|
ELUVIA 6*120*130
|
Facility
|
OP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem Medicaid |
$7,048.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Humana KY Medicaid |
$7,048.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,119.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
ELUVIA 6*120*130
|
Facility
|
IP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
ELUVIA 6*4*130
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 6*4*130
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 6*60*130
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 6*60*130
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 6*80*130
|
Facility
|
OP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem Medicaid |
$4,392.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Humana KY Medicaid |
$4,392.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,480.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
ELUVIA 6*80*130
|
Facility
|
IP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
ELUVIA 7*60*130
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 7*60*130
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
ELUVIA 7*80*130
|
Facility
|
IP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
ELUVIA 7*80*130
|
Facility
|
OP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem Medicaid |
$7,048.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Humana KY Medicaid |
$7,048.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,119.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
EMBLCTMY/THROMBECTOMY CAROTID
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 34001
|
| Hospital Charge Code |
76101336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$645.42 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,646.32
|
| Rate for Payer: Anthem Medicaid |
$645.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,541.09
|
| Rate for Payer: Healthspan PPO |
$1,618.66
|
| Rate for Payer: Humana Medicaid |
$645.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,320.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$658.33
|
| Rate for Payer: Molina Healthcare Passport |
$645.42
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$651.87
|
|
|
EMBLCTMY/THROMBECTOMY CAROTID
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 34001
|
| Hospital Charge Code |
76101336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
EMBLCTMY/THROMBECTOMY CAROTID
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 34001
|
| Hospital Charge Code |
76101336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
EMBLCTMY/THROMBECTOMY CAROTI(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 34001
|
| Hospital Charge Code |
761P1336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$645.42 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,646.32
|
| Rate for Payer: Anthem Medicaid |
$645.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,541.09
|
| Rate for Payer: Healthspan PPO |
$1,618.66
|
| Rate for Payer: Humana Medicaid |
$645.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,320.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$658.33
|
| Rate for Payer: Molina Healthcare Passport |
$645.42
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$651.87
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$9,183.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
76101338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,193.79 |
| Max. Negotiated Rate |
$8,815.68 |
| Rate for Payer: Aetna Commercial |
$7,070.91
|
| Rate for Payer: Anthem Medicaid |
$3,158.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,591.50
|
| Rate for Payer: Cash Price |
$4,591.50
|
| Rate for Payer: Cigna Commercial |
$7,621.89
|
| Rate for Payer: First Health Commercial |
$8,723.85
|
| Rate for Payer: Humana Commercial |
$7,805.55
|
| Rate for Payer: Humana KY Medicaid |
$3,158.03
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.73
|
| Rate for Payer: PHCS Commercial |
$8,815.68
|
| Rate for Payer: United Healthcare All Payer |
$8,081.04
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34151
|
| Hospital Charge Code |
76101339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
IP
|
$12,577.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
76101341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,635.07 |
| Max. Negotiated Rate |
$12,074.38 |
| Rate for Payer: Aetna Commercial |
$9,684.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,810.43
|
| Rate for Payer: Cash Price |
$6,288.74
|
| Rate for Payer: Cigna Commercial |
$10,439.31
|
| Rate for Payer: First Health Commercial |
$11,948.61
|
| Rate for Payer: Humana Commercial |
$10,690.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,313.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,282.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,773.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,068.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,433.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,635.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,899.02
|
| Rate for Payer: PHCS Commercial |
$12,074.38
|
| Rate for Payer: United Healthcare All Payer |
$11,068.18
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
IP
|
$9,183.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
76101338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,193.79 |
| Max. Negotiated Rate |
$8,815.68 |
| Rate for Payer: Aetna Commercial |
$7,070.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.74
|
| Rate for Payer: Cash Price |
$4,591.50
|
| Rate for Payer: Cigna Commercial |
$7,621.89
|
| Rate for Payer: First Health Commercial |
$8,723.85
|
| Rate for Payer: Humana Commercial |
$7,805.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,836.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.73
|
| Rate for Payer: PHCS Commercial |
$8,815.68
|
| Rate for Payer: United Healthcare All Payer |
$8,081.04
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Professional
|
Both
|
$9,183.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
76101338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.90 |
| Max. Negotiated Rate |
$9,183.00 |
| Rate for Payer: Aetna Commercial |
$1,054.72
|
| Rate for Payer: Anthem Medicaid |
$452.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,183.00
|
| Rate for Payer: Cash Price |
$4,591.50
|
| Rate for Payer: Cash Price |
$4,591.50
|
| Rate for Payer: Cigna Commercial |
$1,020.07
|
| Rate for Payer: Healthspan PPO |
$1,037.00
|
| Rate for Payer: Humana Medicaid |
$452.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.96
|
| Rate for Payer: Molina Healthcare Passport |
$452.90
|
| Rate for Payer: Multiplan PHCS |
$5,509.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,428.10
|
| Rate for Payer: UHCCP Medicaid |
$3,214.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.43
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34151
|
| Hospital Charge Code |
76101339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$12,577.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
76101341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,635.07 |
| Max. Negotiated Rate |
$12,074.38 |
| Rate for Payer: Aetna Commercial |
$9,684.66
|
| Rate for Payer: Anthem Medicaid |
$4,325.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,810.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,288.74
|
| Rate for Payer: Cash Price |
$6,288.74
|
| Rate for Payer: Cigna Commercial |
$10,439.31
|
| Rate for Payer: First Health Commercial |
$11,948.61
|
| Rate for Payer: Humana Commercial |
$10,690.86
|
| Rate for Payer: Humana KY Medicaid |
$4,325.40
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,369.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,313.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,282.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,412.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,068.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,433.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,635.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,899.02
|
| Rate for Payer: PHCS Commercial |
$12,074.38
|
| Rate for Payer: United Healthcare All Payer |
$11,068.18
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
IP
|
$9,100.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
76101337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,183.00 |
| Max. Negotiated Rate |
$8,736.00 |
| Rate for Payer: Aetna Commercial |
$7,007.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.00
|
| Rate for Payer: Cash Price |
$4,550.00
|
| Rate for Payer: Cigna Commercial |
$7,553.00
|
| Rate for Payer: First Health Commercial |
$8,645.00
|
| Rate for Payer: Humana Commercial |
$7,735.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,462.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,715.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,008.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,821.00
|
| Rate for Payer: PHCS Commercial |
$8,736.00
|
| Rate for Payer: United Healthcare All Payer |
$8,008.00
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Professional
|
Both
|
$9,100.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
76101337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.42 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$1,055.48
|
| Rate for Payer: Anthem Medicaid |
$521.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,100.00
|
| Rate for Payer: Cash Price |
$4,550.00
|
| Rate for Payer: Cash Price |
$4,550.00
|
| Rate for Payer: Cigna Commercial |
$1,019.48
|
| Rate for Payer: Healthspan PPO |
$1,037.75
|
| Rate for Payer: Humana Medicaid |
$521.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$823.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$531.85
|
| Rate for Payer: Molina Healthcare Passport |
$521.42
|
| Rate for Payer: Multiplan PHCS |
$5,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,370.00
|
| Rate for Payer: UHCCP Medicaid |
$3,185.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$526.63
|
|
