|
HEMI CK/HK LGNSZ5-6 10MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ5-6 10MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGN SZ5-6 5MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGN SZ5-6 5MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
HEMI STEP WDG G11 SZ 1-2 10
|
Facility
|
IP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 1-2 10
|
Facility
|
OP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem Medicaid |
$2,524.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Humana KY Medicaid |
$2,524.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,575.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 3-4 10
|
Facility
|
OP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem Medicaid |
$2,524.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Humana KY Medicaid |
$2,524.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,575.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 3-4 10
|
Facility
|
IP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 5-6 10
|
Facility
|
OP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem Medicaid |
$2,524.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Humana KY Medicaid |
$2,524.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,575.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 5-6 10
|
Facility
|
IP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 7-8 10
|
Facility
|
IP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMI STEP WDG G11 SZ 7-8 10
|
Facility
|
OP
|
$7,341.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,202.50 |
| Max. Negotiated Rate |
$7,048.01 |
| Rate for Payer: Aetna Commercial |
$5,653.09
|
| Rate for Payer: Anthem Medicaid |
$2,524.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,726.51
|
| Rate for Payer: Cash Price |
$3,670.84
|
| Rate for Payer: Cigna Commercial |
$6,093.59
|
| Rate for Payer: First Health Commercial |
$6,974.60
|
| Rate for Payer: Humana Commercial |
$6,240.43
|
| Rate for Payer: Humana KY Medicaid |
$2,524.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,020.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,418.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,575.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,460.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,506.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,873.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,387.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,065.76
|
| Rate for Payer: PHCS Commercial |
$7,048.01
|
| Rate for Payer: United Healthcare All Payer |
$6,460.68
|
|
|
HEMOCULT FECAL GUAIAC
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.45
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Humana Commercial |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.42
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
HEMOCULT FECAL GUAIAC
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem Medicaid |
$4.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Humana Commercial |
$15.30
|
| Rate for Payer: Humana KY Medicaid |
$4.23
|
| Rate for Payer: Humana Medicare Advantage |
$4.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.42
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
HEMODIALYSIS ONE EVALUATION
|
Professional
|
Both
|
$477.42
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
76103010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Aetna Commercial |
$104.33
|
| Rate for Payer: Ambetter Exchange |
$66.46
|
| Rate for Payer: Anthem Medicaid |
$78.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.75
|
| Rate for Payer: Cash Price |
$238.71
|
| Rate for Payer: Cash Price |
$238.71
|
| Rate for Payer: Cigna Commercial |
$95.23
|
| Rate for Payer: Healthspan PPO |
$85.37
|
| Rate for Payer: Humana Medicaid |
$78.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.75
|
| Rate for Payer: Molina Healthcare Passport |
$78.19
|
| Rate for Payer: Multiplan PHCS |
$286.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.40
|
| Rate for Payer: UHCCP Medicaid |
$167.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.46
|
|
|
HEMODIALYSIS ONE EVALUATION (P
|
Professional
|
Both
|
$477.42
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
761P3010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Aetna Commercial |
$104.33
|
| Rate for Payer: Ambetter Exchange |
$66.46
|
| Rate for Payer: Anthem Medicaid |
$78.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.75
|
| Rate for Payer: Cash Price |
$238.71
|
| Rate for Payer: Cash Price |
$238.71
|
| Rate for Payer: Cigna Commercial |
$95.23
|
| Rate for Payer: Healthspan PPO |
$85.37
|
| Rate for Payer: Humana Medicaid |
$78.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.75
|
| Rate for Payer: Molina Healthcare Passport |
$78.19
|
| Rate for Payer: Multiplan PHCS |
$286.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.40
|
| Rate for Payer: UHCCP Medicaid |
$167.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.46
|
|
|
HEMODIALYSIS REPEATED EVAL
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 90937
|
| Hospital Charge Code |
76103011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$171.77 |
| Rate for Payer: Aetna Commercial |
$171.77
|
| Rate for Payer: Ambetter Exchange |
$96.17
|
| Rate for Payer: Anthem Medicaid |
$137.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.40
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$145.60
|
| Rate for Payer: Healthspan PPO |
$140.56
|
| Rate for Payer: Humana Medicaid |
$137.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.12
|
| Rate for Payer: Molina Healthcare Passport |
$137.37
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.02
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.17
|
|
|
HEMODIALYSIS REPEATED EVAL (P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 90937
|
| Hospital Charge Code |
761P3011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$171.77 |
| Rate for Payer: Aetna Commercial |
$171.77
|
| Rate for Payer: Ambetter Exchange |
$96.17
|
| Rate for Payer: Anthem Medicaid |
$137.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.40
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$145.60
|
| Rate for Payer: Healthspan PPO |
$140.56
|
| Rate for Payer: Humana Medicaid |
$137.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.12
|
| Rate for Payer: Molina Healthcare Passport |
$137.37
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.02
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.17
|
|
|
HEMOGLOBIN
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30000568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HEMOGLOBIN
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30000568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$2.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$2.37
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HEMOGLOBIN
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30000568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Ambetter Exchange |
$2.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.84
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$3.45
|
| Rate for Payer: Healthspan PPO |
$2.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.37
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
|
|
HEMOGLOBIN POC
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30001930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$2.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$2.37
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
HEMOGLOBIN POC
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30001930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Ambetter Exchange |
$2.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.84
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$3.45
|
| Rate for Payer: Healthspan PPO |
$2.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.37
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.37
|
|
|
HEMOGLOBIN POC
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
30001930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
