|
PTA VENOUS
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Facility
|
OP
|
$6,307.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
76101571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$6,054.72 |
| Rate for Payer: Aetna Commercial |
$4,856.39
|
| Rate for Payer: Anthem Medicaid |
$2,168.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,919.46
|
| Rate for Payer: Cash Price |
$3,153.50
|
| Rate for Payer: Cigna Commercial |
$5,234.81
|
| Rate for Payer: First Health Commercial |
$5,991.65
|
| Rate for Payer: Humana Commercial |
$5,360.95
|
| Rate for Payer: Humana KY Medicaid |
$2,168.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,191.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,171.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,654.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,212.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,550.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,730.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,955.17
|
| Rate for Payer: PHCS Commercial |
$6,054.72
|
| Rate for Payer: United Healthcare All Payer |
$5,550.16
|
|
|
PTA VENOUS(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761P1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.57
|
| Rate for Payer: Anthem Medicaid |
$122.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$275.28
|
| Rate for Payer: Humana Medicaid |
$122.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.13
|
| Rate for Payer: Molina Healthcare Passport |
$122.68
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$128.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.91
|
|
|
PTA VENOUS(T
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761T1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS(T
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761T1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
OP
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,721.20 |
| Max. Negotiated Rate |
$12,710.40 |
| Rate for Payer: Aetna Commercial |
$10,194.80
|
| Rate for Payer: Anthem Medicaid |
$4,553.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,327.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$10,989.20
|
| Rate for Payer: First Health Commercial |
$12,578.00
|
| Rate for Payer: Humana Commercial |
$11,254.00
|
| Rate for Payer: Humana KY Medicaid |
$4,553.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,599.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,856.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,771.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,644.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,651.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,104.40
|
| Rate for Payer: PHCS Commercial |
$12,710.40
|
| Rate for Payer: United Healthcare All Payer |
$11,651.20
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Professional
|
Both
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.78
|
| Rate for Payer: Anthem Medicaid |
$249.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$13,240.00
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$561.10
|
| Rate for Payer: Humana Medicaid |
$249.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.99
|
| Rate for Payer: Molina Healthcare Passport |
$249.99
|
| Rate for Payer: Multiplan PHCS |
$7,944.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,268.00
|
| Rate for Payer: UHCCP Medicaid |
$262.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.49
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
IP
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,721.20 |
| Max. Negotiated Rate |
$12,710.40 |
| Rate for Payer: Aetna Commercial |
$10,194.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,327.20
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$10,989.20
|
| Rate for Payer: First Health Commercial |
$12,578.00
|
| Rate for Payer: Humana Commercial |
$11,254.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,856.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,771.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,972.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,651.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,104.40
|
| Rate for Payer: PHCS Commercial |
$12,710.40
|
| Rate for Payer: United Healthcare All Payer |
$11,651.20
|
|
|
PTCA ARTERIAL PERIPHERAL(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761P1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.78
|
| Rate for Payer: Anthem Medicaid |
$249.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$561.10
|
| Rate for Payer: Humana Medicaid |
$249.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.99
|
| Rate for Payer: Molina Healthcare Passport |
$249.99
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$262.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.49
|
|
|
PTCA ARTERIAL PERIPHERAL(T
|
Facility
|
IP
|
$10,740.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761T1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,396.20 |
| Max. Negotiated Rate |
$10,310.40 |
| Rate for Payer: Aetna Commercial |
$8,269.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,377.20
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cigna Commercial |
$8,914.20
|
| Rate for Payer: First Health Commercial |
$10,203.00
|
| Rate for Payer: Humana Commercial |
$9,129.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,926.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,222.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,451.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.40
|
| Rate for Payer: PHCS Commercial |
$10,310.40
|
| Rate for Payer: United Healthcare All Payer |
$9,451.20
|
|
|
PTCA ARTERIAL PERIPHERAL(T
|
Facility
|
OP
|
$10,740.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761T1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,396.20 |
| Max. Negotiated Rate |
$10,310.40 |
| Rate for Payer: Aetna Commercial |
$8,269.80
|
| Rate for Payer: Anthem Medicaid |
$3,693.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,377.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cigna Commercial |
$8,914.20
|
| Rate for Payer: First Health Commercial |
$10,203.00
|
| Rate for Payer: Humana Commercial |
$9,129.00
|
| Rate for Payer: Humana KY Medicaid |
$3,693.49
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,731.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,926.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,767.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,451.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.40
|
| Rate for Payer: PHCS Commercial |
$10,310.40
|
| Rate for Payer: United Healthcare All Payer |
$9,451.20
|
|
|
PTCA GW EXTENSION WIRE 165CM
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
PTCA GW EXTENSION WIRE 165CM
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
PT/CAREGIVER TRAING HOME INR
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93792
|
| Hospital Charge Code |
51000180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$73.31
|
| Rate for Payer: Humana Medicaid |
$39.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.71
|
| Rate for Payer: Molina Healthcare Passport |
$39.91
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.31
|
|
|
PT COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
PT COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
PT EVAL HIGH
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 97163
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
PT EVAL HIGH
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 97163
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
PT EVAL LOW
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 97161
|
| Hospital Charge Code |
42000025
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem Medicaid |
$106.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.58
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$258.13
|
| Rate for Payer: First Health Commercial |
$295.45
|
| Rate for Payer: Humana Commercial |
$264.35
|
| Rate for Payer: Humana KY Medicaid |
$106.95
|
| Rate for Payer: Kentucky WC Medicaid |
$108.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$273.68
|
| Rate for Payer: Ohio Health Group HMO |
$233.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.41
|
| Rate for Payer: PHCS Commercial |
$298.56
|
| Rate for Payer: United Healthcare All Payer |
$273.68
|
|
|
PT EVAL LOW
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 97161
|
| Hospital Charge Code |
42000025
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$242.58
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$258.13
|
| Rate for Payer: First Health Commercial |
$295.45
|
| Rate for Payer: Humana Commercial |
$264.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$229.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$273.68
|
| Rate for Payer: Ohio Health Group HMO |
$233.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.41
|
| Rate for Payer: PHCS Commercial |
$298.56
|
| Rate for Payer: United Healthcare All Payer |
$273.68
|
|
|
PT EVAL MOD
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 97162
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.60
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.20
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
PT EVAL MOD
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 97162
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem Medicaid |
$110.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.60
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| Rate for Payer: Humana KY Medicaid |
$110.05
|
| Rate for Payer: Kentucky WC Medicaid |
$111.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.20
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
PT-FOCUSED HLTH RISK ASSMT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
51000344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$6.23
|
| Rate for Payer: Humana Medicaid |
$3.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.45
|
| Rate for Payer: Molina Healthcare Passport |
$3.38
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
|
