|
REMOV SKIN TAGS INCLUDETO 15
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$95.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.02
|
| Rate for Payer: Anthem Medicaid |
$26.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$105.32
|
| Rate for Payer: Healthspan PPO |
$89.24
|
| Rate for Payer: Humana Medicaid |
$26.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.53
|
| Rate for Payer: Molina Healthcare Passport |
$26.99
|
| Rate for Payer: Multiplan PHCS |
$223.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.40
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.26
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
45000029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761P0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$95.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.02
|
| Rate for Payer: Anthem Medicaid |
$26.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$105.32
|
| Rate for Payer: Healthspan PPO |
$89.24
|
| Rate for Payer: Humana Medicaid |
$26.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.53
|
| Rate for Payer: Molina Healthcare Passport |
$26.99
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.26
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
HCPCS 54417
|
| Hospital Charge Code |
76102885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.44 |
| Max. Negotiated Rate |
$2,100.48 |
| Rate for Payer: Aetna Commercial |
$1,684.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cigna Commercial |
$1,816.04
|
| Rate for Payer: First Health Commercial |
$2,078.60
|
| Rate for Payer: Humana Commercial |
$1,859.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,614.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,925.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.28
|
| Rate for Payer: PHCS Commercial |
$2,100.48
|
| Rate for Payer: United Healthcare All Payer |
$1,925.44
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
HCPCS 54417
|
| Hospital Charge Code |
76102885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.44 |
| Max. Negotiated Rate |
$15,540.98 |
| Rate for Payer: Aetna Commercial |
$1,684.76
|
| Rate for Payer: Anthem Medicaid |
$752.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,100.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,706.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,540.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,985.94
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cigna Commercial |
$1,816.04
|
| Rate for Payer: First Health Commercial |
$2,078.60
|
| Rate for Payer: Humana Commercial |
$1,859.80
|
| Rate for Payer: Humana KY Medicaid |
$752.45
|
| Rate for Payer: Humana Medicare Advantage |
$11,100.70
|
| Rate for Payer: Kentucky WC Medicaid |
$760.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,614.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,320.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,925.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.28
|
| Rate for Payer: PHCS Commercial |
$2,100.48
|
| Rate for Payer: United Healthcare All Payer |
$1,925.44
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 54417
|
| Hospital Charge Code |
76102885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.79 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$1,460.83
|
| Rate for Payer: Anthem Medicaid |
$625.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,188.00
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cigna Commercial |
$1,286.53
|
| Rate for Payer: Healthspan PPO |
$1,414.45
|
| Rate for Payer: Humana Medicaid |
$625.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,225.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$638.31
|
| Rate for Payer: Molina Healthcare Passport |
$625.79
|
| Rate for Payer: Multiplan PHCS |
$1,312.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,531.60
|
| Rate for Payer: UHCCP Medicaid |
$765.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$632.05
|
|
|
REMV&REPLC PM GEN DUAL LEAD
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
76101259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.78
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMV&REPLC PM GEN DUAL LEAD
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
76101259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMV&REPLC PM GEN DUAL LEAD
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
76101259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.14 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Anthem Medicaid |
$283.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$656.60
|
| Rate for Payer: Healthspan PPO |
$441.18
|
| Rate for Payer: Humana Medicaid |
$283.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.80
|
| Rate for Payer: Molina Healthcare Passport |
$283.14
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.97
|
|
|
REMV&REPLC PM GEN DUAL LEAD(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
761P1259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.14 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Anthem Medicaid |
$283.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$656.60
|
| Rate for Payer: Healthspan PPO |
$441.18
|
| Rate for Payer: Humana Medicaid |
$283.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.80
|
| Rate for Payer: Molina Healthcare Passport |
$283.14
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.97
|
|
|
REMV&REPLC PM GEN MULT LEAD(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
761P1260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$294.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$683.72
|
| Rate for Payer: Healthspan PPO |
$459.49
|
| Rate for Payer: Humana Medicaid |
$294.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$492.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.74
|
| Rate for Payer: Molina Healthcare Passport |
$294.84
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.79
|
|
|
REMV&REPLC PM GEN MULT LEADS
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
76101260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMV&REPLC PM GEN MULT LEADS
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
76101260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$23,589.87 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,849.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,589.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,747.38
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$16,849.91
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,219.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMV&REPLC PM GEN MULT LEADS
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
76101260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.84 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$294.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$683.72
|
| Rate for Payer: Healthspan PPO |
$459.49
|
| Rate for Payer: Humana Medicaid |
$294.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$492.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.74
|
| Rate for Payer: Molina Healthcare Passport |
$294.84
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.79
|
|
|
RENAGEL (SEVELAMER) 400 MG TAB
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
NDC 68462044626
|
| Hospital Charge Code |
25001305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: Anthem Medicaid |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.75
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna Commercial |
$9.31
|
| Rate for Payer: First Health Commercial |
$10.66
|
| Rate for Payer: Humana Commercial |
$9.54
|
| Rate for Payer: Humana KY Medicaid |
$3.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.87
|
| Rate for Payer: Ohio Health Group HMO |
$8.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Payer |
$9.87
|
|
|
RENAGEL (SEVELAMER) 400 MG TAB
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
NDC 68462044626
|
| Hospital Charge Code |
25001305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.75
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna Commercial |
$9.31
|
| Rate for Payer: First Health Commercial |
$10.66
|
| Rate for Payer: Humana Commercial |
$9.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.87
|
| Rate for Payer: Ohio Health Group HMO |
$8.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Payer |
$9.87
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
IP
|
$3,419.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
76101458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.47 |
| Max. Negotiated Rate |
$3,282.24 |
| Rate for Payer: Aetna Commercial |
$2,632.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.82
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cigna Commercial |
$2,837.77
|
| Rate for Payer: First Health Commercial |
$3,248.05
|
| Rate for Payer: Humana Commercial |
$2,906.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,803.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,523.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,008.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,564.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.89
|
| Rate for Payer: PHCS Commercial |
$3,282.24
|
| Rate for Payer: United Healthcare All Payer |
$3,008.72
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
OP
|
$3,419.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
76101458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.47 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,632.63
|
| Rate for Payer: Anthem Medicaid |
$1,175.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.82
|
| 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 |
$1,709.50
|
| Rate for Payer: Cash Price |
$1,709.50
|
| Rate for Payer: Cigna Commercial |
$2,837.77
|
| Rate for Payer: First Health Commercial |
$3,248.05
|
| Rate for Payer: Humana Commercial |
$2,906.15
|
| Rate for Payer: Humana KY Medicaid |
$1,175.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,803.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,523.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,008.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,564.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.89
|
| Rate for Payer: PHCS Commercial |
$3,282.24
|
| Rate for Payer: United Healthcare All Payer |
$3,008.72
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
36000045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem Medicaid |
$1,278.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| 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 |
$1,859.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Humana KY Medicaid |
$1,278.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.58
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$3,569.28 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.58
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
36000045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$3,569.28 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.58
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$483.34 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem Medicaid |
$1,278.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| 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 |
$1,859.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Humana KY Medicaid |
$1,278.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.58
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$793.00 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$4,697.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,758.00
|
| Rate for Payer: Cash Price |
$3,050.00
|
| Rate for Payer: Cigna Commercial |
$5,063.00
|
| Rate for Payer: First Health Commercial |
$5,795.00
|
| Rate for Payer: Humana Commercial |
$5,185.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,002.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,501.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,368.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,891.00
|
| Rate for Payer: PHCS Commercial |
$5,856.00
|
| Rate for Payer: United Healthcare All Payer |
$5,368.00
|
|
