|
THROMBIN (BOVINE) 20KU SPRAY
|
Facility
|
OP
|
$1,864.17
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.25 |
| Max. Negotiated Rate |
$1,789.60 |
| Rate for Payer: Aetna Commercial |
$1,435.41
|
| Rate for Payer: Anthem Medicaid |
$641.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.05
|
| Rate for Payer: Cash Price |
$932.08
|
| Rate for Payer: Cigna Commercial |
$1,547.26
|
| Rate for Payer: First Health Commercial |
$1,770.96
|
| Rate for Payer: Humana Commercial |
$1,584.54
|
| Rate for Payer: Humana KY Medicaid |
$641.09
|
| Rate for Payer: Kentucky WC Medicaid |
$647.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.28
|
| Rate for Payer: PHCS Commercial |
$1,789.60
|
| Rate for Payer: United Healthcare All Payer |
$1,640.47
|
|
|
THROMBIN (BOVINE) 20KU SPRAY
|
Facility
|
IP
|
$1,864.17
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.25 |
| Max. Negotiated Rate |
$1,789.60 |
| Rate for Payer: Aetna Commercial |
$1,435.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.05
|
| Rate for Payer: Cash Price |
$932.08
|
| Rate for Payer: Cigna Commercial |
$1,547.26
|
| Rate for Payer: First Health Commercial |
$1,770.96
|
| Rate for Payer: Humana Commercial |
$1,584.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.28
|
| Rate for Payer: PHCS Commercial |
$1,789.60
|
| Rate for Payer: United Healthcare All Payer |
$1,640.47
|
|
|
THROMBIN (BOVINE) 20KU VIAL
|
Facility
|
IP
|
$1,628.79
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$488.64 |
| Max. Negotiated Rate |
$1,563.64 |
| Rate for Payer: Aetna Commercial |
$1,254.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,270.46
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cigna Commercial |
$1,351.90
|
| Rate for Payer: First Health Commercial |
$1,547.35
|
| Rate for Payer: Humana Commercial |
$1,384.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,335.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,202.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,433.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,221.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,417.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.87
|
| Rate for Payer: PHCS Commercial |
$1,563.64
|
| Rate for Payer: United Healthcare All Payer |
$1,433.34
|
|
|
THROMBIN (BOVINE) 20KU VIAL
|
Facility
|
OP
|
$1,628.79
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$488.64 |
| Max. Negotiated Rate |
$1,563.64 |
| Rate for Payer: Aetna Commercial |
$1,254.17
|
| Rate for Payer: Anthem Medicaid |
$560.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,270.46
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cigna Commercial |
$1,351.90
|
| Rate for Payer: First Health Commercial |
$1,547.35
|
| Rate for Payer: Humana Commercial |
$1,384.47
|
| Rate for Payer: Humana KY Medicaid |
$560.14
|
| Rate for Payer: Kentucky WC Medicaid |
$565.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,335.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,202.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$571.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,433.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,221.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,417.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.87
|
| Rate for Payer: PHCS Commercial |
$1,563.64
|
| Rate for Payer: United Healthcare All Payer |
$1,433.34
|
|
|
THROMBIN TIME
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
30000629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
THROMBIN TIME
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
30000629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$5.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$5.77
|
| Rate for Payer: Humana Medicare Advantage |
$5.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
THROMBLYTIC ART/VEN THERAPY
|
Facility
|
OP
|
$6,492.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
76101538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,232.60 |
| Max. Negotiated Rate |
$6,232.32 |
| Rate for Payer: Aetna Commercial |
$4,998.84
|
| Rate for Payer: Anthem Medicaid |
$2,232.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,063.76
|
| 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 |
$3,246.00
|
| Rate for Payer: Cash Price |
$3,246.00
|
| Rate for Payer: Cigna Commercial |
$5,388.36
|
| Rate for Payer: First Health Commercial |
$6,167.40
|
| Rate for Payer: Humana Commercial |
$5,518.20
|
| Rate for Payer: Humana KY Medicaid |
$2,232.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,255.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,323.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,791.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,277.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,712.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,648.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,479.48
|
| Rate for Payer: PHCS Commercial |
$6,232.32
|
| Rate for Payer: United Healthcare All Payer |
$5,712.96
|
|
|
THROMBLYTIC ART/VEN THERAPY
|
Facility
|
IP
|
$6,492.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
76101538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,947.60 |
| Max. Negotiated Rate |
$6,232.32 |
| Rate for Payer: Aetna Commercial |
$4,998.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,063.76
|
| Rate for Payer: Cash Price |
$3,246.00
|
| Rate for Payer: Cigna Commercial |
$5,388.36
|
| Rate for Payer: First Health Commercial |
$6,167.40
|
| Rate for Payer: Humana Commercial |
$5,518.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,323.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,791.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,712.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,648.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,479.48
|
| Rate for Payer: PHCS Commercial |
$6,232.32
|
| Rate for Payer: United Healthcare All Payer |
$5,712.96
|
|
|
THROMBLYTIC ART/VEN THERAPY
|
Professional
|
Both
|
$6,492.00
|
|
|
Service Code
|
HCPCS 37213
|
| Hospital Charge Code |
76101538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.48 |
| Max. Negotiated Rate |
$3,895.20 |
| Rate for Payer: Ambetter Exchange |
$216.15
|
| Rate for Payer: Anthem Medicaid |
$202.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.38
|
| Rate for Payer: Cash Price |
$3,246.00
|
| Rate for Payer: Cash Price |
$3,246.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$216.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.53
|
| Rate for Payer: Molina Healthcare Passport |
$202.48
|
| Rate for Payer: Multiplan PHCS |
$3,895.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.00
|
| Rate for Payer: UHCCP Medicaid |
$2,272.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.15
|
|
|
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 |
$467.31 |
| Rate for Payer: Ambetter Exchange |
$216.15
|
| Rate for Payer: Anthem Medicaid |
$202.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.38
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$216.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.15
|
| 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 |
$281.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.15
|
|
|
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 |
$1,974.67 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,478.76
|
| 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 |
$2,871.00
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$4,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,995.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.98
|
| 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 |
$1,722.60 |
| 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 |
$4,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,995.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.98
|
| Rate for Payer: PHCS Commercial |
$5,512.32
|
| Rate for Payer: United Healthcare All Payer |
$5,052.96
|
|
|
THROMBOENDARTERECTOMY
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
76101380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.20 |
| 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 |
$1,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.66
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
THROMBOENDARTERECTOMY
|
Facility
|
IP
|
$1,714.00
|
|
|
Service Code
|
HCPCS 35302
|
| Hospital Charge Code |
76101380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.20 |
| 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 |
$1,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.66
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
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: Ambetter Exchange |
$1,045.99
|
| Rate for Payer: Anthem Medicaid |
$869.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,045.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,045.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,255.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,045.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.99
|
| 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 |
$1,359.79
|
| Rate for Payer: UHCCP Medicaid |
$599.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,045.99
|
|
|
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: Ambetter Exchange |
$1,045.99
|
| Rate for Payer: Anthem Medicaid |
$869.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,045.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,045.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,255.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,045.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.99
|
| 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 |
$1,359.79
|
| Rate for Payer: UHCCP Medicaid |
$599.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,045.99
|
|
|
THROMBOENDARTERECTOMY TIBI
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
76101382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.00 |
| 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 |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| 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: Ambetter Exchange |
$1,195.35
|
| Rate for Payer: Anthem Medicaid |
$994.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,195.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,195.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,434.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,195.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| 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 |
$1,553.95
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,195.35
|
|
|
THROMBOENDARTERECTOMY TIBI
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 35304
|
| Hospital Charge Code |
76101382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.00 |
| 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 |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
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: Ambetter Exchange |
$1,195.35
|
| Rate for Payer: Anthem Medicaid |
$994.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,195.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,195.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,434.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,195.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| 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 |
$1,553.95
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,195.35
|
|
|
THROMBOENDARTERECTOMY - WITH
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
76101386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| 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 |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
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 |
$2,278.46 |
| Rate for Payer: Aetna Commercial |
$2,278.46
|
| Rate for Payer: Ambetter Exchange |
$1,207.17
|
| Rate for Payer: Anthem Medicaid |
$1,035.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,207.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,207.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,448.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,207.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.17
|
| 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 |
$1,569.32
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,045.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,207.17
|
|
|
THROMBOENDARTERECTOMY - WITH
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35351
|
| Hospital Charge Code |
76101386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| 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 |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| 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 |
$2,278.46 |
| Rate for Payer: Aetna Commercial |
$2,278.46
|
| Rate for Payer: Ambetter Exchange |
$1,207.17
|
| Rate for Payer: Anthem Medicaid |
$1,035.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,207.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,207.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,448.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,207.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.17
|
| 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 |
$1,569.32
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,045.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,207.17
|
|
|
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 |
$473.51 |
| Rate for Payer: Aetna Commercial |
$473.51
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| 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
|
|
