|
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: Ambetter Exchange |
$397.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$349.52
|
| Rate for Payer: Anthem Medicaid |
$3,377.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$397.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$397.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$477.50
|
| 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 |
$3,377.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$397.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,445.52
|
| Rate for Payer: Molina Healthcare Passport |
$3,377.96
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.30
|
| Rate for Payer: UHCCP Medicaid |
$367.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,411.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$397.92
|
|
|
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: Ambetter Exchange |
$443.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.31
|
| Rate for Payer: Anthem Medicaid |
$5,672.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$443.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$443.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$532.13
|
| 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 |
$5,672.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$656.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$443.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$443.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,785.48
|
| Rate for Payer: Molina Healthcare Passport |
$5,672.04
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$576.47
|
| Rate for Payer: UHCCP Medicaid |
$409.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,728.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.44
|
|
|
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 |
$5,197.50 |
| 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 |
$13,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,072.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,954.25
|
| Rate for Payer: PHCS Commercial |
$16,632.00
|
| Rate for Payer: United Healthcare All Payer |
$15,246.00
|
|
|
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 |
$5,958.07 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$13,340.25
|
| Rate for Payer: Anthem Medicaid |
$5,958.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,513.50
|
| 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 |
$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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$13,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,072.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,954.25
|
| Rate for Payer: PHCS Commercial |
$16,632.00
|
| Rate for Payer: United Healthcare All Payer |
$15,246.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTERY
|
Facility
|
IP
|
$18,375.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
76101565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,512.50 |
| 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 |
$14,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,986.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,678.75
|
| Rate for Payer: PHCS Commercial |
$17,640.00
|
| Rate for Payer: United Healthcare All Payer |
$16,170.00
|
|
|
VASC EMBOLIZE/OCCLUDE ARTERY
|
Facility
|
OP
|
$18,375.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
76101565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,319.16 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$14,148.75
|
| Rate for Payer: Anthem Medicaid |
$6,319.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,332.50
|
| 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 |
$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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$14,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,986.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,678.75
|
| 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 |
$11,025.00 |
| Rate for Payer: Ambetter Exchange |
$443.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.31
|
| Rate for Payer: Anthem Medicaid |
$5,672.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$443.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$443.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$532.13
|
| 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 |
$5,672.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$656.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$443.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$443.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,785.48
|
| Rate for Payer: Molina Healthcare Passport |
$5,672.04
|
| Rate for Payer: Multiplan PHCS |
$11,025.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$576.47
|
| Rate for Payer: UHCCP Medicaid |
$409.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,728.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$443.44
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED
|
Facility
|
OP
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
76101567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,259.42 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$5,058.90
|
| Rate for Payer: Anthem Medicaid |
$2,259.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,124.60
|
| 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 |
$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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$5,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,715.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,533.30
|
| Rate for Payer: PHCS Commercial |
$6,307.20
|
| Rate for Payer: United Healthcare All Payer |
$5,781.60
|
|
|
VASC EMBOLIZE/OCCLUDE BLEED
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
76101567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,971.00 |
| 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 |
$5,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,715.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,533.30
|
| 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: Ambetter Exchange |
$613.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$542.86
|
| Rate for Payer: Anthem Medicaid |
$5,031.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$613.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$613.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$736.58
|
| 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 |
$5,031.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$912.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$613.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,131.75
|
| Rate for Payer: Molina Healthcare Passport |
$5,031.13
|
| Rate for Payer: Multiplan PHCS |
$3,942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$797.97
|
| Rate for Payer: UHCCP Medicaid |
$570.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,081.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$613.82
|
|
|
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: Ambetter Exchange |
$613.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$542.86
|
| Rate for Payer: Anthem Medicaid |
$5,031.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$613.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$613.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$736.58
|
| 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 |
$5,031.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$912.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$613.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5,131.75
|
| Rate for Payer: Molina Healthcare Passport |
$5,031.13
|
| Rate for Payer: Multiplan PHCS |
$3,942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$797.97
|
| Rate for Payer: UHCCP Medicaid |
$570.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5,081.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$613.82
|
|
|
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: Ambetter Exchange |
$521.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$465.38
|
| Rate for Payer: Anthem Medicaid |
$7,157.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$521.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$521.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.35
|
| 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 |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$782.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$521.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7,301.01
|
| Rate for Payer: Molina Healthcare Passport |
$7,157.85
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.55
|
| Rate for Payer: UHCCP Medicaid |
$488.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,229.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$521.96
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| 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 |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| 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 |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.38 |
| Max. Negotiated Rate |
$11,696.10 |
| Rate for Payer: Ambetter Exchange |
$521.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$465.38
|
| Rate for Payer: Anthem Medicaid |
$7,157.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$521.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$521.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.35
|
| 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 |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$782.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$521.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7,301.01
|
| Rate for Payer: Molina Healthcare Passport |
$7,157.85
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.55
|
| Rate for Payer: UHCCP Medicaid |
$488.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,229.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$521.96
|
|
|
VASC EMBOLZ/OCCL INC RADIOLGCA
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 37243
|
| Hospital Charge Code |
76101566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| 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 |
$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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| 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
|
$23,228.31
|
|
|
Service Code
|
CPT 37242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,591.65 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
|
|
VASCULAR SHEATH 6FR FLEXOR
|
Facility
|
IP
|
$1,205.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.57 |
| Max. Negotiated Rate |
$1,157.04 |
| Rate for Payer: Aetna Commercial |
$928.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.10
|
| Rate for Payer: Cash Price |
$602.62
|
| Rate for Payer: Cigna Commercial |
$1,000.36
|
| Rate for Payer: First Health Commercial |
$1,144.99
|
| Rate for Payer: Humana Commercial |
$1,024.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.62
|
| Rate for Payer: Ohio Health Group HMO |
$903.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.62
|
| Rate for Payer: PHCS Commercial |
$1,157.04
|
| Rate for Payer: United Healthcare All Payer |
$1,060.62
|
|
|
VASCULAR SHEATH 6FR FLEXOR
|
Facility
|
OP
|
$1,205.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.57 |
| Max. Negotiated Rate |
$1,157.04 |
| Rate for Payer: Aetna Commercial |
$928.04
|
| Rate for Payer: Anthem Medicaid |
$414.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.10
|
| Rate for Payer: Cash Price |
$602.62
|
| Rate for Payer: Cigna Commercial |
$1,000.36
|
| Rate for Payer: First Health Commercial |
$1,144.99
|
| Rate for Payer: Humana Commercial |
$1,024.46
|
| Rate for Payer: Humana KY Medicaid |
$414.49
|
| Rate for Payer: Kentucky WC Medicaid |
$418.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.62
|
| Rate for Payer: Ohio Health Group HMO |
$903.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.62
|
| Rate for Payer: PHCS Commercial |
$1,157.04
|
| Rate for Payer: United Healthcare All Payer |
$1,060.62
|
|
|
VASCULAR SHEATH 7FR FLEXOR
|
Facility
|
IP
|
$1,205.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.57 |
| Max. Negotiated Rate |
$1,157.04 |
| Rate for Payer: Aetna Commercial |
$928.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.10
|
| Rate for Payer: Cash Price |
$602.62
|
| Rate for Payer: Cigna Commercial |
$1,000.36
|
| Rate for Payer: First Health Commercial |
$1,144.99
|
| Rate for Payer: Humana Commercial |
$1,024.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.62
|
| Rate for Payer: Ohio Health Group HMO |
$903.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.62
|
| Rate for Payer: PHCS Commercial |
$1,157.04
|
| Rate for Payer: United Healthcare All Payer |
$1,060.62
|
|
|
VASCULAR SHEATH 7FR FLEXOR
|
Facility
|
OP
|
$1,205.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.57 |
| Max. Negotiated Rate |
$1,157.04 |
| Rate for Payer: Aetna Commercial |
$928.04
|
| Rate for Payer: Anthem Medicaid |
$414.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.10
|
| Rate for Payer: Cash Price |
$602.62
|
| Rate for Payer: Cigna Commercial |
$1,000.36
|
| Rate for Payer: First Health Commercial |
$1,144.99
|
| Rate for Payer: Humana Commercial |
$1,024.46
|
| Rate for Payer: Humana KY Medicaid |
$414.49
|
| Rate for Payer: Kentucky WC Medicaid |
$418.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.62
|
| Rate for Payer: Ohio Health Group HMO |
$903.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.62
|
| Rate for Payer: PHCS Commercial |
$1,157.04
|
| Rate for Payer: United Healthcare All Payer |
$1,060.62
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Ambetter Exchange |
$220.45
|
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.54
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$489.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.58
|
| Rate for Payer: UHCCP Medicaid |
$285.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.45
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
VASC VEINMAP DIALYSIS ACCESS(P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921P0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$286.58 |
| Rate for Payer: Ambetter Exchange |
$220.45
|
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.54
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.58
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.45
|
|
|
VASC VEINMAP DIALYSIS ACCESS(T
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.44
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
