15
|
| 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 |
$2,769.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$373.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,825.08
|
| Rate for Payer: Molina Healthcare Passport |
$2,769.69
|
| Rate for Payer: Multiplan PHCS |
$1,962.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$485.50
|
| Rate for Payer: UHCCP Medicaid |
$225.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,797.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.46
|
|
|
ILIAC REVASC(T
|
Facility
|
OP
|
$12,498.33
|
|
|
Service Code
|
HCPCS 37220
|
| Hospital Charge Code |
761T1544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,298.18 |
| 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 |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$9,998.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,873.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,623.85
|
| 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 |
$3,749.50 |
| 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 |
$9,998.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,873.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,623.85
|
| Rate for Payer: PHCS Commercial |
$11,998.40
|
| Rate for Payer: United Healthcare All Payer |
$10,998.53
|
|
|
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 |
$13,840.80 |
| Rate for Payer: Aetna Commercial |
$865.31
|
| Rate for Payer: Ambetter Exchange |
$460.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.88
|
| Rate for Payer: Anthem Medicaid |
$4,092.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$460.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$552.29
|
| 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 |
$4,092.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$460.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4,174.23
|
| Rate for Payer: Molina Healthcare Passport |
$4,092.38
|
| Rate for Payer: Multiplan PHCS |
$13,840.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$598.31
|
| Rate for Payer: UHCCP Medicaid |
$273.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4,133.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.24
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
OP
|
$23,068.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
76101545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,933.09 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,993.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$18,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,069.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,916.92
|
| Rate for Payer: PHCS Commercial |
$22,145.28
|
| Rate for Payer: United Healthcare All Payer |
$20,299.84
|
|
|
ILIAC REVASC W/STENT
|
Facility
|
IP
|
$23,068.00
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
76101545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,920.40 |
| 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 |
$18,454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,069.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,916.92
|
| Rate for Payer: PHCS Commercial |
$22,145.28
|
| Rate for Payer: United Healthcare All Payer |
$20,299.84
|
|
|
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 |
$8,859.26 |
| Rate for Payer: Aetna Commercial |
$367.32
|
| Rate for Payer: Ambetter Exchange |
$198.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.50
|
| Rate for Payer: Anthem Medicaid |
$2,253.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.85
|
| 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 |
$2,253.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,298.80
|
| Rate for Payer: Molina Healthcare Passport |
$2,253.73
|
| Rate for Payer: Multiplan PHCS |
$8,859.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.67
|
| Rate for Payer: UHCCP Medicaid |
$116.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,276.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.21
|
|
|
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 |
$4,429.63 |
| 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 |
$11,812.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,845.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,188.15
|
| 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
|
OP
|
$14,765.44
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
76101547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,429.63 |
| 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 |
$11,812.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,845.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,188.15
|
| Rate for Payer: PHCS Commercial |
$14,174.82
|
| Rate for Payer: United Healthcare All Payer |
$12,993.59
|
|
|
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: Ambetter Exchange |
$198.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.50
|
| Rate for Payer: Anthem Medicaid |
$2,253.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.85
|
| 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 |
$2,253.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,298.80
|
| Rate for Payer: Molina Healthcare Passport |
$2,253.73
|
| Rate for Payer: Multiplan PHCS |
$1,540.99
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.67
|
| Rate for Payer: UHCCP Medicaid |
$116.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,276.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.21
|
|
|
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 |
$3,659.14 |
| 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 |
$9,757.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,611.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,416.02
|
| 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
|
OP
|
$12,197.13
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
761T1547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,659.14 |
| 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 |
$9,757.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,611.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,416.02
|
| Rate for Payer: PHCS Commercial |
$11,709.24
|
| Rate for Payer: United Healthcare All Payer |
$10,733.47
|
|
