|
ARTERIAL BLOOD GAS STICK RT
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761P1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Ambetter Exchange |
$98.61
|
| Rate for Payer: Anthem Medicaid |
$89.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.33
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$155.58
|
| Rate for Payer: Healthspan PPO |
$136.17
|
| Rate for Payer: Humana Medicaid |
$89.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.15
|
| Rate for Payer: Molina Healthcare Passport |
$89.36
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.19
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.61
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Professional
|
Both
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$1,395.71 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Ambetter Exchange |
$98.61
|
| Rate for Payer: Anthem Medicaid |
$89.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.33
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$155.58
|
| Rate for Payer: Healthspan PPO |
$136.17
|
| Rate for Payer: Humana Medicaid |
$89.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.15
|
| Rate for Payer: Molina Healthcare Passport |
$89.36
|
| Rate for Payer: Multiplan PHCS |
$1,395.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.19
|
| Rate for Payer: UHCCP Medicaid |
$814.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.61
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Facility
|
IP
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.85 |
| Max. Negotiated Rate |
$2,233.13 |
| Rate for Payer: Aetna Commercial |
$1,791.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.42
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$1,930.73
|
| Rate for Payer: First Health Commercial |
$2,209.87
|
| Rate for Payer: Humana Commercial |
$1,977.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,023.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.06
|
| Rate for Payer: PHCS Commercial |
$2,233.13
|
| Rate for Payer: United Healthcare All Payer |
$2,047.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Facility
|
OP
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.85 |
| Max. Negotiated Rate |
$2,233.13 |
| Rate for Payer: Aetna Commercial |
$1,791.16
|
| Rate for Payer: Anthem Medicaid |
$799.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.42
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$1,930.73
|
| Rate for Payer: First Health Commercial |
$2,209.87
|
| Rate for Payer: Humana Commercial |
$1,977.25
|
| Rate for Payer: Humana KY Medicaid |
$799.97
|
| Rate for Payer: Kentucky WC Medicaid |
$808.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$816.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,023.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.06
|
| Rate for Payer: PHCS Commercial |
$2,233.13
|
| Rate for Payer: United Healthcare All Payer |
$2,047.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(T
|
Facility
|
IP
|
$2,126.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761T1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.85 |
| Max. Negotiated Rate |
$2,041.13 |
| Rate for Payer: Aetna Commercial |
$1,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,063.09
|
| Rate for Payer: Cigna Commercial |
$1,764.73
|
| Rate for Payer: First Health Commercial |
$2,019.87
|
| Rate for Payer: Humana Commercial |
$1,807.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.06
|
| Rate for Payer: PHCS Commercial |
$2,041.13
|
| Rate for Payer: United Healthcare All Payer |
$1,871.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(T
|
Facility
|
OP
|
$2,126.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761T1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.85 |
| Max. Negotiated Rate |
$2,041.13 |
| Rate for Payer: Aetna Commercial |
$1,637.16
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,063.09
|
| Rate for Payer: Cigna Commercial |
$1,764.73
|
| Rate for Payer: First Health Commercial |
$2,019.87
|
| Rate for Payer: Humana Commercial |
$1,807.25
|
| Rate for Payer: Humana KY Medicaid |
$731.19
|
| Rate for Payer: Kentucky WC Medicaid |
$738.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.06
|
| Rate for Payer: PHCS Commercial |
$2,041.13
|
| Rate for Payer: United Healthcare All Payer |
$1,871.04
|
|
|
ARTERIOGRAM OF EXTREMITY
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000390
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,372.50 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,980.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,156.75
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ARTERIOGRAM OF EXTREMITY
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000390
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,573.34 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem Medicaid |
$1,573.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Humana KY Medicaid |
$1,573.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,980.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,156.75
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
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 |
$1,587.60 |
| Rate for Payer: Aetna Commercial |
$1,045.78
|
| Rate for Payer: Ambetter Exchange |
$617.67
|
| Rate for Payer: Anthem Medicaid |
$475.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$617.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$617.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$741.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.67
|
| 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 |
$802.97
|
| Rate for Payer: UHCCP Medicaid |
$926.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$617.67
|
|
|
ARTERIOVENOUS ANASTOMOSIS
|
Facility
|
IP
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
76101507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$793.80 |
| 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 |
$2,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,302.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,825.74
|
| Rate for Payer: PHCS Commercial |
$2,540.16
|
| Rate for Payer: United Healthcare All Payer |
$2,328.48
|
|
|
ARTERIOVENOUS ANASTOMOSIS
|
Facility
|
OP
|
$2,646.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
76101507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.96 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,037.42
|
| Rate for Payer: Anthem Medicaid |
$909.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,302.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,825.74
|
| 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
|
$6,992.66
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$6,992.66
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
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 |
$1,587.60 |
| Rate for Payer: Aetna Commercial |
$1,045.78
|
| Rate for Payer: Ambetter Exchange |
$617.67
|
| Rate for Payer: Anthem Medicaid |
$475.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$617.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$617.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$741.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.67
|
| 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 |
$802.97
|
| Rate for Payer: UHCCP Medicaid |
$926.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$617.67
|
|
|
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: Ambetter Exchange |
$682.93
|
| Rate for Payer: Anthem Medicaid |
$610.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$682.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.93
|
| 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 |
$887.81
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.93
|
|
|
ARTERIOVENOUS GRAFT PLACEMENT
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
76101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.59 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem Medicaid |
$420.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$978.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$843.87
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
ARTERIOVENOUS GRAFT PLACEMENT
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36820
|
| Hospital Charge Code |
76101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.90 |
| 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 |
$978.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$843.87
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
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: Ambetter Exchange |
$682.93
|
| Rate for Payer: Anthem Medicaid |
$610.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$682.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.93
|
| 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 |
$887.81
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.93
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.60 |
| 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 |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$960.48
|
| 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 |
$135.00 |
| 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 |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
32000367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,141.91
|
| Rate for Payer: Anthem Medicaid |
$510.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,156.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cigna Commercial |
$1,230.89
|
| Rate for Payer: First Health Commercial |
$1,408.85
|
| Rate for Payer: Humana Commercial |
$1,260.55
|
| Rate for Payer: Humana KY Medicaid |
$510.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$515.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,216.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,094.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,305.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.27
|
| Rate for Payer: PHCS Commercial |
$1,423.68
|
| Rate for Payer: United Healthcare All Payer |
$1,305.04
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,141.91
|
| Rate for Payer: Anthem Medicaid |
$510.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,156.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cigna Commercial |
$1,230.89
|
| Rate for Payer: First Health Commercial |
$1,408.85
|
| Rate for Payer: Humana Commercial |
$1,260.55
|
| Rate for Payer: Humana KY Medicaid |
$510.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$515.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,216.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,094.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,305.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.27
|
| Rate for Payer: PHCS Commercial |
$1,423.68
|
| Rate for Payer: United Healthcare All Payer |
$1,305.04
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$444.90 |
| Max. Negotiated Rate |
$1,423.68 |
| Rate for Payer: Aetna Commercial |
$1,141.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,156.74
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cigna Commercial |
$1,230.89
|
| Rate for Payer: First Health Commercial |
$1,408.85
|
| Rate for Payer: Humana Commercial |
$1,260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,216.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,094.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,305.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.27
|
| Rate for Payer: PHCS Commercial |
$1,423.68
|
| Rate for Payer: United Healthcare All Payer |
$1,305.04
|
|
