|
INTRAVASC EA ADDL VESSEL(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761P2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$282.45 |
| Rate for Payer: Aetna Commercial |
$282.45
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$262.77
|
| Rate for Payer: Healthspan PPO |
$256.10
|
| Rate for Payer: Humana Medicaid |
$124.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.96
|
| Rate for Payer: Molina Healthcare Passport |
$124.47
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.71
|
|
|
INTRAVASC EA ADDL VESSEL(T
|
Facility
|
OP
|
$2,886.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761T2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$865.90 |
| Max. Negotiated Rate |
$2,770.88 |
| Rate for Payer: Aetna Commercial |
$2,222.47
|
| Rate for Payer: Anthem Medicaid |
$992.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,251.34
|
| Rate for Payer: Cash Price |
$1,443.16
|
| Rate for Payer: Cigna Commercial |
$2,395.65
|
| Rate for Payer: First Health Commercial |
$2,742.01
|
| Rate for Payer: Humana Commercial |
$2,453.38
|
| Rate for Payer: Humana KY Medicaid |
$992.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,002.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,366.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,130.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,012.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,539.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,164.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,309.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,511.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.57
|
| Rate for Payer: PHCS Commercial |
$2,770.88
|
| Rate for Payer: United Healthcare All Payer |
$2,539.97
|
|
|
INTRAVASC EA ADDL VESSEL(T
|
Facility
|
IP
|
$2,886.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
761T2470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$865.90 |
| Max. Negotiated Rate |
$2,770.88 |
| Rate for Payer: Aetna Commercial |
$2,222.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,251.34
|
| Rate for Payer: Cash Price |
$1,443.16
|
| Rate for Payer: Cigna Commercial |
$2,395.65
|
| Rate for Payer: First Health Commercial |
$2,742.01
|
| Rate for Payer: Humana Commercial |
$2,453.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,366.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,130.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,539.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,164.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,309.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,511.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.57
|
| Rate for Payer: PHCS Commercial |
$2,770.88
|
| Rate for Payer: United Healthcare All Payer |
$2,539.97
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$5,024.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761T2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,507.20 |
| Max. Negotiated Rate |
$4,823.04 |
| Rate for Payer: Aetna Commercial |
$3,868.48
|
| Rate for Payer: Anthem Medicaid |
$1,727.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.72
|
| Rate for Payer: Cash Price |
$2,512.00
|
| Rate for Payer: Cigna Commercial |
$4,169.92
|
| Rate for Payer: First Health Commercial |
$4,772.80
|
| Rate for Payer: Humana Commercial |
$4,270.40
|
| Rate for Payer: Humana KY Medicaid |
$1,727.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,745.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,762.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,370.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.56
|
| Rate for Payer: PHCS Commercial |
$4,823.04
|
| Rate for Payer: United Healthcare All Payer |
$4,421.12
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
48100059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,442.10 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.83
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Professional
|
Both
|
$5,274.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$3,691.80 |
| Rate for Payer: Aetna Commercial |
$457.27
|
| Rate for Payer: Anthem Medicaid |
$200.09
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: Healthspan PPO |
$420.04
|
| Rate for Payer: Humana Medicaid |
$200.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.09
|
| Rate for Payer: Molina Healthcare Passport |
$200.09
|
| Rate for Payer: Multiplan PHCS |
$3,164.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,691.80
|
| Rate for Payer: UHCCP Medicaid |
$1,845.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.09
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$5,274.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,582.20 |
| Max. Negotiated Rate |
$5,063.04 |
| Rate for Payer: Aetna Commercial |
$4,060.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.72
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna Commercial |
$4,377.42
|
| Rate for Payer: First Health Commercial |
$5,010.30
|
| Rate for Payer: Humana Commercial |
$4,482.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,641.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,639.06
|
| Rate for Payer: PHCS Commercial |
$5,063.04
|
| Rate for Payer: United Healthcare All Payer |
$4,641.12
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
48100059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,442.10 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem Medicaid |
$1,653.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Humana KY Medicaid |
$1,653.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,669.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.83
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
IP
|
$5,024.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761T2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,507.20 |
| Max. Negotiated Rate |
$4,823.04 |
| Rate for Payer: Aetna Commercial |
$3,868.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.72
|
| Rate for Payer: Cash Price |
$2,512.00
|
| Rate for Payer: Cigna Commercial |
$4,169.92
|
| Rate for Payer: First Health Commercial |
$4,772.80
|
| Rate for Payer: Humana Commercial |
$4,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,421.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,019.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,370.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.56
|
| Rate for Payer: PHCS Commercial |
$4,823.04
|
| Rate for Payer: United Healthcare All Payer |
$4,421.12
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761P2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$457.27 |
| Rate for Payer: Aetna Commercial |
$457.27
|
| Rate for Payer: Anthem Medicaid |
$200.09
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: Healthspan PPO |
$420.04
|
| Rate for Payer: Humana Medicaid |
$200.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.09
|
| Rate for Payer: Molina Healthcare Passport |
$200.09
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.09
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$5,274.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,582.20 |
| Max. Negotiated Rate |
$5,063.04 |
| Rate for Payer: Aetna Commercial |
$4,060.98
|
| Rate for Payer: Anthem Medicaid |
$1,813.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.72
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna Commercial |
$4,377.42
|
| Rate for Payer: First Health Commercial |
$5,010.30
|
| Rate for Payer: Humana Commercial |
$4,482.90
|
| Rate for Payer: Humana KY Medicaid |
$1,813.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,641.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,639.06
|
| Rate for Payer: PHCS Commercial |
$5,063.04
|
| Rate for Payer: United Healthcare All Payer |
$4,641.12
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$484.80 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.15 |
| Max. Negotiated Rate |
$4,203.34 |
| Rate for Payer: Ambetter Exchange |
$294.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$4,120.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.93
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$496.05
|
| Rate for Payer: Humana Medicaid |
$4,120.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4,203.34
|
| Rate for Payer: Molina Healthcare Passport |
$4,120.92
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$382.34
|
| Rate for Payer: UHCCP Medicaid |
$254.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4,162.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.11
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.67 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem Medicaid |
$173.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| 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 |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Humana KY Medicaid |
$173.67
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,219.70 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,437.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,105.31
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,544.52 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,437.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,105.31
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$926.68 |
| Rate for Payer: Ambetter Exchange |
$223.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.71
|
| Rate for Payer: Anthem Medicaid |
$908.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.92
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$362.36
|
| Rate for Payer: Humana Medicaid |
$908.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$926.68
|
| Rate for Payer: Molina Healthcare Passport |
$908.51
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.25
|
| Rate for Payer: UHCCP Medicaid |
$195.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$917.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.27
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
INTRO CATH DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
761P1515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$926.68 |
| Rate for Payer: Ambetter Exchange |
$223.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.71
|
| Rate for Payer: Anthem Medicaid |
$908.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$267.92
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$362.36
|
| Rate for Payer: Humana Medicaid |
$908.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$926.68
|
| Rate for Payer: Molina Healthcare Passport |
$908.51
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.25
|
| Rate for Payer: UHCCP Medicaid |
$195.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$917.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.27
|
|
|
INTRO CATH DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
761P1516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.15 |
| Max. Negotiated Rate |
$4,203.34 |
| Rate for Payer: Ambetter Exchange |
$294.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$4,120.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.93
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$496.05
|
| Rate for Payer: Humana Medicaid |
$4,120.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4,203.34
|
| Rate for Payer: Molina Healthcare Passport |
$4,120.92
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$382.34
|
| Rate for Payer: UHCCP Medicaid |
$254.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4,162.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.11
|
|
|
INTRODCR MICRA 23F 55.7CM HYDR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR MICRA 23F 55.7CM HYDR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR OPTISEAL GLBL 7FR 13C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR OPTISEAL GLBL 7FR 13C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
