|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
45000240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.60 |
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
76101533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| 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 |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
76101533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
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 |
$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
|
|
|
THROMBOLYSIS CEREBRAL IVINFUS
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
45000240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.88 |
| 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 |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| 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 |
$306.47
|
| 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 |
$367.76
|
| 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 |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$318.78
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
THROMBOLYSIS/SEL CORON ANGIO
|
Facility
|
OP
|
$1,287.00
|
|
|
Service Code
|
HCPCS 92975
|
| Hospital Charge Code |
48000066
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$386.10 |
| Max. Negotiated Rate |
$1,235.52 |
| Rate for Payer: Aetna Commercial |
$990.99
|
| Rate for Payer: Anthem Medicaid |
$442.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.86
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna Commercial |
$1,068.21
|
| Rate for Payer: First Health Commercial |
$1,222.65
|
| Rate for Payer: Humana Commercial |
$1,093.95
|
| Rate for Payer: Humana KY Medicaid |
$442.60
|
| Rate for Payer: Kentucky WC Medicaid |
$447.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,055.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,132.56
|
| Rate for Payer: Ohio Health Group HMO |
$965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.03
|
| Rate for Payer: PHCS Commercial |
$1,235.52
|
| Rate for Payer: United Healthcare All Payer |
$1,132.56
|
|
|
THROMBOLYSIS/SEL CORON ANGIO
|
Facility
|
IP
|
$1,287.00
|
|
|
Service Code
|
HCPCS 92975
|
| Hospital Charge Code |
48000066
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$386.10 |
| Max. Negotiated Rate |
$1,235.52 |
| Rate for Payer: Aetna Commercial |
$990.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.86
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna Commercial |
$1,068.21
|
| Rate for Payer: First Health Commercial |
$1,222.65
|
| Rate for Payer: Humana Commercial |
$1,093.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,055.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,132.56
|
| Rate for Payer: Ohio Health Group HMO |
$965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.03
|
| Rate for Payer: PHCS Commercial |
$1,235.52
|
| Rate for Payer: United Healthcare All Payer |
$1,132.56
|
|
|
THROMBOLYTIC ART THERAPY
|
Facility
|
OP
|
$7,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
76101536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,695.29 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,113.18
|
| 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 |
$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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,269.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,818.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,407.81
|
| 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 |
$2,351.22 |
| 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 |
$6,269.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,818.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,407.81
|
| Rate for Payer: PHCS Commercial |
$7,523.91
|
| Rate for Payer: United Healthcare All Payer |
$6,896.92
|
|
|
THROMBOLYTIC ART THERAPY
|
Professional
|
Both
|
$7,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
76101536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.91 |
| Max. Negotiated Rate |
$4,702.45 |
| Rate for Payer: Ambetter Exchange |
$361.69
|
| Rate for Payer: Anthem Medicaid |
$327.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$361.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$361.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$434.03
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cigna Commercial |
$757.21
|
| Rate for Payer: Healthspan PPO |
$386.89
|
| Rate for Payer: Humana Medicaid |
$327.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$361.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.47
|
| Rate for Payer: Molina Healthcare Passport |
$327.91
|
| Rate for Payer: Multiplan PHCS |
$4,702.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$470.20
|
| Rate for Payer: UHCCP Medicaid |
$2,743.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$361.69
|
|
|
THROMBOLYTIC ART THERAPY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761P1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.91 |
| Max. Negotiated Rate |
$757.21 |
| Rate for Payer: Ambetter Exchange |
$361.69
|
| Rate for Payer: Anthem Medicaid |
$327.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$361.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$361.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$434.03
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$757.21
|
| Rate for Payer: Healthspan PPO |
$386.89
|
| Rate for Payer: Humana Medicaid |
$327.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$361.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.47
|
| Rate for Payer: Molina Healthcare Passport |
$327.91
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$470.20
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$361.69
|
|
|
THROMBOLYTIC ART THERAPY(T
|
Facility
|
IP
|
$6,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761T1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,051.22 |
| Max. Negotiated Rate |
$6,563.91 |
| Rate for Payer: Aetna Commercial |
$5,264.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,333.18
|
| Rate for Payer: Cash Price |
$3,418.70
|
| Rate for Payer: Cigna Commercial |
$5,675.05
|
| Rate for Payer: First Health Commercial |
$6,495.54
|
| Rate for Payer: Humana Commercial |
$5,811.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,606.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,046.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,051.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,016.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,128.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,469.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,948.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,717.81
|
| Rate for Payer: PHCS Commercial |
$6,563.91
|
| Rate for Payer: United Healthcare All Payer |
$6,016.92
|
|
|
THROMBOLYTIC ART THERAPY(T
|
Facility
|
OP
|
$6,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761T1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,351.39 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$5,264.81
|
| Rate for Payer: Anthem Medicaid |
$2,351.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,333.18
|
| 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 |
$3,418.70
|
| Rate for Payer: Cash Price |
$3,418.70
|
| Rate for Payer: Cigna Commercial |
$5,675.05
|
| Rate for Payer: First Health Commercial |
$6,495.54
|
| Rate for Payer: Humana Commercial |
$5,811.80
|
| Rate for Payer: Humana KY Medicaid |
$2,351.39
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,375.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,606.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,046.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,398.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,016.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,128.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,469.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,948.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,717.81
|
| Rate for Payer: PHCS Commercial |
$6,563.91
|
| Rate for Payer: United Healthcare All Payer |
$6,016.92
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
OP
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$2,626.23 |
| Rate for Payer: Aetna Commercial |
$2,106.46
|
| Rate for Payer: Anthem Medicaid |
$940.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,133.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cigna Commercial |
$2,270.60
|
| Rate for Payer: First Health Commercial |
$2,598.88
|
| Rate for Payer: Humana Commercial |
$2,325.31
|
| Rate for Payer: Humana KY Medicaid |
$940.79
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$950.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,243.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,018.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$959.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,051.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,188.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,380.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,887.61
|
| Rate for Payer: PHCS Commercial |
$2,626.23
|
| Rate for Payer: United Healthcare All Payer |
$2,407.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
IP
|
$1,985.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761T1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.70 |
| Max. Negotiated Rate |
$1,906.23 |
| Rate for Payer: Aetna Commercial |
$1,528.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.81
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cigna Commercial |
$1,648.10
|
| Rate for Payer: First Health Commercial |
$1,886.38
|
| Rate for Payer: Humana Commercial |
$1,687.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,370.11
|
| Rate for Payer: PHCS Commercial |
$1,906.23
|
| Rate for Payer: United Healthcare All Payer |
$1,747.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
OP
|
$1,985.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761T1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,906.23 |
| Rate for Payer: Aetna Commercial |
$1,528.96
|
| Rate for Payer: Anthem Medicaid |
$682.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cigna Commercial |
$1,648.10
|
| Rate for Payer: First Health Commercial |
$1,886.38
|
| Rate for Payer: Humana Commercial |
$1,687.81
|
| Rate for Payer: Humana KY Medicaid |
$682.87
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,370.11
|
| Rate for Payer: PHCS Commercial |
$1,906.23
|
| Rate for Payer: United Healthcare All Payer |
$1,747.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
IP
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$820.70 |
| Max. Negotiated Rate |
$2,626.23 |
| Rate for Payer: Aetna Commercial |
$2,106.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,133.81
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cigna Commercial |
$2,270.60
|
| Rate for Payer: First Health Commercial |
$2,598.88
|
| Rate for Payer: Humana Commercial |
$2,325.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,243.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,018.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,051.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,188.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,380.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,887.61
|
| Rate for Payer: PHCS Commercial |
$2,626.23
|
| Rate for Payer: United Healthcare All Payer |
$2,407.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Professional
|
Both
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,914.96 |
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,641.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,914.96
|
| Rate for Payer: UHCCP Medicaid |
$957.48
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761P1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| 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
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
OP
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,546.52 |
| Max. Negotiated Rate |
$4,317.12 |
| Rate for Payer: Aetna Commercial |
$3,462.69
|
| Rate for Payer: Anthem Medicaid |
$1,546.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.66
|
| 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 |
$2,248.50
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$3,732.51
|
| Rate for Payer: First Health Commercial |
$4,272.15
|
| Rate for Payer: Humana Commercial |
$3,822.45
|
| Rate for Payer: Humana KY Medicaid |
$1,546.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,102.93
|
| Rate for Payer: PHCS Commercial |
$4,317.12
|
| Rate for Payer: United Healthcare All Payer |
$3,957.36
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
IP
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,349.10 |
| Max. Negotiated Rate |
$4,317.12 |
| Rate for Payer: Aetna Commercial |
$3,462.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.66
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$3,732.51
|
| Rate for Payer: First Health Commercial |
$4,272.15
|
| Rate for Payer: Humana Commercial |
$3,822.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,102.93
|
| Rate for Payer: PHCS Commercial |
$4,317.12
|
| Rate for Payer: United Healthcare All Payer |
$3,957.36
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Professional
|
Both
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$2,698.20 |
| Rate for Payer: Ambetter Exchange |
$315.66
|
| Rate for Payer: Anthem Medicaid |
$289.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.79
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$668.49
|
| Rate for Payer: Healthspan PPO |
$341.62
|
| Rate for Payer: Humana Medicaid |
$289.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.29
|
| Rate for Payer: Molina Healthcare Passport |
$289.50
|
| Rate for Payer: Multiplan PHCS |
$2,698.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.36
|
| Rate for Payer: UHCCP Medicaid |
$1,573.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.66
|
|
|
THROMBOLYTIC VENOUS THERAPY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761P1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$668.49 |
| Rate for Payer: Ambetter Exchange |
$315.66
|
| Rate for Payer: Anthem Medicaid |
$289.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.79
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$668.49
|
| Rate for Payer: Healthspan PPO |
$341.62
|
| Rate for Payer: Humana Medicaid |
$289.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.29
|
| Rate for Payer: Molina Healthcare Passport |
$289.50
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.36
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.66
|
|
|
THROMBOLYTIC VENOUS THERAPY(T
|
Facility
|
OP
|
$3,597.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761T1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,237.01 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem Medicaid |
$1,237.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| 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 |
$1,798.50
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Humana KY Medicaid |
$1,237.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,249.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,129.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.93
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
|
THROMBOLYTIC VENOUS THERAPY(T
|
Facility
|
IP
|
$3,597.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761T1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,079.10 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,079.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,129.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.93
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
