|
ELOXATIN 0.5MG 100MGVIAL
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
25002649
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.50 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
ELOXATIN 0.5 MG (50 MG VL)
|
Facility
|
IP
|
$272.50
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
25002650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: Aetna Commercial |
$209.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Cigna Commercial |
$226.18
|
| Rate for Payer: First Health Commercial |
$258.88
|
| Rate for Payer: Humana Commercial |
$231.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.80
|
| Rate for Payer: Ohio Health Group HMO |
$204.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.03
|
| Rate for Payer: PHCS Commercial |
$261.60
|
| Rate for Payer: United Healthcare All Payer |
$239.80
|
|
|
ELOXATIN 0.5 MG (50 MG VL)
|
Facility
|
OP
|
$272.50
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
25002650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: Aetna Commercial |
$209.82
|
| Rate for Payer: Anthem Medicaid |
$93.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Cigna Commercial |
$226.18
|
| Rate for Payer: First Health Commercial |
$258.88
|
| Rate for Payer: Humana Commercial |
$231.62
|
| Rate for Payer: Humana KY Medicaid |
$93.71
|
| Rate for Payer: Kentucky WC Medicaid |
$94.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.80
|
| Rate for Payer: Ohio Health Group HMO |
$204.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.03
|
| Rate for Payer: PHCS Commercial |
$261.60
|
| Rate for Payer: United Healthcare All Payer |
$239.80
|
|
|
ELUVIA 6*100*130
|
Facility
|
IP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
ELUVIA 6*100*130
|
Facility
|
OP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem Medicaid |
$7,264.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Humana KY Medicaid |
$7,264.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,338.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,410.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
ELUVIA 6*120*130
|
Facility
|
IP
|
$22,737.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,821.25 |
| Max. Negotiated Rate |
$21,828.00 |
| Rate for Payer: Aetna Commercial |
$17,507.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,735.25
|
| Rate for Payer: Cash Price |
$11,368.75
|
| Rate for Payer: Cigna Commercial |
$18,872.12
|
| Rate for Payer: First Health Commercial |
$21,600.62
|
| Rate for Payer: Humana Commercial |
$19,326.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,644.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,780.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,821.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,009.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,053.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,688.88
|
| Rate for Payer: PHCS Commercial |
$21,828.00
|
| Rate for Payer: United Healthcare All Payer |
$20,009.00
|
|
|
ELUVIA 6*120*130
|
Facility
|
OP
|
$22,737.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,821.25 |
| Max. Negotiated Rate |
$21,828.00 |
| Rate for Payer: Aetna Commercial |
$17,507.88
|
| Rate for Payer: Anthem Medicaid |
$7,819.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,735.25
|
| Rate for Payer: Cash Price |
$11,368.75
|
| Rate for Payer: Cigna Commercial |
$18,872.12
|
| Rate for Payer: First Health Commercial |
$21,600.62
|
| Rate for Payer: Humana Commercial |
$19,326.88
|
| Rate for Payer: Humana KY Medicaid |
$7,819.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,899.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,644.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,780.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,821.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,976.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,009.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,053.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,688.88
|
| Rate for Payer: PHCS Commercial |
$21,828.00
|
| Rate for Payer: United Healthcare All Payer |
$20,009.00
|
|
|
ELUVIA 6*4*130
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELUVIA 6*4*130
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELUVIA 6*60*130
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
ELUVIA 6*60*130
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem Medicaid |
$7,393.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Humana KY Medicaid |
$7,393.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,542.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
ELUVIA 6*80*130
|
Facility
|
OP
|
$22,737.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,821.25 |
| Max. Negotiated Rate |
$21,828.00 |
| Rate for Payer: Aetna Commercial |
$17,507.88
|
| Rate for Payer: Anthem Medicaid |
$7,819.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,735.25
|
| Rate for Payer: Cash Price |
$11,368.75
|
| Rate for Payer: Cigna Commercial |
$18,872.12
|
| Rate for Payer: First Health Commercial |
$21,600.62
|
| Rate for Payer: Humana Commercial |
$19,326.88
|
| Rate for Payer: Humana KY Medicaid |
$7,819.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,899.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,644.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,780.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,821.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,976.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,009.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,053.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,688.88
|
| Rate for Payer: PHCS Commercial |
$21,828.00
|
| Rate for Payer: United Healthcare All Payer |
$20,009.00
|
|
|
ELUVIA 6*80*130
|
Facility
|
IP
|
$22,737.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,821.25 |
| Max. Negotiated Rate |
$21,828.00 |
| Rate for Payer: Aetna Commercial |
$17,507.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,735.25
|
| Rate for Payer: Cash Price |
$11,368.75
|
| Rate for Payer: Cigna Commercial |
$18,872.12
|
| Rate for Payer: First Health Commercial |
$21,600.62
|
| Rate for Payer: Humana Commercial |
$19,326.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,644.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,780.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,821.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,009.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,053.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,688.88
|
| Rate for Payer: PHCS Commercial |
$21,828.00
|
| Rate for Payer: United Healthcare All Payer |
$20,009.00
|
|
|
ELUVIA 7*60*130
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELUVIA 7*60*130
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELUVIA 7*80*130
|
Facility
|
IP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
ELUVIA 7*80*130
|
Facility
|
OP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem Medicaid |
$7,264.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Humana KY Medicaid |
$7,264.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,338.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,410.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
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 |
$1,646.32 |
| Rate for Payer: Aetna Commercial |
$1,646.32
|
| Rate for Payer: Ambetter Exchange |
$861.81
|
| Rate for Payer: Anthem Medicaid |
$645.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$861.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$861.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,034.17
|
| 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 |
$1,618.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$861.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$861.81
|
| 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 |
$1,120.35
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$651.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$861.81
|
|
|
EMBLCTMY/THROMBECTOMY CAROTID
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 34001
|
| Hospital Charge Code |
76101336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| 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 |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| 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 |
$562.50 |
| 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 |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| 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 |
$1,646.32 |
| Rate for Payer: Aetna Commercial |
$1,646.32
|
| Rate for Payer: Ambetter Exchange |
$861.81
|
| Rate for Payer: Anthem Medicaid |
$645.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$861.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$861.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,034.17
|
| 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 |
$1,618.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$861.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$861.81
|
| 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 |
$1,120.35
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$651.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$861.81
|
|
|
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 |
$5,509.80 |
| Rate for Payer: Aetna Commercial |
$1,054.72
|
| Rate for Payer: Ambetter Exchange |
$558.57
|
| Rate for Payer: Anthem Medicaid |
$452.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$558.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$558.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$670.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$558.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.57
|
| 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 |
$726.14
|
| Rate for Payer: UHCCP Medicaid |
$3,214.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$558.57
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$12,577.48
|
|
|
Service Code
|
HCPCS 34203
|
| Hospital Charge Code |
76101341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,325.40 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,810.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$10,061.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,942.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,678.46
|
| Rate for Payer: PHCS Commercial |
$12,074.38
|
| Rate for Payer: United Healthcare All Payer |
$11,068.18
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 34151
|
| Hospital Charge Code |
76101339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
EMBOLECTOMY OR THROMBECTOMY -
|
Facility
|
OP
|
$9,100.00
|
|
|
Service Code
|
HCPCS 34101
|
| Hospital Charge Code |
76101337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,129.49 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$7,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,917.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,279.00
|
| Rate for Payer: PHCS Commercial |
$8,736.00
|
| Rate for Payer: United Healthcare All Payer |
$8,008.00
|
|
