|
THROMBLYTIC ART/VEN THERAPY(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
761P1538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.48 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Anthem Medicaid |
$202.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$467.31
|
| Rate for Payer: Healthspan PPO |
$239.00
|
| Rate for Payer: Humana Medicaid |
$202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.53
|
| Rate for Payer: Molina Healthcare Passport |
$202.48
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.50
|
|
|
THROMBLYTIC ART/VEN THERAPY(T
|
Facility
|
OP
|
$5,742.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
761T1538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.46 |
| Max. Negotiated Rate |
$5,512.32 |
| Rate for Payer: Aetna Commercial |
$4,421.34
|
| Rate for Payer: Anthem Medicaid |
$1,974.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,478.76
|
| 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 |
$2,871.00
|
| Rate for Payer: Cash Price |
$2,871.00
|
| Rate for Payer: Cigna Commercial |
$4,765.86
|
| Rate for Payer: First Health Commercial |
$5,454.90
|
| Rate for Payer: Humana Commercial |
$4,880.70
|
| Rate for Payer: Humana KY Medicaid |
$1,974.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,708.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,237.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,014.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,052.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,780.02
|
| Rate for Payer: PHCS Commercial |
$5,512.32
|
| Rate for Payer: United Healthcare All Payer |
$5,052.96
|
|
|
THROMBLYTIC ART/VEN THERAPY(T
|
Facility
|
IP
|
$5,742.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
761T1538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.46 |
| Max. Negotiated Rate |
$5,512.32 |
| Rate for Payer: Aetna Commercial |
$4,421.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,478.76
|
| Rate for Payer: Cash Price |
$2,871.00
|
| Rate for Payer: Cigna Commercial |
$4,765.86
|
| Rate for Payer: First Health Commercial |
$5,454.90
|
| Rate for Payer: Humana Commercial |
$4,880.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,708.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,237.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,052.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,780.02
|
| Rate for Payer: PHCS Commercial |
$5,512.32
|
| Rate for Payer: United Healthcare All Payer |
$5,052.96
|
|
|
THROMBOENDARTERECTOMY
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
76101380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.90 |
| Max. Negotiated Rate |
$1,976.22 |
| Rate for Payer: Aetna Commercial |
$1,976.22
|
| Rate for Payer: Anthem Medicaid |
$869.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,714.00
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,839.18
|
| Rate for Payer: Healthspan PPO |
$1,943.02
|
| Rate for Payer: Humana Medicaid |
$869.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,535.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.60
|
| Rate for Payer: Molina Healthcare Passport |
$869.22
|
| Rate for Payer: Multiplan PHCS |
$1,028.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,199.80
|
| Rate for Payer: UHCCP Medicaid |
$599.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.91
|
|
|
THROMBOENDARTERECTOMY
|
Facility
|
IP
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
76101380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$1,645.44 |
| Rate for Payer: Aetna Commercial |
$1,319.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.92
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,422.62
|
| Rate for Payer: First Health Commercial |
$1,628.30
|
| Rate for Payer: Humana Commercial |
$1,456.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,508.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.34
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
THROMBOENDARTERECTOMY
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
76101380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$1,645.44 |
| Rate for Payer: Aetna Commercial |
$1,319.78
|
| Rate for Payer: Anthem Medicaid |
$589.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.92
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,422.62
|
| Rate for Payer: First Health Commercial |
$1,628.30
|
| Rate for Payer: Humana Commercial |
$1,456.90
|
| Rate for Payer: Humana KY Medicaid |
$589.44
|
| Rate for Payer: Kentucky WC Medicaid |
$595.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,508.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.34
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
THROMBOENDARTERECTOMY(P
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
761P1380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.90 |
| Max. Negotiated Rate |
$1,976.22 |
| Rate for Payer: Aetna Commercial |
$1,976.22
|
| Rate for Payer: Anthem Medicaid |
$869.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,714.00
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,839.18
|
| Rate for Payer: Healthspan PPO |
$1,943.02
|
| Rate for Payer: Humana Medicaid |
$869.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,535.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.60
|
| Rate for Payer: Molina Healthcare Passport |
$869.22
|
| Rate for Payer: Multiplan PHCS |
$1,028.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,199.80
|
| Rate for Payer: UHCCP Medicaid |
$599.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.91
|
|
|
THROMBOENDARTERECTOMY TIBI
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
76101382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
THROMBOENDARTERECTOMY TIBI
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
76101382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
THROMBOENDARTERECTOMY TIBI
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
76101382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,262.23 |
| Rate for Payer: Aetna Commercial |
$2,262.23
|
| Rate for Payer: Anthem Medicaid |
$994.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$2,102.80
|
| Rate for Payer: Healthspan PPO |
$2,224.21
|
| Rate for Payer: Humana Medicaid |
$994.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,754.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.67
|
| Rate for Payer: Molina Healthcare Passport |
$994.77
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.72
|
|
|
THROMBOENDARTERECTOMY TIBI(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
761P1382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,262.23 |
| Rate for Payer: Aetna Commercial |
$2,262.23
|
| Rate for Payer: Anthem Medicaid |
$994.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$2,102.80
|
| Rate for Payer: Healthspan PPO |
$2,224.21
|
| Rate for Payer: Humana Medicaid |
$994.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,754.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.67
|
| Rate for Payer: Molina Healthcare Passport |
$994.77
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.72
|
|
|
THROMBOENDARTERECTOMY - WITH
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
76101386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,278.46
|
| Rate for Payer: Anthem Medicaid |
$1,035.08
|
| 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 |
$2,172.24
|
| Rate for Payer: Healthspan PPO |
$2,240.18
|
| Rate for Payer: Humana Medicaid |
$1,035.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,763.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,055.78
|
| Rate for Payer: Molina Healthcare Passport |
$1,035.08
|
| 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 |
$1,045.43
|
|
|
THROMBOENDARTERECTOMY - WITH
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
76101386
|
|
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
|
|
|
THROMBOENDARTERECTOMY - WITH
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
76101386
|
|
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
|
|
|
THROMBOENDARTERECTOMY - WITH(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
761P1386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,278.46
|
| Rate for Payer: Anthem Medicaid |
$1,035.08
|
| 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 |
$2,172.24
|
| Rate for Payer: Healthspan PPO |
$2,240.18
|
| Rate for Payer: Humana Medicaid |
$1,035.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,763.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,055.78
|
| Rate for Payer: Molina Healthcare Passport |
$1,035.08
|
| 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 |
$1,045.43
|
|
|
THROMBOLYSIS CEREBRAL IVINFU(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
761P1533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$473.51
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$417.90
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$211.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$446.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.73
|
| Rate for Payer: Molina Healthcare Passport |
$211.50
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.62
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
45000240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem Medicaid |
$158.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Humana KY Medicaid |
$158.88
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$160.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
76101533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$473.51
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$417.90
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$211.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$446.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.73
|
| Rate for Payer: Molina Healthcare Passport |
$211.50
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.62
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
45000240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
76101533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
76101533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
THROMBOLYSIS/SEL CORON ANGIO
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 92975
|
| Hospital Charge Code |
48000066
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$162.63 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem Medicaid |
$430.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Humana KY Medicaid |
$430.22
|
| Rate for Payer: Kentucky WC Medicaid |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.81
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
THROMBOLYSIS/SEL CORON ANGIO
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 92975
|
| Hospital Charge Code |
48000066
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$162.63 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.81
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
THROMBOLYTIC ART THERAPY
|
Facility
|
OP
|
$7,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
76101536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.86 |
| Max. Negotiated Rate |
$7,523.91 |
| Rate for Payer: Aetna Commercial |
$6,034.81
|
| Rate for Payer: Anthem Medicaid |
$2,695.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,113.18
|
| 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 |
$3,918.70
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cigna Commercial |
$6,505.05
|
| Rate for Payer: First Health Commercial |
$7,445.54
|
| Rate for Payer: Humana Commercial |
$6,661.80
|
| Rate for Payer: Humana KY Medicaid |
$2,695.29
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,722.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,784.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,749.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,878.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.60
|
| Rate for Payer: PHCS Commercial |
$7,523.91
|
| Rate for Payer: United Healthcare All Payer |
$6,896.92
|
|
|
THROMBOLYTIC ART THERAPY
|
Facility
|
IP
|
$7,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
76101536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.86 |
| Max. Negotiated Rate |
$7,523.91 |
| Rate for Payer: Aetna Commercial |
$6,034.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,113.18
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cigna Commercial |
$6,505.05
|
| Rate for Payer: First Health Commercial |
$7,445.54
|
| Rate for Payer: Humana Commercial |
$6,661.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,426.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,784.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,351.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,896.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,878.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,567.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.60
|
| Rate for Payer: PHCS Commercial |
$7,523.91
|
| Rate for Payer: United Healthcare All Payer |
$6,896.92
|
|
