|
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 |
$3,401.40 |
| Rate for Payer: Aetna Commercial |
$1,273.33
|
| Rate for Payer: Ambetter Exchange |
$654.97
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$654.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$654.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$785.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$654.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.97
|
| 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 |
$851.46
|
| Rate for Payer: UHCCP Medicaid |
$1,984.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$654.97
|
|
|
THROMBECTOMY - DIRECT OR CATH
|
Facility
|
OP
|
$5,669.00
|
|
|
Service Code
|
HCPCS 34421
|
| Hospital Charge Code |
76101342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,949.57 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,421.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$4,535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,932.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,911.61
|
| 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 |
$1,700.70 |
| 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 |
$4,535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,932.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,911.61
|
| Rate for Payer: PHCS Commercial |
$5,442.24
|
| Rate for Payer: United Healthcare All Payer |
$4,988.72
|
|
|
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 |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,273.33
|
| Rate for Payer: Ambetter Exchange |
$654.97
|
| Rate for Payer: Anthem Medicaid |
$497.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$654.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$654.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$785.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$654.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.97
|
| 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 |
$851.46
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$654.97
|
|
|
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 |
$1,190.70 |
| 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 |
$3,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,453.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.61
|
| 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 |
$1,364.94 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$3,056.13
|
| Rate for Payer: Anthem Medicaid |
$1,364.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,453.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.61
|
| Rate for Payer: PHCS Commercial |
$3,810.24
|
| Rate for Payer: United Healthcare All Payer |
$3,492.72
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
HCPCS 34451
|
| Hospital Charge Code |
76101343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.90 |
| 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 |
$1,842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,003.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.07
|
| Rate for Payer: PHCS Commercial |
$2,210.88
|
| Rate for Payer: United Healthcare All Payer |
$2,026.64
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
HCPCS 34451
|
| Hospital Charge Code |
76101343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.90 |
| Max. Negotiated Rate |
$2,210.88 |
| Rate for Payer: Aetna Commercial |
$1,773.31
|
| 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: 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: 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 |
$1,842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,003.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.07
|
| Rate for Payer: PHCS Commercial |
$2,210.88
|
| Rate for Payer: United Healthcare All Payer |
$2,026.64
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 34451
|
| Hospital Charge Code |
76101343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$724.01 |
| Max. Negotiated Rate |
$2,655.19 |
| Rate for Payer: Aetna Commercial |
$2,655.19
|
| Rate for Payer: Ambetter Exchange |
$1,352.46
|
| Rate for Payer: Anthem Medicaid |
$724.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,352.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,352.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,622.95
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$2,535.50
|
| Rate for Payer: Healthspan PPO |
$2,610.57
|
| Rate for Payer: Humana Medicaid |
$724.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,026.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,352.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$738.49
|
| Rate for Payer: Molina Healthcare Passport |
$724.01
|
| Rate for Payer: Multiplan PHCS |
$1,381.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,758.20
|
| Rate for Payer: UHCCP Medicaid |
$806.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$731.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,352.46
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Professional
|
Both
|
$7,860.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
76101344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.44 |
| Max. Negotiated Rate |
$4,716.37 |
| Rate for Payer: Aetna Commercial |
$1,060.60
|
| Rate for Payer: Ambetter Exchange |
$541.72
|
| Rate for Payer: Anthem Medicaid |
$423.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$541.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$650.06
|
| Rate for Payer: Cash Price |
$3,930.31
|
| Rate for Payer: Cash Price |
$3,930.31
|
| Rate for Payer: Cigna Commercial |
$1,022.39
|
| Rate for Payer: Healthspan PPO |
$1,042.78
|
| Rate for Payer: Humana Medicaid |
$423.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$831.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$541.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.91
|
| Rate for Payer: Molina Healthcare Passport |
$423.44
|
| Rate for Payer: Multiplan PHCS |
$4,716.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.24
|
| Rate for Payer: UHCCP Medicaid |
$2,751.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$541.72
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
IP
|
$7,860.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
76101344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,358.19 |
| 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 |
$5,895.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,838.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,423.83
|
| Rate for Payer: PHCS Commercial |
$7,546.20
|
| Rate for Payer: United Healthcare All Payer |
$6,917.35
|
|
|
THROMBECTOMY - DIRECT OR WITH
|
Facility
|
OP
|
$7,860.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
76101344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,703.27 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,131.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$5,895.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,288.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,838.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,423.83
|
| Rate for Payer: PHCS Commercial |
$7,546.20
|
| Rate for Payer: United Healthcare All Payer |
$6,917.35
|
|
|
THROMBECTOMY - DIRECT OR WIT(P
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 34451
|
| Hospital Charge Code |
761P1343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$724.01 |
| Max. Negotiated Rate |
$2,655.19 |
| Rate for Payer: Aetna Commercial |
$2,655.19
|
| Rate for Payer: Ambetter Exchange |
$1,352.46
|
| Rate for Payer: Anthem Medicaid |
$724.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,352.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,352.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,622.95
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: Cigna Commercial |
$2,535.50
|
| Rate for Payer: Healthspan PPO |
$2,610.57
|
| Rate for Payer: Humana Medicaid |
$724.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,026.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,352.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$738.49
|
| Rate for Payer: Molina Healthcare Passport |
$724.01
|
| Rate for Payer: Multiplan PHCS |
$1,381.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,758.20
|
| Rate for Payer: UHCCP Medicaid |
$806.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$731.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,352.46
|
|
|
THROMBECTOMY - DIRECT OR WIT(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
761P1344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.44 |
| Max. Negotiated Rate |
$1,060.60 |
| Rate for Payer: Aetna Commercial |
$1,060.60
|
| Rate for Payer: Ambetter Exchange |
$541.72
|
| Rate for Payer: Anthem Medicaid |
$423.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$541.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$650.06
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,022.39
|
| Rate for Payer: Healthspan PPO |
$1,042.78
|
| Rate for Payer: Humana Medicaid |
$423.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$831.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$541.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.91
|
| Rate for Payer: Molina Healthcare Passport |
$423.44
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.24
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$541.72
|
|
|
THROMBECTOMY - DIRECT OR WIT(T
|
Facility
|
IP
|
$6,260.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
761T1344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,878.19 |
| Max. Negotiated Rate |
$6,010.20 |
| Rate for Payer: Aetna Commercial |
$4,820.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,883.28
|
| Rate for Payer: Cash Price |
$3,130.31
|
| Rate for Payer: Cigna Commercial |
$5,196.31
|
| Rate for Payer: First Health Commercial |
$5,947.59
|
| Rate for Payer: Humana Commercial |
$5,321.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,878.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,509.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,695.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,008.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,446.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,319.83
|
| Rate for Payer: PHCS Commercial |
$6,010.20
|
| Rate for Payer: United Healthcare All Payer |
$5,509.35
|
|
|
THROMBECTOMY - DIRECT OR WIT(T
|
Facility
|
OP
|
$6,260.62
|
|
|
Service Code
|
HCPCS 34490
|
| Hospital Charge Code |
761T1344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,153.03 |
| Max. Negotiated Rate |
$6,010.20 |
| Rate for Payer: Aetna Commercial |
$4,820.68
|
| Rate for Payer: Anthem Medicaid |
$2,153.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,883.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$3,130.31
|
| Rate for Payer: Cash Price |
$3,130.31
|
| Rate for Payer: Cigna Commercial |
$5,196.31
|
| Rate for Payer: First Health Commercial |
$5,947.59
|
| Rate for Payer: Humana Commercial |
$5,321.53
|
| Rate for Payer: Humana KY Medicaid |
$2,153.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,174.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,509.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,695.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,008.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,446.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,319.83
|
| Rate for Payer: PHCS Commercial |
$6,010.20
|
| Rate for Payer: United Healthcare All Payer |
$5,509.35
|
|
|
THROMBECTOMY - OPEN - ARTERI
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
76101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
THROMBECTOMY - OPEN - ARTERI
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
76101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$752.76 |
| Rate for Payer: Aetna Commercial |
$725.72
|
| Rate for Payer: Ambetter Exchange |
$579.05
|
| Rate for Payer: Anthem Medicaid |
$322.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$579.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$694.86
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$694.76
|
| Rate for Payer: Healthspan PPO |
$580.28
|
| Rate for Payer: Humana Medicaid |
$322.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$579.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.30
|
| Rate for Payer: Molina Healthcare Passport |
$322.84
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.76
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$579.05
|
|
|
THROMBECTOMY - OPEN - ARTERI
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
76101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,992.66
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
|
|
THROMBECTOMY - OPEN - ARTERI(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
761P1510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$752.76 |
| Rate for Payer: Aetna Commercial |
$725.72
|
| Rate for Payer: Ambetter Exchange |
$579.05
|
| Rate for Payer: Anthem Medicaid |
$322.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$579.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$694.86
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$694.76
|
| Rate for Payer: Healthspan PPO |
$580.28
|
| Rate for Payer: Humana Medicaid |
$322.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$579.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.30
|
| Rate for Payer: Molina Healthcare Passport |
$322.84
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.76
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$579.05
|
|
|
THROMBINAR(THROMBI 5000U/1VIAL
|
Facility
|
IP
|
$147.78
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
25003520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Aetna Commercial |
$113.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.27
|
| Rate for Payer: Cash Price |
$73.89
|
| Rate for Payer: Cigna Commercial |
$122.66
|
| Rate for Payer: First Health Commercial |
$140.39
|
| Rate for Payer: Humana Commercial |
$125.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.05
|
| Rate for Payer: Ohio Health Group HMO |
$110.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.97
|
| Rate for Payer: PHCS Commercial |
$141.87
|
| Rate for Payer: United Healthcare All Payer |
$130.05
|
|
|
THROMBINAR(THROMBI 5000U/1VIAL
|
Facility
|
OP
|
$468.70
|
|
|
Service Code
|
NDC 338032201
|
| Hospital Charge Code |
25003520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.61 |
| Max. Negotiated Rate |
$449.95 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Anthem Medicaid |
$161.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.59
|
| Rate for Payer: Cash Price |
$234.35
|
| Rate for Payer: Cigna Commercial |
$389.02
|
| Rate for Payer: First Health Commercial |
$445.26
|
| Rate for Payer: Humana Commercial |
$398.39
|
| Rate for Payer: Humana KY Medicaid |
$161.19
|
| Rate for Payer: Kentucky WC Medicaid |
$162.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.46
|
| Rate for Payer: Ohio Health Group HMO |
$351.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.40
|
| Rate for Payer: PHCS Commercial |
$449.95
|
| Rate for Payer: United Healthcare All Payer |
$412.46
|
|
|
THROMBINAR(THROMBI 5000U/1VIAL
|
Facility
|
OP
|
$147.78
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
25003520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$141.87 |
| Rate for Payer: Aetna Commercial |
$113.79
|
| Rate for Payer: Anthem Medicaid |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.27
|
| Rate for Payer: Cash Price |
$73.89
|
| Rate for Payer: Cigna Commercial |
$122.66
|
| Rate for Payer: First Health Commercial |
$140.39
|
| Rate for Payer: Humana Commercial |
$125.61
|
| Rate for Payer: Humana KY Medicaid |
$50.82
|
| Rate for Payer: Kentucky WC Medicaid |
$51.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.05
|
| Rate for Payer: Ohio Health Group HMO |
$110.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.97
|
| Rate for Payer: PHCS Commercial |
$141.87
|
| Rate for Payer: United Healthcare All Payer |
$130.05
|
|
|
THROMBINAR(THROMBI 5000U/1VIAL
|
Facility
|
IP
|
$468.70
|
|
|
Service Code
|
NDC 338032201
|
| Hospital Charge Code |
25003520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.61 |
| Max. Negotiated Rate |
$449.95 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.59
|
| Rate for Payer: Cash Price |
$234.35
|
| Rate for Payer: Cigna Commercial |
$389.02
|
| Rate for Payer: First Health Commercial |
$445.26
|
| Rate for Payer: Humana Commercial |
$398.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.46
|
| Rate for Payer: Ohio Health Group HMO |
$351.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.40
|
| Rate for Payer: PHCS Commercial |
$449.95
|
| Rate for Payer: United Healthcare All Payer |
$412.46
|
|
