|
ARTANE(TRIHEXYPHENIDY 2MG/1TAB
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 70954021210
|
| Hospital Charge Code |
25000256
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
ARTANE(TRIHEXYPHENIDY 2MG/1TAB
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 70954021210
|
| Hospital Charge Code |
25000256
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
ARTANE(TRIHEXYPHENIDY 5MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 591533701
|
| Hospital Charge Code |
25000257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ARTANE(TRIHEXYPHENIDY 5MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 591533701
|
| Hospital Charge Code |
25000257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ART BYP AOR-CELIAC-MSN-RENAL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35631
|
| Hospital Charge Code |
76101409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$3,304.29 |
| Rate for Payer: Aetna Commercial |
$3,304.29
|
| Rate for Payer: Ambetter Exchange |
$1,732.69
|
| Rate for Payer: Anthem Medicaid |
$1,245.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,732.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,732.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,079.23
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$3,164.09
|
| Rate for Payer: Healthspan PPO |
$3,248.77
|
| Rate for Payer: Humana Medicaid |
$1,245.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,549.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,732.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,732.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,270.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,245.65
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,252.50
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,258.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,732.69
|
|
|
ART BYP AOR-CELIAC-MSN-RENAL
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35631
|
| Hospital Charge Code |
76101409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
ART BYP AOR-CELIAC-MSN-RENAL
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35631
|
| Hospital Charge Code |
76101409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
ART BYP AOR-CELIAC-MSN-RENA(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35631
|
| Hospital Charge Code |
761P1409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$3,304.29 |
| Rate for Payer: Aetna Commercial |
$3,304.29
|
| Rate for Payer: Ambetter Exchange |
$1,732.69
|
| Rate for Payer: Anthem Medicaid |
$1,245.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,732.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,732.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,079.23
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$3,164.09
|
| Rate for Payer: Healthspan PPO |
$3,248.77
|
| Rate for Payer: Humana Medicaid |
$1,245.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,549.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,732.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,732.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,270.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,245.65
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,252.50
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,258.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,732.69
|
|
|
ART BYP AORTOBI-ILIAC
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 35638
|
| Hospital Charge Code |
76102953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
ART BYP AORTOBI-ILIAC
|
Professional
|
Both
|
$4,115.00
|
|
|
Service Code
|
HCPCS 35638
|
| Hospital Charge Code |
76102953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,359.03 |
| Max. Negotiated Rate |
$3,094.66 |
| Rate for Payer: Aetna Commercial |
$3,094.66
|
| Rate for Payer: Ambetter Exchange |
$1,637.81
|
| Rate for Payer: Anthem Medicaid |
$1,359.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,637.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,637.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,965.37
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$2,872.98
|
| Rate for Payer: Healthspan PPO |
$3,042.66
|
| Rate for Payer: Humana Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,411.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,637.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,637.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,386.21
|
| Rate for Payer: Molina Healthcare Passport |
$1,359.03
|
| Rate for Payer: Multiplan PHCS |
$2,469.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,129.15
|
| Rate for Payer: UHCCP Medicaid |
$1,440.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,372.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,637.81
|
|
|
ART BYP AORTOBI-ILIAC
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 35638
|
| Hospital Charge Code |
76102953
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
ART BYP AORTOFEMORAL
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35647
|
| Hospital Charge Code |
76101411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ART BYP AORTOFEMORAL
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35647
|
| Hospital Charge Code |
76101411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,763.57 |
| Rate for Payer: Aetna Commercial |
$2,763.57
|
| Rate for Payer: Ambetter Exchange |
$1,439.99
|
| Rate for Payer: Anthem Medicaid |
$1,189.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,439.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,439.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,727.99
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$2,630.86
|
| Rate for Payer: Healthspan PPO |
$2,717.13
|
| Rate for Payer: Humana Medicaid |
$1,189.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,146.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,439.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,213.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,189.26
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,871.99
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,201.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,439.99
|
|
|
ART BYP AORTOFEMORAL
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35647
|
| Hospital Charge Code |
76101411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ART BYP AORTOFEMORAL(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 35647
|
| Hospital Charge Code |
761P1411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,763.57 |
| Rate for Payer: Aetna Commercial |
$2,763.57
|
| Rate for Payer: Ambetter Exchange |
$1,439.99
|
| Rate for Payer: Anthem Medicaid |
$1,189.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,439.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,439.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,727.99
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$2,630.86
|
| Rate for Payer: Healthspan PPO |
$2,717.13
|
| Rate for Payer: Humana Medicaid |
$1,189.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,146.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,439.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,213.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,189.26
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,871.99
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,201.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,439.99
|
|
|
ART BYP AORTOILIAC
|
Professional
|
Both
|
$3,900.00
|
|
|
Service Code
|
HCPCS 35637
|
| Hospital Charge Code |
76103022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,337.61 |
| Max. Negotiated Rate |
$3,029.94 |
| Rate for Payer: Aetna Commercial |
$3,029.94
|
| Rate for Payer: Ambetter Exchange |
$1,561.46
|
| Rate for Payer: Anthem Medicaid |
$1,337.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,561.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,561.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,873.75
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$2,828.23
|
| Rate for Payer: Healthspan PPO |
$2,979.03
|
| Rate for Payer: Humana Medicaid |
$1,337.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,359.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,561.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,364.36
|
| Rate for Payer: Molina Healthcare Passport |
$1,337.61
|
| Rate for Payer: Multiplan PHCS |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,029.90
|
| Rate for Payer: UHCCP Medicaid |
$1,365.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,350.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,561.46
|
|
|
ART BYP AXILL-FEM-FEMORAL
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 35654
|
| Hospital Charge Code |
76102645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$2,439.66 |
| Rate for Payer: Aetna Commercial |
$2,439.66
|
| Rate for Payer: Ambetter Exchange |
$1,281.29
|
| Rate for Payer: Anthem Medicaid |
$1,217.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,281.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,281.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,537.55
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cigna Commercial |
$2,334.68
|
| Rate for Payer: Healthspan PPO |
$2,398.67
|
| Rate for Payer: Humana Medicaid |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,892.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,281.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,241.54
|
| Rate for Payer: Molina Healthcare Passport |
$1,217.20
|
| Rate for Payer: Multiplan PHCS |
$978.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,665.68
|
| Rate for Payer: UHCCP Medicaid |
$570.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,229.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,281.29
|
|
|
ART BYP CAROTID-SUBCLAVIAN
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 35606
|
| Hospital Charge Code |
76101407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ART BYP CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 35606
|
| Hospital Charge Code |
76101407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,065.46 |
| Rate for Payer: Aetna Commercial |
$2,065.46
|
| Rate for Payer: Ambetter Exchange |
$1,101.23
|
| Rate for Payer: Anthem Medicaid |
$1,066.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,101.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,101.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,321.48
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,976.52
|
| Rate for Payer: Healthspan PPO |
$2,030.75
|
| Rate for Payer: Humana Medicaid |
$1,066.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,621.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,101.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,087.92
|
| Rate for Payer: Molina Healthcare Passport |
$1,066.59
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,431.60
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,101.23
|
|
|
ART BYP CAROTID-SUBCLAVIAN
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 35606
|
| Hospital Charge Code |
76101407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ART BYP CAROTID-SUBCLAVIAN(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 35606
|
| Hospital Charge Code |
761P1407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,065.46 |
| Rate for Payer: Aetna Commercial |
$2,065.46
|
| Rate for Payer: Ambetter Exchange |
$1,101.23
|
| Rate for Payer: Anthem Medicaid |
$1,066.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,101.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,101.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,321.48
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,976.52
|
| Rate for Payer: Healthspan PPO |
$2,030.75
|
| Rate for Payer: Humana Medicaid |
$1,066.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,621.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,101.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,087.92
|
| Rate for Payer: Molina Healthcare Passport |
$1,066.59
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,431.60
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,101.23
|
|
|
ART BYP GRFT AORCEL/AORMESEN
|
Facility
|
IP
|
$5,025.00
|
|
|
Service Code
|
HCPCS 35531
|
| Hospital Charge Code |
76101395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,507.50 |
| Max. Negotiated Rate |
$4,824.00 |
| Rate for Payer: Aetna Commercial |
$3,869.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.50
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$4,170.75
|
| Rate for Payer: First Health Commercial |
$4,773.75
|
| Rate for Payer: Humana Commercial |
$4,271.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,422.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.25
|
| Rate for Payer: PHCS Commercial |
$4,824.00
|
| Rate for Payer: United Healthcare All Payer |
$4,422.00
|
|
|
ART BYP GRFT AORCEL/AORMESEN
|
Facility
|
OP
|
$5,025.00
|
|
|
Service Code
|
HCPCS 35531
|
| Hospital Charge Code |
76101395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,507.50 |
| Max. Negotiated Rate |
$4,824.00 |
| Rate for Payer: Aetna Commercial |
$3,869.25
|
| Rate for Payer: Anthem Medicaid |
$1,728.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,919.50
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$4,170.75
|
| Rate for Payer: First Health Commercial |
$4,773.75
|
| Rate for Payer: Humana Commercial |
$4,271.25
|
| Rate for Payer: Humana KY Medicaid |
$1,728.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,120.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,708.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,422.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,371.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.25
|
| Rate for Payer: PHCS Commercial |
$4,824.00
|
| Rate for Payer: United Healthcare All Payer |
$4,422.00
|
|
|
ART BYP GRFT AORCEL/AORMESEN
|
Professional
|
Both
|
$5,025.00
|
|
|
Service Code
|
HCPCS 35531
|
| Hospital Charge Code |
76101395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,347.14 |
| Max. Negotiated Rate |
$3,583.21 |
| Rate for Payer: Aetna Commercial |
$3,583.21
|
| Rate for Payer: Ambetter Exchange |
$1,835.30
|
| Rate for Payer: Anthem Medicaid |
$1,347.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,835.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,835.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,202.36
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$3,397.96
|
| Rate for Payer: Healthspan PPO |
$3,522.99
|
| Rate for Payer: Humana Medicaid |
$1,347.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,777.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,835.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,835.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,374.08
|
| Rate for Payer: Molina Healthcare Passport |
$1,347.14
|
| Rate for Payer: Multiplan PHCS |
$3,015.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,385.89
|
| Rate for Payer: UHCCP Medicaid |
$1,758.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,360.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,835.30
|
|
|
ART BYP GRFT AORCEL/AORMESE(P
|
Professional
|
Both
|
$5,025.00
|
|
|
Service Code
|
HCPCS 35531
|
| Hospital Charge Code |
761P1395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,347.14 |
| Max. Negotiated Rate |
$3,583.21 |
| Rate for Payer: Aetna Commercial |
$3,583.21
|
| Rate for Payer: Ambetter Exchange |
$1,835.30
|
| Rate for Payer: Anthem Medicaid |
$1,347.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,835.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,835.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,202.36
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$3,397.96
|
| Rate for Payer: Healthspan PPO |
$3,522.99
|
| Rate for Payer: Humana Medicaid |
$1,347.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,777.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,835.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,835.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,374.08
|
| Rate for Payer: Molina Healthcare Passport |
$1,347.14
|
| Rate for Payer: Multiplan PHCS |
$3,015.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,385.89
|
| Rate for Payer: UHCCP Medicaid |
$1,758.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,360.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,835.30
|
|
