|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$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 Medicaid |
$3,129.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.00
|
| 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 |
$4,550.00
|
| 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: Humana KY Medicaid |
$3,129.49
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,161.34
|
| 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 |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,192.28
|
| 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
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34151
|
| Hospital Charge Code |
76101339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.77 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$2,459.25
|
| Rate for Payer: Anthem Medicaid |
$825.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,342.80
|
| Rate for Payer: Healthspan PPO |
$2,417.93
|
| Rate for Payer: Humana Medicaid |
$825.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,907.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$842.29
|
| Rate for Payer: Molina Healthcare Passport |
$825.77
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.03
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Professional
|
Both
|
$12,577.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
76101341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$597.81 |
| Max. Negotiated Rate |
$12,577.48 |
| Rate for Payer: Aetna Commercial |
$1,693.37
|
| Rate for Payer: Anthem Medicaid |
$597.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$12,577.48
|
| Rate for Payer: Cash Price |
$6,288.74
|
| Rate for Payer: Cash Price |
$6,288.74
|
| Rate for Payer: Cigna Commercial |
$1,629.27
|
| Rate for Payer: Healthspan PPO |
$1,664.91
|
| Rate for Payer: Humana Medicaid |
$597.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,318.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$609.77
|
| Rate for Payer: Molina Healthcare Passport |
$597.81
|
| Rate for Payer: Multiplan PHCS |
$7,546.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,804.24
|
| Rate for Payer: UHCCP Medicaid |
$4,402.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$603.79
|
|
|
EMBOLECTOMY OR THROMBECTOMY (P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
761P1338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.90 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,054.72
|
| Rate for Payer: Anthem Medicaid |
$452.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| 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 |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.43
|
|
|
EMBOLECTOMY OR THROMBECTOMY (P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34151
|
| Hospital Charge Code |
761P1339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.77 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$2,459.25
|
| Rate for Payer: Anthem Medicaid |
$825.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,342.80
|
| Rate for Payer: Healthspan PPO |
$2,417.93
|
| Rate for Payer: Humana Medicaid |
$825.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,907.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$842.29
|
| Rate for Payer: Molina Healthcare Passport |
$825.77
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.03
|
|
|
EMBOLECTOMY OR THROMBECTOMY (P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
761P1337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.42 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,055.48
|
| Rate for Payer: Anthem Medicaid |
$521.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| 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 |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$526.63
|
|
|
EMBOLECTOMY OR THROMBECTOMY (P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
761P1341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$597.81 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,693.37
|
| Rate for Payer: Anthem Medicaid |
$597.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,629.27
|
| Rate for Payer: Healthspan PPO |
$1,664.91
|
| Rate for Payer: Humana Medicaid |
$597.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,318.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$609.77
|
| Rate for Payer: Molina Healthcare Passport |
$597.81
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$603.79
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
IP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
761T1337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.00 |
| Max. Negotiated Rate |
$7,296.00 |
| Rate for Payer: Aetna Commercial |
$5,852.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,928.00
|
| Rate for Payer: Cash Price |
$3,800.00
|
| Rate for Payer: Cigna Commercial |
$6,308.00
|
| Rate for Payer: First Health Commercial |
$7,220.00
|
| Rate for Payer: Humana Commercial |
$6,460.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,232.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,688.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.00
|
| Rate for Payer: PHCS Commercial |
$7,296.00
|
| Rate for Payer: United Healthcare All Payer |
$6,688.00
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
IP
|
$6,583.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
761T1338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.79 |
| Max. Negotiated Rate |
$6,319.68 |
| Rate for Payer: Aetna Commercial |
$5,068.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,134.74
|
| Rate for Payer: Cash Price |
$3,291.50
|
| Rate for Payer: Cigna Commercial |
$5,463.89
|
| Rate for Payer: First Health Commercial |
$6,253.85
|
| Rate for Payer: Humana Commercial |
$5,595.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,793.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.73
|
| Rate for Payer: PHCS Commercial |
$6,319.68
|
| Rate for Payer: United Healthcare All Payer |
$5,793.04
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
OP
|
$10,077.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
761T1341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,310.07 |
| Max. Negotiated Rate |
$9,674.38 |
| Rate for Payer: Aetna Commercial |
$7,759.66
|
| Rate for Payer: Anthem Medicaid |
$3,465.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,860.43
|
| 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 |
$5,038.74
|
| Rate for Payer: Cash Price |
$5,038.74
|
| Rate for Payer: Cigna Commercial |
$8,364.31
|
| Rate for Payer: First Health Commercial |
$9,573.61
|
| Rate for Payer: Humana Commercial |
$8,565.86
|
| Rate for Payer: Humana KY Medicaid |
$3,465.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,500.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,263.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,437.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,535.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,868.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,558.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,015.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,124.02
|
| Rate for Payer: PHCS Commercial |
$9,674.38
|
| Rate for Payer: United Healthcare All Payer |
$8,868.18
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
IP
|
$10,077.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
761T1341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,310.07 |
| Max. Negotiated Rate |
$9,674.38 |
| Rate for Payer: Aetna Commercial |
$7,759.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,860.43
|
| Rate for Payer: Cash Price |
$5,038.74
|
| Rate for Payer: Cigna Commercial |
$8,364.31
|
| Rate for Payer: First Health Commercial |
$9,573.61
|
| Rate for Payer: Humana Commercial |
$8,565.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,263.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,437.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,023.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,868.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,558.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,015.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,124.02
|
| Rate for Payer: PHCS Commercial |
$9,674.38
|
| Rate for Payer: United Healthcare All Payer |
$8,868.18
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
OP
|
$6,583.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
761T1338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.79 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$5,068.91
|
| Rate for Payer: Anthem Medicaid |
$2,263.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,134.74
|
| 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 |
$3,291.50
|
| Rate for Payer: Cash Price |
$3,291.50
|
| Rate for Payer: Cigna Commercial |
$5,463.89
|
| Rate for Payer: First Health Commercial |
$6,253.85
|
| Rate for Payer: Humana Commercial |
$5,595.55
|
| Rate for Payer: Humana KY Medicaid |
$2,263.89
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,286.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,309.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,793.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,316.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.73
|
| Rate for Payer: PHCS Commercial |
$6,319.68
|
| Rate for Payer: United Healthcare All Payer |
$5,793.04
|
|
|
EMBOLECTOMY OR THROMBECTOMY (T
|
Facility
|
OP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
761T1337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.00 |
| Max. Negotiated Rate |
$7,296.00 |
| Rate for Payer: Aetna Commercial |
$5,852.00
|
| Rate for Payer: Anthem Medicaid |
$2,613.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,928.00
|
| 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 |
$3,800.00
|
| Rate for Payer: Cash Price |
$3,800.00
|
| Rate for Payer: Cigna Commercial |
$6,308.00
|
| Rate for Payer: First Health Commercial |
$7,220.00
|
| Rate for Payer: Humana Commercial |
$6,460.00
|
| Rate for Payer: Humana KY Medicaid |
$2,613.64
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,640.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,232.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,666.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,688.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.00
|
| Rate for Payer: PHCS Commercial |
$7,296.00
|
| Rate for Payer: United Healthcare All Payer |
$6,688.00
|
|
|
EMBOLIZATION S & I
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
EMBOLIZATION S & I
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
EMEND 1MG [150MG/5ML VIAL]
|
Facility
|
OP
|
$1,823.73
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
25002066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.08 |
| Max. Negotiated Rate |
$1,750.78 |
| Rate for Payer: Aetna Commercial |
$1,404.27
|
| Rate for Payer: Anthem Medicaid |
$627.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.51
|
| Rate for Payer: Cash Price |
$911.86
|
| Rate for Payer: Cigna Commercial |
$1,513.70
|
| Rate for Payer: First Health Commercial |
$1,732.54
|
| Rate for Payer: Humana Commercial |
$1,550.17
|
| Rate for Payer: Humana KY Medicaid |
$627.18
|
| Rate for Payer: Kentucky WC Medicaid |
$633.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.36
|
| Rate for Payer: PHCS Commercial |
$1,750.78
|
| Rate for Payer: United Healthcare All Payer |
$1,604.88
|
|
|
EMEND 1MG [150MG/5ML VIAL]
|
Facility
|
IP
|
$1,823.73
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
25002066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.08 |
| Max. Negotiated Rate |
$1,750.78 |
| Rate for Payer: Aetna Commercial |
$1,404.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.51
|
| Rate for Payer: Cash Price |
$911.86
|
| Rate for Payer: Cigna Commercial |
$1,513.70
|
| Rate for Payer: First Health Commercial |
$1,732.54
|
| Rate for Payer: Humana Commercial |
$1,550.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.36
|
| Rate for Payer: PHCS Commercial |
$1,750.78
|
| Rate for Payer: United Healthcare All Payer |
$1,604.88
|
|
|
EMEND 40MG CAPSULE
|
Facility
|
IP
|
$159.95
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
25002527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$153.55 |
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.76
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cigna Commercial |
$132.76
|
| Rate for Payer: First Health Commercial |
$151.95
|
| Rate for Payer: Humana Commercial |
$135.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.76
|
| Rate for Payer: Ohio Health Group HMO |
$119.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.58
|
| Rate for Payer: PHCS Commercial |
$153.55
|
| Rate for Payer: United Healthcare All Payer |
$140.76
|
|
|
EMEND 40MG CAPSULE
|
Facility
|
OP
|
$159.95
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
25002527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$153.55 |
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Anthem Medicaid |
$55.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.76
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cigna Commercial |
$132.76
|
| Rate for Payer: First Health Commercial |
$151.95
|
| Rate for Payer: Humana Commercial |
$135.96
|
| Rate for Payer: Humana KY Medicaid |
$55.01
|
| Rate for Payer: Kentucky WC Medicaid |
$55.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.76
|
| Rate for Payer: Ohio Health Group HMO |
$119.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.58
|
| Rate for Payer: PHCS Commercial |
$153.55
|
| Rate for Payer: United Healthcare All Payer |
$140.76
|
|
|
EMEND 5MG(125 PO LIQ)
|
Facility
|
IP
|
$511.83
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
25004515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$491.36 |
| Rate for Payer: Aetna Commercial |
$394.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.23
|
| Rate for Payer: Cash Price |
$255.92
|
| Rate for Payer: Cigna Commercial |
$424.82
|
| Rate for Payer: First Health Commercial |
$486.24
|
| Rate for Payer: Humana Commercial |
$435.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.41
|
| Rate for Payer: Ohio Health Group HMO |
$383.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.67
|
| Rate for Payer: PHCS Commercial |
$491.36
|
| Rate for Payer: United Healthcare All Payer |
$450.41
|
|
|
EMEND 5MG(125 PO LIQ)
|
Facility
|
OP
|
$511.83
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
25004515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$491.36 |
| Rate for Payer: Aetna Commercial |
$394.11
|
| Rate for Payer: Anthem Medicaid |
$176.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.23
|
| Rate for Payer: Cash Price |
$255.92
|
| Rate for Payer: Cigna Commercial |
$424.82
|
| Rate for Payer: First Health Commercial |
$486.24
|
| Rate for Payer: Humana Commercial |
$435.06
|
| Rate for Payer: Humana KY Medicaid |
$176.02
|
| Rate for Payer: Kentucky WC Medicaid |
$177.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.41
|
| Rate for Payer: Ohio Health Group HMO |
$383.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.67
|
| Rate for Payer: PHCS Commercial |
$491.36
|
| Rate for Payer: United Healthcare All Payer |
$450.41
|
|
|
EMG 1 EXTREMITY
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.39
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
EMG 1 EXTREMITY
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna Commercial |
$124.62
|
| Rate for Payer: Anthem Medicaid |
$59.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$269.00
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$133.14
|
| Rate for Payer: Healthspan PPO |
$109.77
|
| Rate for Payer: Humana Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.78
|
| Rate for Payer: Molina Healthcare Passport |
$59.59
|
| Rate for Payer: Multiplan PHCS |
$161.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.30
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.19
|
|
|
EMG 1 EXTREMITY
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$92.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$92.51
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$93.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.39
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
EMG 1 EXTREMITY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
922P0001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$133.14 |
| Rate for Payer: Aetna Commercial |
$124.62
|
| Rate for Payer: Anthem Medicaid |
$59.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$133.14
|
| Rate for Payer: Healthspan PPO |
$109.77
|
| Rate for Payer: Humana Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.78
|
| Rate for Payer: Molina Healthcare Passport |
$59.59
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.19
|
|
