|
ENDOVENOUS ABLATION(T
|
Facility
|
OP
|
$3,657.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761T1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.48 |
| Max. Negotiated Rate |
$3,511.22 |
| Rate for Payer: Aetna Commercial |
$2,816.29
|
| Rate for Payer: Anthem Medicaid |
$1,257.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,852.87
|
| Rate for Payer: Cash Price |
$1,828.76
|
| Rate for Payer: Cigna Commercial |
$3,035.74
|
| Rate for Payer: First Health Commercial |
$3,474.64
|
| Rate for Payer: Humana Commercial |
$3,108.89
|
| Rate for Payer: Humana KY Medicaid |
$1,257.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,218.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.83
|
| Rate for Payer: PHCS Commercial |
$3,511.22
|
| Rate for Payer: United Healthcare All Payer |
$3,218.62
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
ENDOVENOUS LASER - 1ST VEIN
|
Facility
|
OP
|
$8,581.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
76101466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,115.57 |
| Max. Negotiated Rate |
$8,238.05 |
| Rate for Payer: Aetna Commercial |
$6,607.60
|
| Rate for Payer: Anthem Medicaid |
$2,951.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,693.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,290.65
|
| Rate for Payer: Cash Price |
$4,290.65
|
| Rate for Payer: Cigna Commercial |
$7,122.48
|
| Rate for Payer: First Health Commercial |
$8,152.24
|
| Rate for Payer: Humana Commercial |
$7,294.10
|
| Rate for Payer: Humana KY Medicaid |
$2,951.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,981.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,036.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,333.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,010.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,551.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.20
|
| Rate for Payer: PHCS Commercial |
$8,238.05
|
| Rate for Payer: United Healthcare All Payer |
$7,551.54
|
|
|
ENDOVENOUS LASER - 1ST VEIN
|
Facility
|
IP
|
$8,581.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
76101466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,115.57 |
| Max. Negotiated Rate |
$8,238.05 |
| Rate for Payer: Aetna Commercial |
$6,607.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,693.41
|
| Rate for Payer: Cash Price |
$4,290.65
|
| Rate for Payer: Cigna Commercial |
$7,122.48
|
| Rate for Payer: First Health Commercial |
$8,152.24
|
| Rate for Payer: Humana Commercial |
$7,294.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,036.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,333.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,574.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,551.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,435.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.20
|
| Rate for Payer: PHCS Commercial |
$8,238.05
|
| Rate for Payer: United Healthcare All Payer |
$7,551.54
|
|
|
ENDOVENOUS LASER - 1ST VEIN
|
Professional
|
Both
|
$8,581.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
76101466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.71 |
| Max. Negotiated Rate |
$8,581.30 |
| Rate for Payer: Aetna Commercial |
$536.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$280.66
|
| Rate for Payer: Anthem Medicaid |
$271.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,581.30
|
| Rate for Payer: Cash Price |
$4,290.65
|
| Rate for Payer: Cash Price |
$4,290.65
|
| Rate for Payer: Cigna Commercial |
$2,740.45
|
| Rate for Payer: Healthspan PPO |
$1,689.60
|
| Rate for Payer: Humana Medicaid |
$271.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.14
|
| Rate for Payer: Molina Healthcare Passport |
$271.71
|
| Rate for Payer: Multiplan PHCS |
$5,148.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,006.91
|
| Rate for Payer: UHCCP Medicaid |
$294.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.43
|
|
|
ENDOVENOUS LASER - 1ST VEIN(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
761P1466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.71 |
| Max. Negotiated Rate |
$2,740.45 |
| Rate for Payer: Aetna Commercial |
$536.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$280.66
|
| Rate for Payer: Anthem Medicaid |
$271.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$2,740.45
|
| Rate for Payer: Healthspan PPO |
$1,689.60
|
| Rate for Payer: Humana Medicaid |
$271.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.14
|
| Rate for Payer: Molina Healthcare Passport |
$271.71
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$294.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.43
|
|
|
ENDOVENOUS LASER - 1ST VEIN(T
|
Facility
|
IP
|
$6,281.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
761T1466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.57 |
| Max. Negotiated Rate |
$6,030.05 |
| Rate for Payer: Aetna Commercial |
$4,836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,899.41
|
| Rate for Payer: Cash Price |
$3,140.65
|
| Rate for Payer: Cigna Commercial |
$5,213.48
|
| Rate for Payer: First Health Commercial |
$5,967.24
|
| Rate for Payer: Humana Commercial |
$5,339.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,150.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,635.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,884.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,527.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,710.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$816.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,947.20
|
| Rate for Payer: PHCS Commercial |
$6,030.05
|
| Rate for Payer: United Healthcare All Payer |
$5,527.54
|
|
|
ENDOVENOUS LASER - 1ST VEIN(T
|
Facility
|
OP
|
$6,281.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
761T1466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.57 |
| Max. Negotiated Rate |
$6,030.05 |
| Rate for Payer: Aetna Commercial |
$4,836.60
|
| Rate for Payer: Anthem Medicaid |
$2,160.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,899.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,140.65
|
| Rate for Payer: Cash Price |
$3,140.65
|
| Rate for Payer: Cigna Commercial |
$5,213.48
|
| Rate for Payer: First Health Commercial |
$5,967.24
|
| Rate for Payer: Humana Commercial |
$5,339.10
|
| Rate for Payer: Humana KY Medicaid |
$2,160.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,182.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,150.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,635.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,203.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,527.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,710.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$816.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,947.20
|
| Rate for Payer: PHCS Commercial |
$6,030.05
|
| Rate for Payer: United Healthcare All Payer |
$5,527.54
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
OP
|
$6,864.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
76101463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.34 |
| Max. Negotiated Rate |
$6,589.58 |
| Rate for Payer: Aetna Commercial |
$5,285.40
|
| Rate for Payer: Anthem Medicaid |
$2,360.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,354.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,432.07
|
| Rate for Payer: Cash Price |
$3,432.07
|
| Rate for Payer: Cigna Commercial |
$5,697.24
|
| Rate for Payer: First Health Commercial |
$6,520.94
|
| Rate for Payer: Humana Commercial |
$5,834.53
|
| Rate for Payer: Humana KY Medicaid |
$2,360.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,384.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,628.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,065.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,407.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,040.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,148.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.89
|
| Rate for Payer: PHCS Commercial |
$6,589.58
|
| Rate for Payer: United Healthcare All Payer |
$6,040.45
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Professional
|
Both
|
$6,864.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
76101463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.59 |
| Max. Negotiated Rate |
$6,864.15 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$141.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,864.15
|
| Rate for Payer: Cash Price |
$3,432.07
|
| Rate for Payer: Cash Price |
$3,432.07
|
| Rate for Payer: Cigna Commercial |
$2,347.27
|
| Rate for Payer: Humana Medicaid |
$141.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.78
|
| Rate for Payer: Molina Healthcare Passport |
$141.94
|
| Rate for Payer: Multiplan PHCS |
$4,118.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,804.90
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.36
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
IP
|
$6,864.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
76101463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.34 |
| Max. Negotiated Rate |
$6,589.58 |
| Rate for Payer: Aetna Commercial |
$5,285.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,354.04
|
| Rate for Payer: Cash Price |
$3,432.07
|
| Rate for Payer: Cigna Commercial |
$5,697.24
|
| Rate for Payer: First Health Commercial |
$6,520.94
|
| Rate for Payer: Humana Commercial |
$5,834.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,628.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,065.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,059.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,040.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,148.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.89
|
| Rate for Payer: PHCS Commercial |
$6,589.58
|
| Rate for Payer: United Healthcare All Payer |
$6,040.45
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEI(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
761P1463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.59 |
| Max. Negotiated Rate |
$2,347.27 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$141.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$2,347.27
|
| Rate for Payer: Humana Medicaid |
$141.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.78
|
| Rate for Payer: Molina Healthcare Passport |
$141.94
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.36
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEI(T
|
Facility
|
IP
|
$6,389.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
761T1463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$830.59 |
| Max. Negotiated Rate |
$6,133.58 |
| Rate for Payer: Aetna Commercial |
$4,919.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,983.54
|
| Rate for Payer: Cash Price |
$3,194.57
|
| Rate for Payer: Cigna Commercial |
$5,302.99
|
| Rate for Payer: First Health Commercial |
$6,069.69
|
| Rate for Payer: Humana Commercial |
$5,430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,239.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,715.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,916.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,622.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,791.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,980.64
|
| Rate for Payer: PHCS Commercial |
$6,133.58
|
| Rate for Payer: United Healthcare All Payer |
$5,622.45
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEI(T
|
Facility
|
OP
|
$6,389.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
761T1463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$830.59 |
| Max. Negotiated Rate |
$6,133.58 |
| Rate for Payer: Aetna Commercial |
$4,919.65
|
| Rate for Payer: Anthem Medicaid |
$2,197.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,983.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,194.57
|
| Rate for Payer: Cash Price |
$3,194.57
|
| Rate for Payer: Cigna Commercial |
$5,302.99
|
| Rate for Payer: First Health Commercial |
$6,069.69
|
| Rate for Payer: Humana Commercial |
$5,430.78
|
| Rate for Payer: Humana KY Medicaid |
$2,197.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,219.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,239.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,715.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,241.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,622.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,791.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,980.64
|
| Rate for Payer: PHCS Commercial |
$6,133.58
|
| Rate for Payer: United Healthcare All Payer |
$5,622.45
|
|
|
ENDRNT AAA AORTC EXT 23*23*49
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
ENDRNT AAA AORTC EXT 23*23*49
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
ENDRNT AAA AORTC EXT 23*23*70
|
Facility
|
IP
|
$32,083.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.89 |
| Max. Negotiated Rate |
$30,800.40 |
| Rate for Payer: Aetna Commercial |
$24,704.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
| Rate for Payer: Cash Price |
$16,041.88
|
| Rate for Payer: Cigna Commercial |
$26,629.51
|
| Rate for Payer: First Health Commercial |
$30,479.56
|
| Rate for Payer: Humana Commercial |
$27,271.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
| Rate for Payer: PHCS Commercial |
$30,800.40
|
| Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
|
ENDRNT AAA AORTC EXT 23*23*70
|
Facility
|
OP
|
$32,083.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.89 |
| Max. Negotiated Rate |
$30,800.40 |
| Rate for Payer: Aetna Commercial |
$24,704.49
|
| Rate for Payer: Anthem Medicaid |
$11,033.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
| Rate for Payer: Cash Price |
$16,041.88
|
| Rate for Payer: Cigna Commercial |
$26,629.51
|
| Rate for Payer: First Health Commercial |
$30,479.56
|
| Rate for Payer: Humana Commercial |
$27,271.19
|
| Rate for Payer: Humana KY Medicaid |
$11,033.60
|
| Rate for Payer: Kentucky WC Medicaid |
$11,145.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,254.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
| Rate for Payer: PHCS Commercial |
$30,800.40
|
| Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
|
ENDRNT AAA AORTC EXT 25*25*49
|
Facility
|
OP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem Medicaid |
$6,891.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Humana KY Medicaid |
$6,891.33
|
| Rate for Payer: Kentucky WC Medicaid |
$6,961.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,029.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
ENDRNT AAA AORTC EXT 25*25*49
|
Facility
|
IP
|
$20,038.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,605.04 |
| Max. Negotiated Rate |
$19,237.20 |
| Rate for Payer: Aetna Commercial |
$15,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,630.22
|
| Rate for Payer: Cash Price |
$10,019.38
|
| Rate for Payer: Cigna Commercial |
$16,632.16
|
| Rate for Payer: First Health Commercial |
$19,036.81
|
| Rate for Payer: Humana Commercial |
$17,032.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,431.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,788.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,011.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,634.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,029.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,007.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.01
|
| Rate for Payer: PHCS Commercial |
$19,237.20
|
| Rate for Payer: United Healthcare All Payer |
$17,634.10
|
|
|
ENDRNT AAA AORTC EXT 25*25*70
|
Facility
|
IP
|
$32,083.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.89 |
| Max. Negotiated Rate |
$30,800.40 |
| Rate for Payer: Aetna Commercial |
$24,704.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
| Rate for Payer: Cash Price |
$16,041.88
|
| Rate for Payer: Cigna Commercial |
$26,629.51
|
| Rate for Payer: First Health Commercial |
$30,479.56
|
| Rate for Payer: Humana Commercial |
$27,271.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
| Rate for Payer: PHCS Commercial |
$30,800.40
|
| Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
|
ENDRNT AAA AORTC EXT 25*25*70
|
Facility
|
OP
|
$32,083.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.89 |
| Max. Negotiated Rate |
$30,800.40 |
| Rate for Payer: Aetna Commercial |
$24,704.49
|
| Rate for Payer: Anthem Medicaid |
$11,033.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
| Rate for Payer: Cash Price |
$16,041.88
|
| Rate for Payer: Cigna Commercial |
$26,629.51
|
| Rate for Payer: First Health Commercial |
$30,479.56
|
| Rate for Payer: Humana Commercial |
$27,271.19
|
| Rate for Payer: Humana KY Medicaid |
$11,033.60
|
| Rate for Payer: Kentucky WC Medicaid |
$11,145.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,254.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
| Rate for Payer: PHCS Commercial |
$30,800.40
|
| Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
|
ENDRNT AAA AORTC EXT 28*28*49
|
Facility
|
OP
|
$20,403.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.49 |
| Max. Negotiated Rate |
$19,587.60 |
| Rate for Payer: Aetna Commercial |
$15,710.89
|
| Rate for Payer: Anthem Medicaid |
$7,016.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,914.92
|
| Rate for Payer: Cash Price |
$10,201.88
|
| Rate for Payer: Cigna Commercial |
$16,935.11
|
| Rate for Payer: First Health Commercial |
$19,383.56
|
| Rate for Payer: Humana Commercial |
$17,343.19
|
| Rate for Payer: Humana KY Medicaid |
$7,016.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,088.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,731.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,057.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,121.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,955.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.16
|
| Rate for Payer: PHCS Commercial |
$19,587.60
|
| Rate for Payer: United Healthcare All Payer |
$17,955.30
|
|
|
ENDRNT AAA AORTC EXT 28*28*49
|
Facility
|
IP
|
$20,403.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.49 |
| Max. Negotiated Rate |
$19,587.60 |
| Rate for Payer: Aetna Commercial |
$15,710.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,914.92
|
| Rate for Payer: Cash Price |
$10,201.88
|
| Rate for Payer: Cigna Commercial |
$16,935.11
|
| Rate for Payer: First Health Commercial |
$19,383.56
|
| Rate for Payer: Humana Commercial |
$17,343.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,731.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,057.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,121.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,955.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.16
|
| Rate for Payer: PHCS Commercial |
$19,587.60
|
| Rate for Payer: United Healthcare All Payer |
$17,955.30
|
|
|
ENDRNT AAA AORTC EXT 28*28*70
|
Facility
|
OP
|
$32,448.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.34 |
| Max. Negotiated Rate |
$31,150.80 |
| Rate for Payer: Aetna Commercial |
$24,985.54
|
| Rate for Payer: Anthem Medicaid |
$11,159.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,310.02
|
| Rate for Payer: Cash Price |
$16,224.38
|
| Rate for Payer: Cigna Commercial |
$26,932.46
|
| Rate for Payer: First Health Commercial |
$30,826.31
|
| Rate for Payer: Humana Commercial |
$27,581.44
|
| Rate for Payer: Humana KY Medicaid |
$11,159.13
|
| Rate for Payer: Kentucky WC Medicaid |
$11,272.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,607.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,947.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,734.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,383.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,554.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,489.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,059.11
|
| Rate for Payer: PHCS Commercial |
$31,150.80
|
| Rate for Payer: United Healthcare All Payer |
$28,554.90
|
|
