|
INTRAPROCEDURAL CORONARY FFR(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761P2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
|
|
INTRAPROCEDURAL CORONARY FFR(T
|
Facility
|
IP
|
$6,030.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761T2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.90 |
| Max. Negotiated Rate |
$5,788.80 |
| Rate for Payer: Aetna Commercial |
$4,643.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,703.40
|
| Rate for Payer: Cash Price |
$3,015.00
|
| Rate for Payer: Cigna Commercial |
$5,004.90
|
| Rate for Payer: First Health Commercial |
$5,728.50
|
| Rate for Payer: Humana Commercial |
$5,125.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,944.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,306.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.30
|
| Rate for Payer: PHCS Commercial |
$5,788.80
|
| Rate for Payer: United Healthcare All Payer |
$5,306.40
|
|
|
INTRAPROCEDURAL CORONARY FFR(T
|
Facility
|
OP
|
$6,030.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761T2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.90 |
| Max. Negotiated Rate |
$5,788.80 |
| Rate for Payer: Aetna Commercial |
$4,643.10
|
| Rate for Payer: Anthem Medicaid |
$2,073.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,703.40
|
| Rate for Payer: Cash Price |
$3,015.00
|
| Rate for Payer: Cigna Commercial |
$5,004.90
|
| Rate for Payer: First Health Commercial |
$5,728.50
|
| Rate for Payer: Humana Commercial |
$5,125.50
|
| Rate for Payer: Humana KY Medicaid |
$2,073.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,094.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,944.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,115.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,306.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.30
|
| Rate for Payer: PHCS Commercial |
$5,788.80
|
| Rate for Payer: United Healthcare All Payer |
$5,306.40
|
|
|
INTRASPINAL TRIAL KIT 8516
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
INTRASPINAL TRIAL KIT 8516
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
INTRAVA DOP VELOCITY ADTL VE(P
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761P2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$267.83 |
| Rate for Payer: Aetna Commercial |
$267.83
|
| Rate for Payer: Anthem Medicaid |
$182.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$241.00
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$247.78
|
| Rate for Payer: Healthspan PPO |
$253.42
|
| Rate for Payer: Humana Medicaid |
$182.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.83
|
| Rate for Payer: Molina Healthcare Passport |
$182.19
|
| Rate for Payer: Multiplan PHCS |
$144.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.70
|
| Rate for Payer: UHCCP Medicaid |
$84.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.01
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem Medicaid |
$299.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Humana KY Medicaid |
$299.54
|
| Rate for Payer: Kentucky WC Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.01
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem Medicaid |
$216.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Humana KY Medicaid |
$216.66
|
| Rate for Payer: Kentucky WC Medicaid |
$218.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$871.00 |
| Rate for Payer: Aetna Commercial |
$267.83
|
| Rate for Payer: Anthem Medicaid |
$182.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$871.00
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$247.78
|
| Rate for Payer: Healthspan PPO |
$253.42
|
| Rate for Payer: Humana Medicaid |
$182.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.83
|
| Rate for Payer: Molina Healthcare Passport |
$182.19
|
| Rate for Payer: Multiplan PHCS |
$522.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.70
|
| Rate for Payer: UHCCP Medicaid |
$304.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.01
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.01
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
INTRAVA DOP VELOCITY ADTL VE(T
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761T2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem Medicaid |
$216.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Humana KY Medicaid |
$216.66
|
| Rate for Payer: Kentucky WC Medicaid |
$218.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVA DOP VELOCITY ADTL VE(T
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761T2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
OP
|
$2,283.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
48100060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$296.79 |
| Max. Negotiated Rate |
$2,191.68 |
| Rate for Payer: Aetna Commercial |
$1,757.91
|
| Rate for Payer: Anthem Medicaid |
$785.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,780.74
|
| Rate for Payer: Cash Price |
$1,141.50
|
| Rate for Payer: Cigna Commercial |
$1,894.89
|
| Rate for Payer: First Health Commercial |
$2,168.85
|
| Rate for Payer: Humana Commercial |
$1,940.55
|
| Rate for Payer: Humana KY Medicaid |
$785.12
|
| Rate for Payer: Kentucky WC Medicaid |
$793.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,872.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,684.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$800.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,009.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.73
|
| Rate for Payer: PHCS Commercial |
$2,191.68
|
| Rate for Payer: United Healthcare All Payer |
$2,009.04
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
IP
|
$2,283.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
48100060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$296.79 |
| Max. Negotiated Rate |
$2,191.68 |
| Rate for Payer: Aetna Commercial |
$1,757.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,780.74
|
| Rate for Payer: Cash Price |
$1,141.50
|
| Rate for Payer: Cigna Commercial |
$1,894.89
|
| Rate for Payer: First Health Commercial |
$2,168.85
|
| Rate for Payer: Humana Commercial |
$1,940.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,872.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,684.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,009.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,712.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.73
|
| Rate for Payer: PHCS Commercial |
$2,191.68
|
| Rate for Payer: United Healthcare All Payer |
$2,009.04
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
OP
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.72 |
| Max. Negotiated Rate |
$2,914.88 |
| Rate for Payer: Aetna Commercial |
$2,337.97
|
| Rate for Payer: Anthem Medicaid |
$1,044.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.34
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$2,520.15
|
| Rate for Payer: First Health Commercial |
$2,884.51
|
| Rate for Payer: Humana Commercial |
$2,580.88
|
| Rate for Payer: Humana KY Medicaid |
$1,044.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$607.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.26
|
| Rate for Payer: PHCS Commercial |
$2,914.88
|
| Rate for Payer: United Healthcare All Payer |
$2,671.97
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
IP
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.72 |
| Max. Negotiated Rate |
$2,914.88 |
| Rate for Payer: Aetna Commercial |
$2,337.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.34
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$2,520.15
|
| Rate for Payer: First Health Commercial |
$2,884.51
|
| Rate for Payer: Humana Commercial |
$2,580.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$607.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.26
|
| Rate for Payer: PHCS Commercial |
$2,914.88
|
| Rate for Payer: United Healthcare All Payer |
$2,671.97
|
|
|
INTRAVASC EA ADDL VESSEL
|
Professional
|
Both
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$3,036.33 |
| Rate for Payer: Aetna Commercial |
$282.45
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,036.33
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$262.77
|
| Rate for Payer: Healthspan PPO |
$256.10
|
| Rate for Payer: Humana Medicaid |
$124.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.96
|
| Rate for Payer: Molina Healthcare Passport |
$124.47
|
| Rate for Payer: Multiplan PHCS |
$1,821.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,125.43
|
| Rate for Payer: UHCCP Medicaid |
$1,062.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.71
|
|
|
INTRAVASC EA ADDL VESSEL(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761P2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$282.45 |
| Rate for Payer: Aetna Commercial |
$282.45
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$262.77
|
| Rate for Payer: Healthspan PPO |
$256.10
|
| Rate for Payer: Humana Medicaid |
$124.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.96
|
| Rate for Payer: Molina Healthcare Passport |
$124.47
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.71
|
|
|
INTRAVASC EA ADDL VESSEL(T
|
Facility
|
IP
|
$2,886.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761T2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.22 |
| Max. Negotiated Rate |
$2,770.88 |
| Rate for Payer: Aetna Commercial |
$2,222.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,251.34
|
| Rate for Payer: Cash Price |
$1,443.16
|
| Rate for Payer: Cigna Commercial |
$2,395.65
|
| Rate for Payer: First Health Commercial |
$2,742.01
|
| Rate for Payer: Humana Commercial |
$2,453.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,366.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,130.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,539.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,164.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$577.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$894.76
|
| Rate for Payer: PHCS Commercial |
$2,770.88
|
| Rate for Payer: United Healthcare All Payer |
$2,539.97
|
|
|
INTRAVASC EA ADDL VESSEL(T
|
Facility
|
OP
|
$2,886.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761T2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.22 |
| Max. Negotiated Rate |
$2,770.88 |
| Rate for Payer: Aetna Commercial |
$2,222.47
|
| Rate for Payer: Anthem Medicaid |
$992.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,251.34
|
| Rate for Payer: Cash Price |
$1,443.16
|
| Rate for Payer: Cigna Commercial |
$2,395.65
|
| Rate for Payer: First Health Commercial |
$2,742.01
|
| Rate for Payer: Humana Commercial |
$2,453.38
|
| Rate for Payer: Humana KY Medicaid |
$992.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,002.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,366.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,130.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,012.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,539.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,164.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$577.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$894.76
|
| Rate for Payer: PHCS Commercial |
$2,770.88
|
| Rate for Payer: United Healthcare All Payer |
$2,539.97
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$4,514.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
48100059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$4,333.44 |
| Rate for Payer: Aetna Commercial |
$3,475.78
|
| Rate for Payer: Anthem Medicaid |
$1,552.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.92
|
| Rate for Payer: Cash Price |
$2,257.00
|
| Rate for Payer: Cigna Commercial |
$3,746.62
|
| Rate for Payer: First Health Commercial |
$4,288.30
|
| Rate for Payer: Humana Commercial |
$3,836.90
|
| Rate for Payer: Humana KY Medicaid |
$1,552.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,568.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,331.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,972.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.34
|
| Rate for Payer: PHCS Commercial |
$4,333.44
|
| Rate for Payer: United Healthcare All Payer |
$3,972.32
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$4,882.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761T2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.66 |
| Max. Negotiated Rate |
$4,686.72 |
| Rate for Payer: Aetna Commercial |
$3,759.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.96
|
| Rate for Payer: Cash Price |
$2,441.00
|
| Rate for Payer: Cigna Commercial |
$4,052.06
|
| Rate for Payer: First Health Commercial |
$4,637.90
|
| Rate for Payer: Humana Commercial |
$4,149.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.42
|
| Rate for Payer: PHCS Commercial |
$4,686.72
|
| Rate for Payer: United Healthcare All Payer |
$4,296.16
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$5,132.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.16 |
| Max. Negotiated Rate |
$4,926.72 |
| Rate for Payer: Aetna Commercial |
$3,951.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,002.96
|
| Rate for Payer: Cash Price |
$2,566.00
|
| Rate for Payer: Cigna Commercial |
$4,259.56
|
| Rate for Payer: First Health Commercial |
$4,875.40
|
| Rate for Payer: Humana Commercial |
$4,362.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,208.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,787.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,516.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,590.92
|
| Rate for Payer: PHCS Commercial |
$4,926.72
|
| Rate for Payer: United Healthcare All Payer |
$4,516.16
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$4,514.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
48100059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$4,333.44 |
| Rate for Payer: Aetna Commercial |
$3,475.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.92
|
| Rate for Payer: Cash Price |
$2,257.00
|
| Rate for Payer: Cigna Commercial |
$3,746.62
|
| Rate for Payer: First Health Commercial |
$4,288.30
|
| Rate for Payer: Humana Commercial |
$3,836.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,331.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,972.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.34
|
| Rate for Payer: PHCS Commercial |
$4,333.44
|
| Rate for Payer: United Healthcare All Payer |
$3,972.32
|
|
