|
VARIZIG 125 UNIT/1.2 ML VL
|
Facility
|
OP
|
$3,932.57
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
25003878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$511.23 |
| Max. Negotiated Rate |
$3,775.27 |
| Rate for Payer: Aetna Commercial |
$3,028.08
|
| Rate for Payer: Anthem Medicaid |
$1,352.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,255.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,158.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,045.53
|
| Rate for Payer: Cash Price |
$1,966.29
|
| Rate for Payer: Cash Price |
$1,966.29
|
| Rate for Payer: Cigna Commercial |
$3,264.03
|
| Rate for Payer: First Health Commercial |
$3,735.94
|
| Rate for Payer: Humana Commercial |
$3,342.68
|
| Rate for Payer: Humana KY Medicaid |
$1,352.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,255.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,707.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.10
|
| Rate for Payer: PHCS Commercial |
$3,775.27
|
| Rate for Payer: United Healthcare All Payer |
$3,460.66
|
|
|
VASCADE VCS 5F
|
Facility
|
OP
|
$2,025.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$1,944.48 |
| Rate for Payer: Aetna Commercial |
$1,559.64
|
| Rate for Payer: Anthem Medicaid |
$696.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.89
|
| Rate for Payer: Cash Price |
$1,012.75
|
| Rate for Payer: Cigna Commercial |
$1,681.16
|
| Rate for Payer: First Health Commercial |
$1,924.22
|
| Rate for Payer: Humana Commercial |
$1,721.68
|
| Rate for Payer: Humana KY Medicaid |
$696.57
|
| Rate for Payer: Kentucky WC Medicaid |
$703.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$1,944.48
|
| Rate for Payer: United Healthcare All Payer |
$1,782.44
|
|
|
VASCADE VCS 5F
|
Facility
|
IP
|
$2,025.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$1,944.48 |
| Rate for Payer: Aetna Commercial |
$1,559.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.89
|
| Rate for Payer: Cash Price |
$1,012.75
|
| Rate for Payer: Cigna Commercial |
$1,681.16
|
| Rate for Payer: First Health Commercial |
$1,924.22
|
| Rate for Payer: Humana Commercial |
$1,721.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$1,944.48
|
| Rate for Payer: United Healthcare All Payer |
$1,782.44
|
|
|
VASCADE VCS 6/7F
|
Facility
|
OP
|
$2,025.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$1,944.48 |
| Rate for Payer: Aetna Commercial |
$1,559.64
|
| Rate for Payer: Anthem Medicaid |
$696.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.89
|
| Rate for Payer: Cash Price |
$1,012.75
|
| Rate for Payer: Cigna Commercial |
$1,681.16
|
| Rate for Payer: First Health Commercial |
$1,924.22
|
| Rate for Payer: Humana Commercial |
$1,721.68
|
| Rate for Payer: Humana KY Medicaid |
$696.57
|
| Rate for Payer: Kentucky WC Medicaid |
$703.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$1,944.48
|
| Rate for Payer: United Healthcare All Payer |
$1,782.44
|
|
|
VASCADE VCS 6/7F
|
Facility
|
IP
|
$2,025.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$1,944.48 |
| Rate for Payer: Aetna Commercial |
$1,559.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.89
|
| Rate for Payer: Cash Price |
$1,012.75
|
| Rate for Payer: Cigna Commercial |
$1,681.16
|
| Rate for Payer: First Health Commercial |
$1,924.22
|
| Rate for Payer: Humana Commercial |
$1,721.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$1,944.48
|
| Rate for Payer: United Healthcare All Payer |
$1,782.44
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$628.80 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.05
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.52 |
| Max. Negotiated Rate |
$5,515.96 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$349.52
|
| Rate for Payer: Anthem Medicaid |
$366.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.00
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$821.22
|
| Rate for Payer: Healthspan PPO |
$5,515.96
|
| Rate for Payer: Humana Medicaid |
$366.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.49
|
| Rate for Payer: Molina Healthcare Passport |
$366.17
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.50
|
| Rate for Payer: UHCCP Medicaid |
$367.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.83
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem Medicaid |
$225.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| 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 |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Humana KY Medicaid |
$225.25
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$227.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$229.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.05
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
|
VASC EMBOLIZATION/OCC VENOUS(P
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
761P1564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.52 |
| Max. Negotiated Rate |
$5,515.96 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$349.52
|
| Rate for Payer: Anthem Medicaid |
$366.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.00
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$821.22
|
| Rate for Payer: Healthspan PPO |
$5,515.96
|
| Rate for Payer: Humana Medicaid |
$366.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.49
|
| Rate for Payer: Molina Healthcare Passport |
$366.17
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.50
|
| Rate for Payer: UHCCP Medicaid |
$367.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.83
|
|
|
VASC EMBOLIZE/OCCLUDE ARTER(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
761P1565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.31 |
| Max. Negotiated Rate |
$9,267.62 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.31
|
| Rate for Payer: Anthem Medicaid |
$408.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$916.98
|
| Rate for Payer: Healthspan PPO |
$9,267.62
|
| Rate for Payer: Humana Medicaid |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$656.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.03
|
| Rate for Payer: Molina Healthcare Passport |
$408.85
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$409.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$412.94
|
|
|
VASC EMBOLIZE/OCCLUDE ARTER(T
|
Facility
|
OP
|
$17,325.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
761T1565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,252.25 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Aetna Commercial |
$13,340.25
|
| Rate for Payer: Anthem Medicaid |
$5,958.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,513.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$8,662.50
|
| Rate for Payer: Cash Price |
$8,662.50
|
| Rate for Payer: Cigna Commercial |
$14,379.75
|
| Rate for Payer: First Health Commercial |
$16,458.75
|
| Rate for Payer: Humana Commercial |
$14,726.25
|
| Rate for Payer: Humana KY Medicaid |
$5,958.07
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$6,018.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,206.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,785.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,077.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,252.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,370.75
|
| Rate for Payer: PHCS Commercial |
$16,632.00
|
| Rate for Payer: United Healthcare All Payer |
$15,246.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTER(T
|
Facility
|
IP
|
$17,325.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
761T1565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,252.25 |
| Max. Negotiated Rate |
$16,632.00 |
| Rate for Payer: Aetna Commercial |
$13,340.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,513.50
|
| Rate for Payer: Cash Price |
$8,662.50
|
| Rate for Payer: Cigna Commercial |
$14,379.75
|
| Rate for Payer: First Health Commercial |
$16,458.75
|
| Rate for Payer: Humana Commercial |
$14,726.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,206.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,785.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,197.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,252.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,370.75
|
| Rate for Payer: PHCS Commercial |
$16,632.00
|
| Rate for Payer: United Healthcare All Payer |
$15,246.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTERY
|
Facility
|
OP
|
$18,375.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
76101565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,388.75 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Aetna Commercial |
$14,148.75
|
| Rate for Payer: Anthem Medicaid |
$6,319.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,332.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$9,187.50
|
| Rate for Payer: Cash Price |
$9,187.50
|
| Rate for Payer: Cigna Commercial |
$15,251.25
|
| Rate for Payer: First Health Commercial |
$17,456.25
|
| Rate for Payer: Humana Commercial |
$15,618.75
|
| Rate for Payer: Humana KY Medicaid |
$6,319.16
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$6,383.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,067.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,560.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,445.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,170.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,388.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.25
|
| Rate for Payer: PHCS Commercial |
$17,640.00
|
| Rate for Payer: United Healthcare All Payer |
$16,170.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTERY
|
Facility
|
IP
|
$18,375.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
76101565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,388.75 |
| Max. Negotiated Rate |
$17,640.00 |
| Rate for Payer: Aetna Commercial |
$14,148.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,332.50
|
| Rate for Payer: Cash Price |
$9,187.50
|
| Rate for Payer: Cigna Commercial |
$15,251.25
|
| Rate for Payer: First Health Commercial |
$17,456.25
|
| Rate for Payer: Humana Commercial |
$15,618.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,067.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,560.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,512.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,170.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,388.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.25
|
| Rate for Payer: PHCS Commercial |
$17,640.00
|
| Rate for Payer: United Healthcare All Payer |
$16,170.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTERY
|
Professional
|
Both
|
$18,375.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
76101565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.31 |
| Max. Negotiated Rate |
$18,375.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.31
|
| Rate for Payer: Anthem Medicaid |
$408.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$18,375.00
|
| Rate for Payer: Cash Price |
$9,187.50
|
| Rate for Payer: Cash Price |
$9,187.50
|
| Rate for Payer: Cigna Commercial |
$916.98
|
| Rate for Payer: Healthspan PPO |
$9,267.62
|
| Rate for Payer: Humana Medicaid |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$656.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.03
|
| Rate for Payer: Molina Healthcare Passport |
$408.85
|
| Rate for Payer: Multiplan PHCS |
$11,025.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12,862.50
|
| Rate for Payer: UHCCP Medicaid |
$409.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$412.94
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED
|
Facility
|
OP
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
76101567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.10 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$5,058.90
|
| Rate for Payer: Anthem Medicaid |
$2,259.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,124.60
|
| 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 |
$3,285.00
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cigna Commercial |
$5,453.10
|
| Rate for Payer: First Health Commercial |
$6,241.50
|
| Rate for Payer: Humana Commercial |
$5,584.50
|
| Rate for Payer: Humana KY Medicaid |
$2,259.42
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,282.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,387.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,848.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,304.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,781.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,927.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.70
|
| Rate for Payer: PHCS Commercial |
$6,307.20
|
| Rate for Payer: United Healthcare All Payer |
$5,781.60
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED
|
Professional
|
Both
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
76101567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.86 |
| Max. Negotiated Rate |
$8,214.91 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$542.86
|
| Rate for Payer: Anthem Medicaid |
$568.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,570.00
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cigna Commercial |
$1,275.38
|
| Rate for Payer: Healthspan PPO |
$8,214.91
|
| Rate for Payer: Humana Medicaid |
$568.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$912.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.06
|
| Rate for Payer: Molina Healthcare Passport |
$568.69
|
| Rate for Payer: Multiplan PHCS |
$3,942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,599.00
|
| Rate for Payer: UHCCP Medicaid |
$570.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.38
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
76101567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.10 |
| Max. Negotiated Rate |
$6,307.20 |
| Rate for Payer: Aetna Commercial |
$5,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,124.60
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cigna Commercial |
$5,453.10
|
| Rate for Payer: First Health Commercial |
$6,241.50
|
| Rate for Payer: Humana Commercial |
$5,584.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,387.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,848.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,971.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,781.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,927.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.70
|
| Rate for Payer: PHCS Commercial |
$6,307.20
|
| Rate for Payer: United Healthcare All Payer |
$5,781.60
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED(P
|
Professional
|
Both
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
761P1567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.86 |
| Max. Negotiated Rate |
$8,214.91 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$542.86
|
| Rate for Payer: Anthem Medicaid |
$568.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,570.00
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cash Price |
$3,285.00
|
| Rate for Payer: Cigna Commercial |
$1,275.38
|
| Rate for Payer: Healthspan PPO |
$8,214.91
|
| Rate for Payer: Humana Medicaid |
$568.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$912.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.06
|
| Rate for Payer: Molina Healthcare Passport |
$568.69
|
| Rate for Payer: Multiplan PHCS |
$3,942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,599.00
|
| Rate for Payer: UHCCP Medicaid |
$570.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.38
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| 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 |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
761P1566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.38 |
| Max. Negotiated Rate |
$11,696.10 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$465.38
|
| Rate for Payer: Anthem Medicaid |
$487.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$1,093.32
|
| Rate for Payer: Healthspan PPO |
$11,696.10
|
| Rate for Payer: Humana Medicaid |
$487.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$782.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.22
|
| Rate for Payer: Molina Healthcare Passport |
$487.47
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$488.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.34
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.38 |
| Max. Negotiated Rate |
$11,696.10 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$465.38
|
| Rate for Payer: Anthem Medicaid |
$487.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$1,093.32
|
| Rate for Payer: Healthspan PPO |
$11,696.10
|
| Rate for Payer: Humana Medicaid |
$487.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$782.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.22
|
| Rate for Payer: Molina Healthcare Passport |
$487.47
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$488.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.34
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
VASCULAR EMBOLIZATION OR OCCLUSION, INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION; ARTERIAL, OTHER THAN HEMORRHAGE OR TUMOR (EG, CONGENITAL OR ACQUIRED ARTERIAL MALFORMATIONS, ARTERIOVENOUS MALFORMATIONS, ARTERIOVENOUS FISTULAS, ANEURYSMS, PSEUDOANEURYSMS)
|
Facility
|
OP
|
$21,228.97
|
|
|
Service Code
|
CPT 37242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,163.55 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
|
|
VASCULAR SHEATH 6FR FLEXOR
|
Facility
|
OP
|
$1,155.52
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$1,109.30 |
| Rate for Payer: Aetna Commercial |
$889.75
|
| Rate for Payer: Anthem Medicaid |
$397.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.31
|
| Rate for Payer: Cash Price |
$577.76
|
| Rate for Payer: Cigna Commercial |
$959.08
|
| Rate for Payer: First Health Commercial |
$1,097.74
|
| Rate for Payer: Humana Commercial |
$982.19
|
| Rate for Payer: Humana KY Medicaid |
$397.38
|
| Rate for Payer: Kentucky WC Medicaid |
$401.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.86
|
| Rate for Payer: Ohio Health Group HMO |
$866.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.21
|
| Rate for Payer: PHCS Commercial |
$1,109.30
|
| Rate for Payer: United Healthcare All Payer |
$1,016.86
|
|
