|
TIB/PER REVASC STNT & ATHER
|
Facility
|
IP
|
$4,227.53
|
|
|
Service Code
|
HCPCS 37235
|
| Hospital Charge Code |
76101559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,268.26 |
| Max. Negotiated Rate |
$4,058.43 |
| Rate for Payer: Aetna Commercial |
$3,255.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,297.47
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cigna Commercial |
$3,508.85
|
| Rate for Payer: First Health Commercial |
$4,016.15
|
| Rate for Payer: Humana Commercial |
$3,593.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,466.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,119.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,720.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,170.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,382.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,677.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.00
|
| Rate for Payer: PHCS Commercial |
$4,058.43
|
| Rate for Payer: United Healthcare All Payer |
$3,720.23
|
|
|
TIB/PER REVASC STNT & ATHER(P
|
Professional
|
Both
|
$4,227.53
|
|
|
Service Code
|
HCPCS 37235
|
| Hospital Charge Code |
761P1559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.08 |
| Max. Negotiated Rate |
$3,866.70 |
| Rate for Payer: Aetna Commercial |
$674.30
|
| Rate for Payer: Ambetter Exchange |
$347.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$203.08
|
| Rate for Payer: Anthem Medicaid |
$3,619.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$347.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$347.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$417.48
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cigna Commercial |
$763.86
|
| Rate for Payer: Healthspan PPO |
$3,866.70
|
| Rate for Payer: Humana Medicaid |
$3,619.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$347.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,691.53
|
| Rate for Payer: Molina Healthcare Passport |
$3,619.15
|
| Rate for Payer: Multiplan PHCS |
$2,536.52
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$452.27
|
| Rate for Payer: UHCCP Medicaid |
$213.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,655.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$347.90
|
|
|
TIB/PER REVASC W/ATHER
|
Facility
|
IP
|
$10,704.29
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
76101553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,211.29 |
| Max. Negotiated Rate |
$10,276.12 |
| Rate for Payer: Aetna Commercial |
$8,242.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,349.35
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cigna Commercial |
$8,884.56
|
| Rate for Payer: First Health Commercial |
$10,169.08
|
| Rate for Payer: Humana Commercial |
$9,098.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,777.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,899.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,211.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,419.78
|
| Rate for Payer: Ohio Health Group HMO |
$8,028.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,563.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,312.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,385.96
|
| Rate for Payer: PHCS Commercial |
$10,276.12
|
| Rate for Payer: United Healthcare All Payer |
$9,419.78
|
|
|
TIB/PER REVASC W/ATHER
|
Professional
|
Both
|
$10,704.29
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
76101553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$9,935.59 |
| Rate for Payer: Aetna Commercial |
$1,239.51
|
| Rate for Payer: Ambetter Exchange |
$645.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$374.02
|
| Rate for Payer: Anthem Medicaid |
$9,313.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$645.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$645.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$774.64
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cigna Commercial |
$1,401.69
|
| Rate for Payer: Healthspan PPO |
$9,935.59
|
| Rate for Payer: Humana Medicaid |
$9,313.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$645.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9,499.98
|
| Rate for Payer: Molina Healthcare Passport |
$9,313.71
|
| Rate for Payer: Multiplan PHCS |
$6,422.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$839.19
|
| Rate for Payer: UHCCP Medicaid |
$392.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9,406.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$645.53
|
|
|
TIB/PER REVASC W/ATHER
|
Facility
|
OP
|
$10,704.29
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
76101553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,681.21 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$8,242.30
|
| Rate for Payer: Anthem Medicaid |
$3,681.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,349.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cigna Commercial |
$8,884.56
|
| Rate for Payer: First Health Commercial |
$10,169.08
|
| Rate for Payer: Humana Commercial |
$9,098.65
|
| Rate for Payer: Humana KY Medicaid |
$3,681.21
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,718.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,777.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,899.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,755.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,419.78
|
| Rate for Payer: Ohio Health Group HMO |
$8,028.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,563.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,312.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,385.96
|
| Rate for Payer: PHCS Commercial |
$10,276.12
|
| Rate for Payer: United Healthcare All Payer |
$9,419.78
|
|
|
TIBPER REVASC W/ATHER ADD-ON
|
Facility
|
IP
|
$1,595.81
|
|
|
Service Code
|
HCPCS 37233
|
| Hospital Charge Code |
76101557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.74 |
| Max. Negotiated Rate |
$1,531.98 |
| Rate for Payer: Aetna Commercial |
$1,228.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,244.73
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cigna Commercial |
$1,324.52
|
| Rate for Payer: First Health Commercial |
$1,516.02
|
| Rate for Payer: Humana Commercial |
$1,356.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,177.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,196.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,276.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.11
|
| Rate for Payer: PHCS Commercial |
$1,531.98
|
| Rate for Payer: United Healthcare All Payer |
$1,404.31
|
|
|
TIBPER REVASC W/ATHER ADD-ON
|
Facility
|
OP
|
$1,595.81
|
|
|
Service Code
|
HCPCS 37233
|
| Hospital Charge Code |
76101557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.74 |
| Max. Negotiated Rate |
$1,531.98 |
| Rate for Payer: Aetna Commercial |
$1,228.77
|
| Rate for Payer: Anthem Medicaid |
$548.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,244.73
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cigna Commercial |
$1,324.52
|
| Rate for Payer: First Health Commercial |
$1,516.02
|
| Rate for Payer: Humana Commercial |
$1,356.44
|
| Rate for Payer: Humana KY Medicaid |
$548.80
|
| Rate for Payer: Kentucky WC Medicaid |
$554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,177.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,196.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,276.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.11
|
| Rate for Payer: PHCS Commercial |
$1,531.98
|
| Rate for Payer: United Healthcare All Payer |
$1,404.31
|
|
|
TIBPER REVASC W/ATHER ADD-ON
|
Professional
|
Both
|
$1,595.81
|
|
|
Service Code
|
HCPCS 37233
|
| Hospital Charge Code |
76101557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$1,400.17 |
| Rate for Payer: Aetna Commercial |
$570.63
|
| Rate for Payer: Ambetter Exchange |
$300.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.18
|
| Rate for Payer: Anthem Medicaid |
$1,300.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.37
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cigna Commercial |
$645.38
|
| Rate for Payer: Healthspan PPO |
$1,400.17
|
| Rate for Payer: Humana Medicaid |
$1,300.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.45
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.44
|
| Rate for Payer: Multiplan PHCS |
$957.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.40
|
| Rate for Payer: UHCCP Medicaid |
$180.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.31
|
|
|
TIBPER REVASC W/ATHER ADD-O(P
|
Professional
|
Both
|
$1,595.81
|
|
|
Service Code
|
HCPCS 37233
|
| Hospital Charge Code |
761P1557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$1,400.17 |
| Rate for Payer: Aetna Commercial |
$570.63
|
| Rate for Payer: Ambetter Exchange |
$300.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.18
|
| Rate for Payer: Anthem Medicaid |
$1,300.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.37
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Cigna Commercial |
$645.38
|
| Rate for Payer: Healthspan PPO |
$1,400.17
|
| Rate for Payer: Humana Medicaid |
$1,300.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.45
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.44
|
| Rate for Payer: Multiplan PHCS |
$957.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.40
|
| Rate for Payer: UHCCP Medicaid |
$180.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.31
|
|
|
TIB/PER REVASC W/ATHER(P
|
Professional
|
Both
|
$10,704.29
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
761P1553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$9,935.59 |
| Rate for Payer: Aetna Commercial |
$1,239.51
|
| Rate for Payer: Ambetter Exchange |
$645.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$374.02
|
| Rate for Payer: Anthem Medicaid |
$9,313.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$645.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$645.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$774.64
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cash Price |
$5,352.15
|
| Rate for Payer: Cigna Commercial |
$1,401.69
|
| Rate for Payer: Healthspan PPO |
$9,935.59
|
| Rate for Payer: Humana Medicaid |
$9,313.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$645.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9,499.98
|
| Rate for Payer: Molina Healthcare Passport |
$9,313.71
|
| Rate for Payer: Multiplan PHCS |
$6,422.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$839.19
|
| Rate for Payer: UHCCP Medicaid |
$392.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9,406.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$645.53
|
|
|
TIB/PER REVASC W/STENT
|
Professional
|
Both
|
$8,437.79
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
76101554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$7,811.49 |
| Rate for Payer: Aetna Commercial |
$1,192.29
|
| Rate for Payer: Ambetter Exchange |
$648.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$359.60
|
| Rate for Payer: Anthem Medicaid |
$7,317.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$648.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$648.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$777.74
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cigna Commercial |
$1,352.66
|
| Rate for Payer: Healthspan PPO |
$7,811.49
|
| Rate for Payer: Humana Medicaid |
$7,317.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$648.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7,463.86
|
| Rate for Payer: Molina Healthcare Passport |
$7,317.51
|
| Rate for Payer: Multiplan PHCS |
$5,062.67
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$842.56
|
| Rate for Payer: UHCCP Medicaid |
$377.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,390.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$648.12
|
|
|
TIB/PER REVASC W/STENT
|
Facility
|
OP
|
$8,437.79
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
76101554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,901.76 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$6,497.10
|
| Rate for Payer: Anthem Medicaid |
$2,901.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,581.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cigna Commercial |
$7,003.37
|
| Rate for Payer: First Health Commercial |
$8,015.90
|
| Rate for Payer: Humana Commercial |
$7,172.12
|
| Rate for Payer: Humana KY Medicaid |
$2,901.76
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,931.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,918.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,227.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,425.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,328.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,750.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,340.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,822.08
|
| Rate for Payer: PHCS Commercial |
$8,100.28
|
| Rate for Payer: United Healthcare All Payer |
$7,425.26
|
|
|
TIB/PER REVASC W/STENT
|
Facility
|
IP
|
$8,437.79
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
76101554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,531.34 |
| Max. Negotiated Rate |
$8,100.28 |
| Rate for Payer: Aetna Commercial |
$6,497.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,581.48
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cigna Commercial |
$7,003.37
|
| Rate for Payer: First Health Commercial |
$8,015.90
|
| Rate for Payer: Humana Commercial |
$7,172.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,918.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,227.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,531.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,425.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,328.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,750.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,340.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,822.08
|
| Rate for Payer: PHCS Commercial |
$8,100.28
|
| Rate for Payer: United Healthcare All Payer |
$7,425.26
|
|
|
TIB/PER REVASC W/STENT(P
|
Professional
|
Both
|
$8,437.79
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
761P1554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.60 |
| Max. Negotiated Rate |
$7,811.49 |
| Rate for Payer: Aetna Commercial |
$1,192.29
|
| Rate for Payer: Ambetter Exchange |
$648.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$359.60
|
| Rate for Payer: Anthem Medicaid |
$7,317.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$648.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$648.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$777.74
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cash Price |
$4,218.90
|
| Rate for Payer: Cigna Commercial |
$1,352.66
|
| Rate for Payer: Healthspan PPO |
$7,811.49
|
| Rate for Payer: Humana Medicaid |
$7,317.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$648.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7,463.86
|
| Rate for Payer: Molina Healthcare Passport |
$7,317.51
|
| Rate for Payer: Multiplan PHCS |
$5,062.67
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$842.56
|
| Rate for Payer: UHCCP Medicaid |
$377.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,390.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$648.12
|
|
|
TIB/PER REVASC W/TLA
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
76101552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.32 |
| Max. Negotiated Rate |
$5,062.57 |
| Rate for Payer: Aetna Commercial |
$959.61
|
| Rate for Payer: Ambetter Exchange |
$505.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$289.32
|
| Rate for Payer: Anthem Medicaid |
$4,736.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.46
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$1,086.08
|
| Rate for Payer: Healthspan PPO |
$5,062.57
|
| Rate for Payer: Humana Medicaid |
$4,736.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4,831.25
|
| Rate for Payer: Molina Healthcare Passport |
$4,736.52
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.99
|
| Rate for Payer: UHCCP Medicaid |
$303.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4,783.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.38
|
|
|
TIB/PER REVASC W/TLA
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
76101552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
TIB/PER REVASC W/TLA
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
76101552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,891.45 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
TIB/PER REVASC W/TLA(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
761P1552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.32 |
| Max. Negotiated Rate |
$5,062.57 |
| Rate for Payer: Aetna Commercial |
$959.61
|
| Rate for Payer: Ambetter Exchange |
$505.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$289.32
|
| Rate for Payer: Anthem Medicaid |
$4,736.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.46
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$1,086.08
|
| Rate for Payer: Healthspan PPO |
$5,062.57
|
| Rate for Payer: Humana Medicaid |
$4,736.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4,831.25
|
| Rate for Payer: Molina Healthcare Passport |
$4,736.52
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.99
|
| Rate for Payer: UHCCP Medicaid |
$303.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4,783.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.38
|
|
|
TIB PLATE L LAT PROX JIG HEAD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG HEAD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG TAIL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG TAIL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIE-IN TRAPEZIUM KIT
|
Facility
|
OP
|
$9,113.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.12 |
| Max. Negotiated Rate |
$8,749.20 |
| Rate for Payer: Aetna Commercial |
$7,017.59
|
| Rate for Payer: Anthem Medicaid |
$3,134.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.73
|
| Rate for Payer: Cash Price |
$4,556.88
|
| Rate for Payer: Cigna Commercial |
$7,564.41
|
| Rate for Payer: First Health Commercial |
$8,658.06
|
| Rate for Payer: Humana Commercial |
$7,746.69
|
| Rate for Payer: Humana KY Medicaid |
$3,134.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,197.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,928.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.49
|
| Rate for Payer: PHCS Commercial |
$8,749.20
|
| Rate for Payer: United Healthcare All Payer |
$8,020.10
|
|
|
TIE-IN TRAPEZIUM KIT
|
Facility
|
IP
|
$9,113.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.12 |
| Max. Negotiated Rate |
$8,749.20 |
| Rate for Payer: Aetna Commercial |
$7,017.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,108.73
|
| Rate for Payer: Cash Price |
$4,556.88
|
| Rate for Payer: Cigna Commercial |
$7,564.41
|
| Rate for Payer: First Health Commercial |
$8,658.06
|
| Rate for Payer: Humana Commercial |
$7,746.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,928.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.49
|
| Rate for Payer: PHCS Commercial |
$8,749.20
|
| Rate for Payer: United Healthcare All Payer |
$8,020.10
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 1
|
Facility
|
OP
|
$12,208.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,662.67 |
| Max. Negotiated Rate |
$11,720.55 |
| Rate for Payer: Aetna Commercial |
$9,400.86
|
| Rate for Payer: Anthem Medicaid |
$4,198.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,522.95
|
| Rate for Payer: Cash Price |
$6,104.46
|
| Rate for Payer: Cigna Commercial |
$10,133.40
|
| Rate for Payer: First Health Commercial |
$11,598.46
|
| Rate for Payer: Humana Commercial |
$10,377.57
|
| Rate for Payer: Humana KY Medicaid |
$4,198.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,241.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,011.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,010.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,662.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,743.84
|
| Rate for Payer: Ohio Health Group HMO |
$9,156.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,767.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,424.15
|
| Rate for Payer: PHCS Commercial |
$11,720.55
|
| Rate for Payer: United Healthcare All Payer |
$10,743.84
|
|
