|
THRMBNDRTRCTMY W/PATCHGRFT MES
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
HCPCS 35341
|
| Hospital Charge Code |
76101385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.90 |
| Max. Negotiated Rate |
$3,004.80 |
| Rate for Payer: Aetna Commercial |
$2,410.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.40
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,597.90
|
| Rate for Payer: First Health Commercial |
$2,973.50
|
| Rate for Payer: Humana Commercial |
$2,660.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$970.30
|
| Rate for Payer: PHCS Commercial |
$3,004.80
|
| Rate for Payer: United Healthcare All Payer |
$2,754.40
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT MES
|
Professional
|
Both
|
$3,130.00
|
|
|
Service Code
|
HCPCS 35341
|
| Hospital Charge Code |
76101385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,095.50 |
| Max. Negotiated Rate |
$3,130.00 |
| Rate for Payer: Aetna Commercial |
$2,456.81
|
| Rate for Payer: Anthem Medicaid |
$1,246.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,130.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,355.16
|
| Rate for Payer: Healthspan PPO |
$2,415.53
|
| Rate for Payer: Humana Medicaid |
$1,246.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,881.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,271.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,246.23
|
| Rate for Payer: Multiplan PHCS |
$1,878.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,191.00
|
| Rate for Payer: UHCCP Medicaid |
$1,095.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,258.69
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT MES
|
Professional
|
Both
|
$3,130.00
|
|
|
Service Code
|
HCPCS 35341
|
| Hospital Charge Code |
761P1385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,095.50 |
| Max. Negotiated Rate |
$3,130.00 |
| Rate for Payer: Aetna Commercial |
$2,456.81
|
| Rate for Payer: Anthem Medicaid |
$1,246.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,130.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,355.16
|
| Rate for Payer: Healthspan PPO |
$2,415.53
|
| Rate for Payer: Humana Medicaid |
$1,246.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,881.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,271.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,246.23
|
| Rate for Payer: Multiplan PHCS |
$1,878.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,191.00
|
| Rate for Payer: UHCCP Medicaid |
$1,095.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,258.69
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT MES
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
HCPCS 35341
|
| Hospital Charge Code |
76101385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.90 |
| Max. Negotiated Rate |
$3,004.80 |
| Rate for Payer: Aetna Commercial |
$2,410.10
|
| Rate for Payer: Anthem Medicaid |
$1,076.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.40
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,597.90
|
| Rate for Payer: First Health Commercial |
$2,973.50
|
| Rate for Payer: Humana Commercial |
$2,660.50
|
| Rate for Payer: Humana KY Medicaid |
$1,076.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$970.30
|
| Rate for Payer: PHCS Commercial |
$3,004.80
|
| Rate for Payer: United Healthcare All Payer |
$2,754.40
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT POP
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35303
|
| Hospital Charge Code |
761P1381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$955.83 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,174.46
|
| Rate for Payer: Anthem Medicaid |
$955.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,020.81
|
| Rate for Payer: Healthspan PPO |
$2,137.92
|
| Rate for Payer: Humana Medicaid |
$955.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,693.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.95
|
| Rate for Payer: Molina Healthcare Passport |
$955.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.39
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT POP
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35303
|
| Hospital Charge Code |
76101381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT POP
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35303
|
| Hospital Charge Code |
76101381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$955.83 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,174.46
|
| Rate for Payer: Anthem Medicaid |
$955.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,020.81
|
| Rate for Payer: Healthspan PPO |
$2,137.92
|
| Rate for Payer: Humana Medicaid |
$955.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,693.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.95
|
| Rate for Payer: Molina Healthcare Passport |
$955.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.39
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT POP
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35303
|
| Hospital Charge Code |
76101381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT TIB
|
Professional
|
Both
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35321
|
| Hospital Charge Code |
761P1384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$738.10 |
| Max. Negotiated Rate |
$2,740.00 |
| Rate for Payer: Aetna Commercial |
$1,573.01
|
| Rate for Payer: Anthem Medicaid |
$738.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,740.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$1,512.95
|
| Rate for Payer: Healthspan PPO |
$1,546.58
|
| Rate for Payer: Humana Medicaid |
$738.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,219.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$752.86
|
| Rate for Payer: Molina Healthcare Passport |
$738.10
|
| Rate for Payer: Multiplan PHCS |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,918.00
|
| Rate for Payer: UHCCP Medicaid |
$959.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$745.48
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT TIB
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35321
|
| Hospital Charge Code |
76101384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.20 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$2,109.80
|
| Rate for Payer: Anthem Medicaid |
$942.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,137.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,274.20
|
| Rate for Payer: First Health Commercial |
$2,603.00
|
| Rate for Payer: Humana Commercial |
$2,329.00
|
| Rate for Payer: Humana KY Medicaid |
$942.29
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$951.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,246.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,022.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$961.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,411.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$849.40
|
| Rate for Payer: PHCS Commercial |
$2,630.40
|
| Rate for Payer: United Healthcare All Payer |
$2,411.20
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT TIB
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35321
|
| Hospital Charge Code |
76101384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.20 |
| Max. Negotiated Rate |
$2,630.40 |
| Rate for Payer: Aetna Commercial |
$2,109.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,137.20
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,274.20
|
| Rate for Payer: First Health Commercial |
$2,603.00
|
| Rate for Payer: Humana Commercial |
$2,329.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,246.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,022.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,411.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$849.40
|
| Rate for Payer: PHCS Commercial |
$2,630.40
|
| Rate for Payer: United Healthcare All Payer |
$2,411.20
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT TIB
|
Professional
|
Both
|
$2,740.00
|
|
|
Service Code
|
HCPCS 35321
|
| Hospital Charge Code |
76101384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$738.10 |
| Max. Negotiated Rate |
$2,740.00 |
| Rate for Payer: Aetna Commercial |
$1,573.01
|
| Rate for Payer: Anthem Medicaid |
$738.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,740.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$1,512.95
|
| Rate for Payer: Healthspan PPO |
$1,546.58
|
| Rate for Payer: Humana Medicaid |
$738.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,219.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$752.86
|
| Rate for Payer: Molina Healthcare Passport |
$738.10
|
| Rate for Payer: Multiplan PHCS |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,918.00
|
| Rate for Payer: UHCCP Medicaid |
$959.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$745.48
|
|
|
THROMBATE III 1 UN(-500 UNITS)
|
Facility
|
IP
|
$14,206.30
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
25002479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,846.82 |
| Max. Negotiated Rate |
$13,638.05 |
| Rate for Payer: Aetna Commercial |
$10,938.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,080.91
|
| Rate for Payer: Cash Price |
$7,103.15
|
| Rate for Payer: Cigna Commercial |
$11,791.23
|
| Rate for Payer: First Health Commercial |
$13,495.98
|
| Rate for Payer: Humana Commercial |
$12,075.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,649.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,484.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,261.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,501.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,654.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,403.95
|
| Rate for Payer: PHCS Commercial |
$13,638.05
|
| Rate for Payer: United Healthcare All Payer |
$12,501.54
|
|
|
THROMBATE III 1 UN(-500 UNITS)
|
Facility
|
OP
|
$14,206.30
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
25002479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$13,638.05 |
| Rate for Payer: Aetna Commercial |
$10,938.85
|
| Rate for Payer: Anthem Medicaid |
$4,885.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,080.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.23
|
| Rate for Payer: Cash Price |
$7,103.15
|
| Rate for Payer: Cash Price |
$7,103.15
|
| Rate for Payer: Cigna Commercial |
$11,791.23
|
| Rate for Payer: First Health Commercial |
$13,495.98
|
| Rate for Payer: Humana Commercial |
$12,075.36
|
| Rate for Payer: Humana KY Medicaid |
$4,885.55
|
| Rate for Payer: Humana Medicare Advantage |
$3.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,935.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,649.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,484.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,983.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,501.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,654.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,403.95
|
| Rate for Payer: PHCS Commercial |
$13,638.05
|
| Rate for Payer: United Healthcare All Payer |
$12,501.54
|
|
|
THROMB DEV REVISIONS SURGEONS
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
76102565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$71.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$71.19
|
| Rate for Payer: Kentucky WC Medicaid |
$71.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
THROMB DEV REVISIONS SURGEONS
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
76102565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
THROMBECTOMY - DIRECT OR CATH
|
Facility
|
OP
|
$5,669.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
76101342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.97 |
| Max. Negotiated Rate |
$5,442.24 |
| Rate for Payer: Aetna Commercial |
$4,365.13
|
| Rate for Payer: Anthem Medicaid |
$1,949.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,421.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,834.50
|
| Rate for Payer: Cash Price |
$2,834.50
|
| Rate for Payer: Cigna Commercial |
$4,705.27
|
| Rate for Payer: First Health Commercial |
$5,385.55
|
| Rate for Payer: Humana Commercial |
$4,818.65
|
| Rate for Payer: Humana KY Medicaid |
$1,949.57
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,969.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,648.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,183.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,988.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,988.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,251.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,757.39
|
| Rate for Payer: PHCS Commercial |
$5,442.24
|
| Rate for Payer: United Healthcare All Payer |
$4,988.72
|
|
|
THROMBECTOMY - DIRECT OR CATH
|
Facility
|
IP
|
$5,669.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
76101342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.97 |
| Max. Negotiated Rate |
$5,442.24 |
| Rate for Payer: Aetna Commercial |
$4,365.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,421.82
|
| Rate for Payer: Cash Price |
$2,834.50
|
| Rate for Payer: Cigna Commercial |
$4,705.27
|
| Rate for Payer: First Health Commercial |
$5,385.55
|
| Rate for Payer: Humana Commercial |
$4,818.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,648.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,183.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,988.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,251.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,757.39
|
| Rate for Payer: PHCS Commercial |
$5,442.24
|
| Rate for Payer: United Healthcare All Payer |
$4,988.72
|
|
|
THROMBECTOMY - DIRECT OR CATH
|
Professional
|
Both
|
$5,669.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
76101342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$5,669.00 |
| Rate for Payer: Aetna Commercial |
$1,273.33
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,669.00
|
| Rate for Payer: Cash Price |
$2,834.50
|
| Rate for Payer: Cash Price |
$2,834.50
|
| Rate for Payer: Cigna Commercial |
$1,223.19
|
| Rate for Payer: Healthspan PPO |
$1,251.93
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$3,401.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,968.30
|
| Rate for Payer: UHCCP Medicaid |
$1,984.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
|
|
THROMBECTOMY - DIRECT OR CAT(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
761P1342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,273.33
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,223.19
|
| Rate for Payer: Healthspan PPO |
$1,251.93
|
| Rate for Payer: Humana Medicaid |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.33
|
| Rate for Payer: Molina Healthcare Passport |
$497.38
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
|
|
THROMBECTOMY - DIRECT OR CAT(T
|
Facility
|
IP
|
$3,969.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
761T1342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.97 |
| Max. Negotiated Rate |
$3,810.24 |
| Rate for Payer: Aetna Commercial |
$3,056.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.82
|
| Rate for Payer: Cash Price |
$1,984.50
|
| Rate for Payer: Cigna Commercial |
$3,294.27
|
| Rate for Payer: First Health Commercial |
$3,770.55
|
| Rate for Payer: Humana Commercial |
$3,373.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,929.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.39
|
| Rate for Payer: PHCS Commercial |
$3,810.24
|
| Rate for Payer: United Healthcare All Payer |
$3,492.72
|
|
|
THROMBECTOMY - DIRECT OR CAT(T
|
Facility
|
OP
|
$3,969.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
761T1342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.97 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$3,056.13
|
| Rate for Payer: Anthem Medicaid |
$1,364.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,984.50
|
| Rate for Payer: Cash Price |
$1,984.50
|
| Rate for Payer: Cigna Commercial |
$3,294.27
|
| Rate for Payer: First Health Commercial |
$3,770.55
|
| Rate for Payer: Humana Commercial |
$3,373.65
|
| Rate for Payer: Humana KY Medicaid |
$1,364.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,929.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.39
|
| Rate for Payer: PHCS Commercial |
$3,810.24
|
| Rate for Payer: United Healthcare All Payer |
$3,492.72
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
IP
|
$7,860.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
76101344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$7,546.20 |
| Rate for Payer: Aetna Commercial |
$6,052.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.28
|
| Rate for Payer: Cash Price |
$3,930.31
|
| Rate for Payer: Cigna Commercial |
$6,524.31
|
| Rate for Payer: First Health Commercial |
$7,467.59
|
| Rate for Payer: Humana Commercial |
$6,681.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,801.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,358.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.79
|
| Rate for Payer: PHCS Commercial |
$7,546.20
|
| Rate for Payer: United Healthcare All Payer |
$6,917.35
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
HCPCS 34451
|
| Hospital Charge Code |
76101343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.39 |
| Max. Negotiated Rate |
$2,210.88 |
| Rate for Payer: Aetna Commercial |
$1,773.31
|
| Rate for Payer: Anthem Medicaid |
$792.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,796.34
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$1,911.49
|
| Rate for Payer: First Health Commercial |
$2,187.85
|
| Rate for Payer: Humana Commercial |
$1,957.55
|
| Rate for Payer: Humana KY Medicaid |
$792.00
|
| Rate for Payer: Kentucky WC Medicaid |
$800.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,888.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,699.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$807.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,026.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,727.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.93
|
| Rate for Payer: PHCS Commercial |
$2,210.88
|
| Rate for Payer: United Healthcare All Payer |
$2,026.64
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
OP
|
$7,860.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
76101344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$7,546.20 |
| Rate for Payer: Aetna Commercial |
$6,052.68
|
| Rate for Payer: Anthem Medicaid |
$2,703.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,930.31
|
| Rate for Payer: Cash Price |
$3,930.31
|
| Rate for Payer: Cigna Commercial |
$6,524.31
|
| Rate for Payer: First Health Commercial |
$7,467.59
|
| Rate for Payer: Humana Commercial |
$6,681.53
|
| Rate for Payer: Humana KY Medicaid |
$2,703.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,445.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,801.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,757.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,917.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,895.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.79
|
| Rate for Payer: PHCS Commercial |
$7,546.20
|
| Rate for Payer: United Healthcare All Payer |
$6,917.35
|
|
