|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$793.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,697.00
|
| Rate for Payer: Anthem Medicaid |
$2,097.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,758.00
|
| 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 |
$3,050.00
|
| 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: Humana KY Medicaid |
$2,097.79
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,119.14
|
| 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 |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,139.88
|
| 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
|
|
|
RENAL 2>ORDER UNILAL
|
Professional
|
Both
|
$8,647.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
76101457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$8,647.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$317.42
|
| Rate for Payer: Anthem Medicaid |
$315.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,647.00
|
| Rate for Payer: Cash Price |
$4,323.50
|
| Rate for Payer: Cash Price |
$4,323.50
|
| Rate for Payer: Cigna Commercial |
$729.34
|
| Rate for Payer: Healthspan PPO |
$2,610.52
|
| Rate for Payer: Humana Medicaid |
$315.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.22
|
| Rate for Payer: Molina Healthcare Passport |
$315.90
|
| Rate for Payer: Multiplan PHCS |
$5,188.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,052.90
|
| Rate for Payer: UHCCP Medicaid |
$333.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.06
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$793.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,697.00
|
| Rate for Payer: Anthem Medicaid |
$2,097.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,758.00
|
| 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 |
$3,050.00
|
| 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: Humana KY Medicaid |
$2,097.79
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,119.14
|
| 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 |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,139.88
|
| 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
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$8,647.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
76101457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,124.11 |
| Max. Negotiated Rate |
$8,301.12 |
| Rate for Payer: Aetna Commercial |
$6,658.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.66
|
| Rate for Payer: Cash Price |
$4,323.50
|
| Rate for Payer: Cigna Commercial |
$7,177.01
|
| Rate for Payer: First Health Commercial |
$8,214.65
|
| Rate for Payer: Humana Commercial |
$7,349.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.57
|
| Rate for Payer: PHCS Commercial |
$8,301.12
|
| Rate for Payer: United Healthcare All Payer |
$7,609.36
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$8,647.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
76101457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,124.11 |
| Max. Negotiated Rate |
$8,301.12 |
| Rate for Payer: Aetna Commercial |
$6,658.19
|
| Rate for Payer: Anthem Medicaid |
$2,973.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.66
|
| 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 |
$4,323.50
|
| Rate for Payer: Cash Price |
$4,323.50
|
| Rate for Payer: Cigna Commercial |
$7,177.01
|
| Rate for Payer: First Health Commercial |
$8,214.65
|
| Rate for Payer: Humana Commercial |
$7,349.95
|
| Rate for Payer: Humana KY Medicaid |
$2,973.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,003.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,090.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.57
|
| Rate for Payer: PHCS Commercial |
$8,301.12
|
| Rate for Payer: United Healthcare All Payer |
$7,609.36
|
|
|
RENAL 2>ORDER UNILAL(P
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
761P1457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$2,610.52 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$317.42
|
| Rate for Payer: Anthem Medicaid |
$315.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$570.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$729.34
|
| Rate for Payer: Healthspan PPO |
$2,610.52
|
| Rate for Payer: Humana Medicaid |
$315.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.22
|
| Rate for Payer: Molina Healthcare Passport |
$315.90
|
| Rate for Payer: Multiplan PHCS |
$342.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.00
|
| Rate for Payer: UHCCP Medicaid |
$333.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.06
|
|
|
RENAL 2>ORDER UNILAL(T
|
Facility
|
OP
|
$8,077.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
761T1457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.01 |
| Max. Negotiated Rate |
$7,753.92 |
| Rate for Payer: Aetna Commercial |
$6,219.29
|
| Rate for Payer: Anthem Medicaid |
$2,777.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,300.06
|
| 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 |
$4,038.50
|
| Rate for Payer: Cash Price |
$4,038.50
|
| Rate for Payer: Cigna Commercial |
$6,703.91
|
| Rate for Payer: First Health Commercial |
$7,673.15
|
| Rate for Payer: Humana Commercial |
$6,865.45
|
| Rate for Payer: Humana KY Medicaid |
$2,777.68
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,623.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,960.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,833.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,107.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,057.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,615.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,503.87
|
| Rate for Payer: PHCS Commercial |
$7,753.92
|
| Rate for Payer: United Healthcare All Payer |
$7,107.76
|
|
|
RENAL 2>ORDER UNILAL(T
|
Facility
|
IP
|
$8,077.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
761T1457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.01 |
| Max. Negotiated Rate |
$7,753.92 |
| Rate for Payer: Aetna Commercial |
$6,219.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,300.06
|
| Rate for Payer: Cash Price |
$4,038.50
|
| Rate for Payer: Cigna Commercial |
$6,703.91
|
| Rate for Payer: First Health Commercial |
$7,673.15
|
| Rate for Payer: Humana Commercial |
$6,865.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,623.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,960.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,423.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,107.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,057.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,615.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,503.87
|
| Rate for Payer: PHCS Commercial |
$7,753.92
|
| Rate for Payer: United Healthcare All Payer |
$7,107.76
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$10,537.76
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$7,150.62 |
| Max. Negotiated Rate |
$10,537.76 |
| Rate for Payer: Anthem Medicaid |
$7,150.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,526.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,537.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,161.41
|
| Rate for Payer: Humana KY Medicaid |
$7,150.62
|
| Rate for Payer: Humana Medicare Advantage |
$7,526.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,222.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,032.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,293.63
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$17,556.66
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$11,913.45 |
| Max. Negotiated Rate |
$17,556.66 |
| Rate for Payer: Anthem Medicaid |
$11,913.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,540.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,556.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,929.63
|
| Rate for Payer: Humana KY Medicaid |
$11,913.45
|
| Rate for Payer: Humana Medicare Advantage |
$12,540.47
|
| Rate for Payer: Kentucky WC Medicaid |
$12,032.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,048.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,151.72
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$7,118.36
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$4,830.31 |
| Max. Negotiated Rate |
$7,118.36 |
| Rate for Payer: Anthem Medicaid |
$4,830.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,084.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,118.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,864.13
|
| Rate for Payer: Humana KY Medicaid |
$4,830.31
|
| Rate for Payer: Humana Medicare Advantage |
$5,084.54
|
| Rate for Payer: Kentucky WC Medicaid |
$4,878.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,101.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,926.92
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem Medicaid |
$1,226.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| 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 |
$1,782.50
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Humana KY Medicaid |
$1,226.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,238.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,250.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,503.64 |
| Max. Negotiated Rate |
$11,103.84 |
| Rate for Payer: Aetna Commercial |
$8,906.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,021.87
|
| Rate for Payer: Cash Price |
$5,783.25
|
| Rate for Payer: Cigna Commercial |
$9,600.20
|
| Rate for Payer: First Health Commercial |
$10,988.18
|
| Rate for Payer: Humana Commercial |
$9,831.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,484.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,536.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,469.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,178.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,674.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,313.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,503.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,585.62
|
| Rate for Payer: PHCS Commercial |
$11,103.84
|
| Rate for Payer: United Healthcare All Payer |
$10,178.52
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
36000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,422.40 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,069.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER BILATERAL
|
Professional
|
Both
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.51 |
| Max. Negotiated Rate |
$11,566.50 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.46
|
| Rate for Payer: Anthem Medicaid |
$295.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,566.50
|
| Rate for Payer: Cash Price |
$5,783.25
|
| Rate for Payer: Cash Price |
$5,783.25
|
| Rate for Payer: Cigna Commercial |
$682.27
|
| Rate for Payer: Healthspan PPO |
$1,881.54
|
| Rate for Payer: Humana Medicaid |
$295.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.42
|
| Rate for Payer: Molina Healthcare Passport |
$295.51
|
| Rate for Payer: Multiplan PHCS |
$6,939.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,096.55
|
| Rate for Payer: UHCCP Medicaid |
$312.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.47
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,503.64 |
| Max. Negotiated Rate |
$11,103.84 |
| Rate for Payer: Aetna Commercial |
$8,906.20
|
| Rate for Payer: Anthem Medicaid |
$3,977.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,021.87
|
| 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 |
$5,783.25
|
| Rate for Payer: Cash Price |
$5,783.25
|
| Rate for Payer: Cigna Commercial |
$9,600.20
|
| Rate for Payer: First Health Commercial |
$10,988.18
|
| Rate for Payer: Humana Commercial |
$9,831.52
|
| Rate for Payer: Humana KY Medicaid |
$3,977.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,018.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,484.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,536.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,057.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,178.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,674.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,313.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,503.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,585.62
|
| Rate for Payer: PHCS Commercial |
$11,103.84
|
| Rate for Payer: United Healthcare All Payer |
$10,178.52
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
36000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem Medicaid |
$1,226.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| 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 |
$1,782.50
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Humana KY Medicaid |
$1,226.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,238.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,250.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,422.40 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,069.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER BILATERAL(P
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
761P1456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.51 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.46
|
| Rate for Payer: Anthem Medicaid |
$295.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,600.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$682.27
|
| Rate for Payer: Healthspan PPO |
$1,881.54
|
| Rate for Payer: Humana Medicaid |
$295.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.42
|
| Rate for Payer: Molina Healthcare Passport |
$295.51
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,520.00
|
| Rate for Payer: UHCCP Medicaid |
$312.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.47
|
|
|
RENAL FIRST ORDER BILATERAL(T
|
Facility
|
IP
|
$7,966.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
761T1456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,035.64 |
| Max. Negotiated Rate |
$7,647.84 |
| Rate for Payer: Aetna Commercial |
$6,134.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.87
|
| Rate for Payer: Cash Price |
$3,983.25
|
| Rate for Payer: Cigna Commercial |
$6,612.20
|
| Rate for Payer: First Health Commercial |
$7,568.18
|
| Rate for Payer: Humana Commercial |
$6,771.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.62
|
| Rate for Payer: PHCS Commercial |
$7,647.84
|
| Rate for Payer: United Healthcare All Payer |
$7,010.52
|
|
|
RENAL FIRST ORDER BILATERAL(T
|
Facility
|
OP
|
$7,966.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
761T1456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,035.64 |
| Max. Negotiated Rate |
$7,647.84 |
| Rate for Payer: Aetna Commercial |
$6,134.20
|
| Rate for Payer: Anthem Medicaid |
$2,739.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.87
|
| 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 |
$3,983.25
|
| Rate for Payer: Cash Price |
$3,983.25
|
| Rate for Payer: Cigna Commercial |
$6,612.20
|
| Rate for Payer: First Health Commercial |
$7,568.18
|
| Rate for Payer: Humana Commercial |
$6,771.52
|
| Rate for Payer: Humana KY Medicaid |
$2,739.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,767.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,794.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.62
|
| Rate for Payer: PHCS Commercial |
$7,647.84
|
| Rate for Payer: United Healthcare All Payer |
$7,010.52
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
36000042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem Medicaid |
$1,226.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| 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 |
$1,782.50
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Humana KY Medicaid |
$1,226.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,238.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,250.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
36000042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.45 |
| Max. Negotiated Rate |
$3,422.40 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,069.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,105.15
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$8,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
76101455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,154.38 |
| Max. Negotiated Rate |
$8,524.68 |
| Rate for Payer: Aetna Commercial |
$6,837.51
|
| Rate for Payer: Anthem Medicaid |
$3,053.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,926.31
|
| 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 |
$4,439.94
|
| Rate for Payer: Cash Price |
$4,439.94
|
| Rate for Payer: Cigna Commercial |
$7,370.30
|
| Rate for Payer: First Health Commercial |
$8,435.89
|
| Rate for Payer: Humana Commercial |
$7,547.90
|
| Rate for Payer: Humana KY Medicaid |
$3,053.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,084.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,281.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,553.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,115.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,814.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,659.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,775.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,154.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,752.76
|
| Rate for Payer: PHCS Commercial |
$8,524.68
|
| Rate for Payer: United Healthcare All Payer |
$7,814.29
|
|
