|
ENDOVENOUS ABLATION
|
Facility
|
IP
|
$4,307.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
76101465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.26 |
| Max. Negotiated Rate |
$4,135.22 |
| Rate for Payer: Aetna Commercial |
$3,316.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,359.87
|
| Rate for Payer: Cash Price |
$2,153.76
|
| Rate for Payer: Cigna Commercial |
$3,575.24
|
| Rate for Payer: First Health Commercial |
$4,092.14
|
| Rate for Payer: Humana Commercial |
$3,661.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,532.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,178.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,790.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,230.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,446.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,747.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.19
|
| Rate for Payer: PHCS Commercial |
$4,135.22
|
| Rate for Payer: United Healthcare All Payer |
$3,790.62
|
|
|
ENDOVENOUS ABLATION(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761P1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$597.19 |
| Rate for Payer: Aetna Commercial |
$260.41
|
| Rate for Payer: Ambetter Exchange |
$125.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.27
|
| Rate for Payer: Anthem Medicaid |
$306.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.88
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$597.19
|
| Rate for Payer: Healthspan PPO |
$447.44
|
| Rate for Payer: Humana Medicaid |
$306.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.13
|
| Rate for Payer: Molina Healthcare Passport |
$306.01
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.45
|
| Rate for Payer: UHCCP Medicaid |
$132.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.73
|
|
|
ENDOVENOUS ABLATION(T
|
Facility
|
OP
|
$3,657.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761T1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,097.26 |
| 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 |
$2,926.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,523.69
|
| Rate for Payer: PHCS Commercial |
$3,511.22
|
| Rate for Payer: United Healthcare All Payer |
$3,218.62
|
|
|
ENDOVENOUS ABLATION(T
|
Facility
|
IP
|
$3,657.52
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
761T1465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,097.26 |
| Max. Negotiated Rate |
$3,511.22 |
| Rate for Payer: Aetna Commercial |
$2,816.29
|
| 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: 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: 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 |
$2,926.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,523.69
|
| 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
|
$4,071.52
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
ENDOVENOUS LASER - 1ST VEIN
|
Facility
|
OP
|
$8,581.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
76101466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.23 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,693.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$8,152.23
|
| Rate for Payer: Humana Commercial |
$7,294.10
|
| Rate for Payer: Humana KY Medicaid |
$2,951.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$6,865.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,465.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,921.10
|
| 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 |
$260.53 |
| Max. Negotiated Rate |
$5,148.78 |
| Rate for Payer: Aetna Commercial |
$536.87
|
| Rate for Payer: Ambetter Exchange |
$260.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$280.66
|
| Rate for Payer: Anthem Medicaid |
$1,103.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$260.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.64
|
| 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 |
$1,103.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$260.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,125.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,103.62
|
| Rate for Payer: Multiplan PHCS |
$5,148.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.69
|
| Rate for Payer: UHCCP Medicaid |
$294.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,114.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.53
|
|
|
ENDOVENOUS LASER - 1ST VEIN
|
Facility
|
IP
|
$8,581.30
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
76101466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,574.39 |
| 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 |
$8,152.23
|
| 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 |
$6,865.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,465.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,921.10
|
| Rate for Payer: PHCS Commercial |
$8,238.05
|
| Rate for Payer: United Healthcare All Payer |
$7,551.54
|
|
|
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 |
$260.53 |
| Max. Negotiated Rate |
$2,740.45 |
| Rate for Payer: Aetna Commercial |
$536.87
|
| Rate for Payer: Ambetter Exchange |
$260.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$280.66
|
| Rate for Payer: Anthem Medicaid |
$1,103.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$260.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.64
|
| 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 |
$1,103.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$260.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,125.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,103.62
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.69
|
| Rate for Payer: UHCCP Medicaid |
$294.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,114.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.53
|
|
|
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 |
$1,884.39 |
| 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 |
$5,967.23
|
| 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 |
$5,025.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,464.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,334.10
|
| 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 |
$2,160.14 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,899.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$5,967.23
|
| Rate for Payer: Humana Commercial |
$5,339.10
|
| Rate for Payer: Humana KY Medicaid |
$2,160.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$5,025.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,464.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,334.10
|
| Rate for Payer: PHCS Commercial |
$6,030.05
|
| Rate for Payer: United Healthcare All Payer |
$5,527.54
|
|
|
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 |
$4,118.49 |
| Rate for Payer: Ambetter Exchange |
$169.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$1,114.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$169.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$169.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$203.58
|
| 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 |
$1,114.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,136.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,114.27
|
| Rate for Payer: Multiplan PHCS |
$4,118.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.54
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,125.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$169.65
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
IP
|
$6,864.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
76101463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,059.24 |
| 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 |
$5,491.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,971.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,736.26
|
| Rate for Payer: PHCS Commercial |
$6,589.58
|
| Rate for Payer: United Healthcare All Payer |
$6,040.45
|
|
|
ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
OP
|
$6,864.15
|
|
|
Service Code
|
HCPCS 36473
|
| Hospital Charge Code |
76101463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,360.58 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,354.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$5,491.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,971.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,736.26
|
| 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: Ambetter Exchange |
$169.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$1,114.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$169.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$169.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$203.58
|
| 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 |
$1,114.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$225.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,136.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,114.27
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.54
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,125.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$169.65
|
|
|
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 |
$1,916.74 |
| 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 |
$5,111.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,558.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,408.51
|
| 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 |
$2,197.23 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,983.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$5,111.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,558.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,408.51
|
| 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
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
ENDRNT AAA AORTC EXT 23*23*49
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
ENDRNT AAA AORTC EXT 23*23*70
|
Facility
|
IP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
|
ENDRNT AAA AORTC EXT 23*23*70
|
Facility
|
OP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem Medicaid |
$11,359.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Humana KY Medicaid |
$11,359.45
|
| Rate for Payer: Kentucky WC Medicaid |
$11,475.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,587.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
|
ENDRNT AAA AORTC EXT 25*25*49
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
ENDRNT AAA AORTC EXT 25*25*49
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
ENDRNT AAA AORTC EXT 25*25*70
|
Facility
|
OP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem Medicaid |
$11,359.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Humana KY Medicaid |
$11,359.45
|
| Rate for Payer: Kentucky WC Medicaid |
$11,475.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,587.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
|
ENDRNT AAA AORTC EXT 25*25*70
|
Facility
|
IP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
