|
TRANSCATH EMBOLIZATION(T
|
Facility
|
OP
|
$4,503.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T0176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$585.39 |
| Max. Negotiated Rate |
$4,322.88 |
| Rate for Payer: Aetna Commercial |
$3,467.31
|
| Rate for Payer: Anthem Medicaid |
$1,548.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,512.34
|
| Rate for Payer: Cash Price |
$2,251.50
|
| Rate for Payer: Cigna Commercial |
$3,737.49
|
| Rate for Payer: First Health Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial |
$3,827.55
|
| Rate for Payer: Humana KY Medicaid |
$1,548.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,564.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,692.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,323.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,962.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.93
|
| Rate for Payer: PHCS Commercial |
$4,322.88
|
| Rate for Payer: United Healthcare All Payer |
$3,962.64
|
|
|
TRANSCATH EMBOLIZATION(T
|
Facility
|
IP
|
$4,503.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T0176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$585.39 |
| Max. Negotiated Rate |
$4,322.88 |
| Rate for Payer: Aetna Commercial |
$3,467.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,512.34
|
| Rate for Payer: Cash Price |
$2,251.50
|
| Rate for Payer: Cigna Commercial |
$3,737.49
|
| Rate for Payer: First Health Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial |
$3,827.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,692.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,323.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,962.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.93
|
| Rate for Payer: PHCS Commercial |
$4,322.88
|
| Rate for Payer: United Healthcare All Payer |
$3,962.64
|
|
|
TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 37200
|
| Hospital Charge Code |
76101535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 37200
|
| Hospital Charge Code |
76101535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$147.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
TRANSCATHETER BIOPSY
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 37200
|
| Hospital Charge Code |
76101535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$376.10
|
| Rate for Payer: Anthem Medicaid |
$179.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$337.29
|
| Rate for Payer: Healthspan PPO |
$300.72
|
| Rate for Payer: Humana Medicaid |
$179.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.20
|
| Rate for Payer: Molina Healthcare Passport |
$179.61
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.41
|
|
|
TRANSCATHETER BIOPSY(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 37200
|
| Hospital Charge Code |
761P1535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$376.10
|
| Rate for Payer: Anthem Medicaid |
$179.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$337.29
|
| Rate for Payer: Healthspan PPO |
$300.72
|
| Rate for Payer: Humana Medicaid |
$179.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.20
|
| Rate for Payer: Molina Healthcare Passport |
$179.61
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.41
|
|
|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT LOWER EXTREMITY ARTERY(S) FOR OCCLUSIVE DISEASE, CERVICAL CAROTID, EXTRACRANIAL VERTEBRAL OR INTRATHORACIC CAROTID, INTRACRANIAL, OR CORONARY), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ALL ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL ARTERY
|
Facility
|
OP
|
$13,318.61
|
|
|
Service Code
|
CPT 37236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,513.29 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
|
|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT LOWER EXTREMITY ARTERY(S) FOR OCCLUSIVE DISEASE, CERVICAL CAROTID, EXTRACRANIAL VERTEBRAL OR INTRATHORACIC CAROTID, INTRACRANIAL, OR CORONARY), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ALL ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL ARTERY
|
Facility
|
OP
|
$13,318.61
|
|
|
Service Code
|
CPT 37236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,513.29 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
|
|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL VEIN
|
Facility
|
OP
|
$13,318.61
|
|
|
Service Code
|
CPT 37238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,513.29 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
|
|
TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL VEIN
|
Facility
|
OP
|
$13,318.61
|
|
|
Service Code
|
CPT 37238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,513.29 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
|
|
TRANSCATH IMPWRLSPULARTRYPRS(P
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
761P1281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$601.32 |
| Rate for Payer: Anthem Medicaid |
$267.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$601.32
|
| Rate for Payer: Humana Medicaid |
$267.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.70
|
| Rate for Payer: Molina Healthcare Passport |
$267.35
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$270.02
|
|
|
TRANSCATH IMPWRLSPULARTRYPRSR
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
76101281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$35,187.17 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,133.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,187.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,930.48
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$25,133.69
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,160.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
TRANSCATH IMPWRLSPULARTRYPRSR
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
76101281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$601.32 |
| Rate for Payer: Anthem Medicaid |
$267.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$601.32
|
| Rate for Payer: Humana Medicaid |
$267.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.70
|
| Rate for Payer: Molina Healthcare Passport |
$267.35
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$270.02
|
|
|
TRANSCATH IMPWRLSPULARTRYPRSR
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
76101281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
360T1276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem Medicaid |
$381.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Humana KY Medicaid |
$381.73
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$385.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
360P1276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$1,496.39 |
| Rate for Payer: Aetna Commercial |
$1,496.39
|
| Rate for Payer: Anthem Medicaid |
$861.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,110.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$1,301.55
|
| Rate for Payer: Healthspan PPO |
$1,168.34
|
| Rate for Payer: Humana Medicaid |
$861.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,128.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$878.59
|
| Rate for Payer: Molina Healthcare Passport |
$861.36
|
| Rate for Payer: Multiplan PHCS |
$666.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.00
|
| Rate for Payer: UHCCP Medicaid |
$388.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$869.97
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
36001276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$1,496.39 |
| Rate for Payer: Aetna Commercial |
$1,496.39
|
| Rate for Payer: Anthem Medicaid |
$861.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,110.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$1,301.55
|
| Rate for Payer: Healthspan PPO |
$1,168.34
|
| Rate for Payer: Humana Medicaid |
$861.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,128.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$878.59
|
| Rate for Payer: Molina Healthcare Passport |
$861.36
|
| Rate for Payer: Multiplan PHCS |
$666.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.00
|
| Rate for Payer: UHCCP Medicaid |
$388.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$869.97
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
36001276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
360T1276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$1,065.60 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
TRANSCATH OCCLUSION NON-CNS
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 61626
|
| Hospital Charge Code |
36001276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$854.70
|
| Rate for Payer: Anthem Medicaid |
$381.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$921.30
|
| Rate for Payer: First Health Commercial |
$1,054.50
|
| Rate for Payer: Humana Commercial |
$943.50
|
| Rate for Payer: Humana KY Medicaid |
$381.73
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$385.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.80
|
| Rate for Payer: Ohio Health Group HMO |
$832.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.10
|
| Rate for Payer: PHCS Commercial |
$1,065.60
|
| Rate for Payer: United Healthcare All Payer |
$976.80
|
|
|
TRANSCATH RETRI OF FOREIGN BOD
|
Facility
|
IP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
TRANSCATH RETRI OF FOREIGN BOD
|
Facility
|
OP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem Medicaid |
$1,423.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Humana KY Medicaid |
$1,423.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
TRANSCATH STENT CCA W/EPS
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 37215
|
| Hospital Charge Code |
76101540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$1,597.44 |
| Rate for Payer: Aetna Commercial |
$1,281.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,297.92
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cigna Commercial |
$1,381.12
|
| Rate for Payer: First Health Commercial |
$1,580.80
|
| Rate for Payer: Humana Commercial |
$1,414.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,364.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,228.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,464.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$216.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.84
|
| Rate for Payer: PHCS Commercial |
$1,597.44
|
| Rate for Payer: United Healthcare All Payer |
$1,464.32
|
|
|
TRANSCATH STENT CCA W/EPS
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS 37215
|
| Hospital Charge Code |
76101540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$1,597.44 |
| Rate for Payer: Aetna Commercial |
$1,281.28
|
| Rate for Payer: Anthem Medicaid |
$572.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,297.92
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cigna Commercial |
$1,381.12
|
| Rate for Payer: First Health Commercial |
$1,580.80
|
| Rate for Payer: Humana Commercial |
$1,414.40
|
| Rate for Payer: Humana KY Medicaid |
$572.25
|
| Rate for Payer: Kentucky WC Medicaid |
$578.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,364.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,228.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$583.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,464.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,248.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$216.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.84
|
| Rate for Payer: PHCS Commercial |
$1,597.44
|
| Rate for Payer: United Healthcare All Payer |
$1,464.32
|
|
|
TRANSCATH STENT CCA W/EPS
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 37215
|
| Hospital Charge Code |
76101540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.40 |
| Max. Negotiated Rate |
$1,757.05 |
| Rate for Payer: Aetna Commercial |
$1,736.26
|
| Rate for Payer: Anthem Medicaid |
$815.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,664.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cigna Commercial |
$1,757.05
|
| Rate for Payer: Healthspan PPO |
$1,388.30
|
| Rate for Payer: Humana Medicaid |
$815.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,479.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$831.61
|
| Rate for Payer: Molina Healthcare Passport |
$815.30
|
| Rate for Payer: Multiplan PHCS |
$998.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,164.80
|
| Rate for Payer: UHCCP Medicaid |
$582.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$823.45
|
|
