|
ARTERIOVENOUS ANASTOMOSIS
|
Professional
|
Both
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
76101507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.86 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Aetna Commercial |
$1,045.78
|
| Rate for Payer: Anthem Medicaid |
$475.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,646.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$803.18
|
| Rate for Payer: Healthspan PPO |
$836.20
|
| Rate for Payer: Humana Medicaid |
$475.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$916.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.38
|
| Rate for Payer: Molina Healthcare Passport |
$475.86
|
| Rate for Payer: Multiplan PHCS |
$1,587.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,852.20
|
| Rate for Payer: UHCCP Medicaid |
$926.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.62
|
|
|
ARTERIOVENOUS ANASTOMOSIS
|
Facility
|
OP
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
76101507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,037.42
|
| Rate for Payer: Anthem Medicaid |
$909.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$2,196.18
|
| Rate for Payer: First Health Commercial |
$2,513.70
|
| Rate for Payer: Humana Commercial |
$2,249.10
|
| Rate for Payer: Humana KY Medicaid |
$909.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$919.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,169.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$928.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,328.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,984.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$820.26
|
| Rate for Payer: PHCS Commercial |
$2,540.16
|
| Rate for Payer: United Healthcare All Payer |
$2,328.48
|
|
|
ARTERIOVENOUS ANASTOMOSIS
|
Facility
|
IP
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
76101507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$2,540.16 |
| Rate for Payer: Aetna Commercial |
$2,037.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.88
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$2,196.18
|
| Rate for Payer: First Health Commercial |
$2,513.70
|
| Rate for Payer: Humana Commercial |
$2,249.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,169.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,328.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,984.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$820.26
|
| Rate for Payer: PHCS Commercial |
$2,540.16
|
| Rate for Payer: United Healthcare All Payer |
$2,328.48
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$6,652.97
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,752.12 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$6,652.97
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,752.12 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
ARTERIOVENOUS ANASTOMOSIS(P
|
Professional
|
Both
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
761P1507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.86 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Aetna Commercial |
$1,045.78
|
| Rate for Payer: Anthem Medicaid |
$475.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,646.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$803.18
|
| Rate for Payer: Healthspan PPO |
$836.20
|
| Rate for Payer: Humana Medicaid |
$475.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$916.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.38
|
| Rate for Payer: Molina Healthcare Passport |
$475.86
|
| Rate for Payer: Multiplan PHCS |
$1,587.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,852.20
|
| Rate for Payer: UHCCP Medicaid |
$926.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.62
|
|
|
ARTERIOVENOUS GRAFT PLACEMEN(P
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
761P1506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,275.13 |
| Rate for Payer: Aetna Commercial |
$1,275.13
|
| Rate for Payer: Anthem Medicaid |
$610.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,223.00
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,211.42
|
| Rate for Payer: Healthspan PPO |
$1,019.58
|
| Rate for Payer: Humana Medicaid |
$610.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,077.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.68
|
| Rate for Payer: Molina Healthcare Passport |
$610.47
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.10
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.57
|
|
|
ARTERIOVENOUS GRAFT PLACEMENT
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
76101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,275.13 |
| Rate for Payer: Aetna Commercial |
$1,275.13
|
| Rate for Payer: Anthem Medicaid |
$610.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,223.00
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,211.42
|
| Rate for Payer: Healthspan PPO |
$1,019.58
|
| Rate for Payer: Humana Medicaid |
$610.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,077.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.68
|
| Rate for Payer: Molina Healthcare Passport |
$610.47
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.10
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.57
|
|
|
ARTERIOVENOUS GRAFT PLACEMENT
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
76101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.99 |
| Max. Negotiated Rate |
$1,174.08 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.13
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
ARTERIOVENOUS GRAFT PLACEMENT
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
76101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.99 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem Medicaid |
$420.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Humana KY Medicaid |
$420.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$424.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.13
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
ARTERI VENOUS SHUNT
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
76101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.62
|
| Rate for Payer: Anthem Medicaid |
$118.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Humana Medicaid |
$118.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.21
|
| Rate for Payer: Molina Healthcare Passport |
$118.83
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$130.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.02
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem Medicaid |
$478.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Humana KY Medicaid |
$478.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$483.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$488.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
32000367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem Medicaid |
$478.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Humana KY Medicaid |
$478.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$483.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$488.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,336.32 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem Medicaid |
$478.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Humana KY Medicaid |
$478.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$483.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$488.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
76101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
76101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
32000367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,336.32 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$1,336.32 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.52
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
761P1514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.62
|
| Rate for Payer: Anthem Medicaid |
$118.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Humana Medicaid |
$118.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.21
|
| Rate for Payer: Molina Healthcare Passport |
$118.83
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$130.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.02
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
ARTERY BYPASS GRAFT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.91 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,964.95
|
| Rate for Payer: Anthem Medicaid |
$934.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,883.40
|
| Rate for Payer: Healthspan PPO |
$1,931.93
|
| Rate for Payer: Humana Medicaid |
$934.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.61
|
| Rate for Payer: Molina Healthcare Passport |
$934.91
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.26
|
|
