|
RENAL FIRST ORDER UNILATERAL
|
Professional
|
Both
|
$8,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
76101455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$8,879.88 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.57
|
| Rate for Payer: Anthem Medicaid |
$226.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,879.88
|
| Rate for Payer: Cash Price |
$4,439.94
|
| Rate for Payer: Cash Price |
$4,439.94
|
| Rate for Payer: Cigna Commercial |
$523.78
|
| Rate for Payer: Healthspan PPO |
$1,708.65
|
| Rate for Payer: Humana Medicaid |
$226.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$356.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.38
|
| Rate for Payer: Molina Healthcare Passport |
$226.84
|
| Rate for Payer: Multiplan PHCS |
$5,327.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,215.92
|
| Rate for Payer: UHCCP Medicaid |
$240.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.11
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$6,926.31
|
| 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: 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 |
$2,663.96
|
| 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
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
48100025
|
|
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 UNILATERAL
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
48100025
|
|
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 UNILATERAL(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
761P1455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.57
|
| Rate for Payer: Anthem Medicaid |
$226.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$523.78
|
| Rate for Payer: Healthspan PPO |
$1,708.65
|
| Rate for Payer: Humana Medicaid |
$226.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$356.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.38
|
| Rate for Payer: Molina Healthcare Passport |
$226.84
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$240.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.11
|
|
|
RENAL FIRST ORDER UNILATERAL(T
|
Facility
|
OP
|
$6,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
761T1455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.38 |
| Max. Negotiated Rate |
$6,604.68 |
| Rate for Payer: Aetna Commercial |
$5,297.51
|
| Rate for Payer: Anthem Medicaid |
$2,365.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,366.31
|
| 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 |
$3,439.94
|
| Rate for Payer: Cash Price |
$3,439.94
|
| Rate for Payer: Cigna Commercial |
$5,710.30
|
| Rate for Payer: First Health Commercial |
$6,535.89
|
| Rate for Payer: Humana Commercial |
$5,847.90
|
| Rate for Payer: Humana KY Medicaid |
$2,365.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,641.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,077.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,054.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,159.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,375.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,132.76
|
| Rate for Payer: PHCS Commercial |
$6,604.68
|
| Rate for Payer: United Healthcare All Payer |
$6,054.29
|
|
|
RENAL FIRST ORDER UNILATERAL(T
|
Facility
|
IP
|
$6,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
761T1455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.38 |
| Max. Negotiated Rate |
$6,604.68 |
| Rate for Payer: Aetna Commercial |
$5,297.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,366.31
|
| Rate for Payer: Cash Price |
$3,439.94
|
| Rate for Payer: Cigna Commercial |
$5,710.30
|
| Rate for Payer: First Health Commercial |
$6,535.89
|
| Rate for Payer: Humana Commercial |
$5,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,641.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,077.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,063.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,054.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,159.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,375.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,132.76
|
| Rate for Payer: PHCS Commercial |
$6,604.68
|
| Rate for Payer: United Healthcare All Payer |
$6,054.29
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
30000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.68
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Humana Medicare Advantage |
$8.68
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
30000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.34
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
RENAL SHEATH
|
Facility
|
OP
|
$1,091.32
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$1,047.67 |
| Rate for Payer: Aetna Commercial |
$840.32
|
| Rate for Payer: Anthem Medicaid |
$375.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.23
|
| Rate for Payer: Cash Price |
$545.66
|
| Rate for Payer: Cigna Commercial |
$905.80
|
| Rate for Payer: First Health Commercial |
$1,036.75
|
| Rate for Payer: Humana Commercial |
$927.62
|
| Rate for Payer: Humana KY Medicaid |
$375.30
|
| Rate for Payer: Kentucky WC Medicaid |
$379.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.36
|
| Rate for Payer: Ohio Health Group HMO |
$818.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.31
|
| Rate for Payer: PHCS Commercial |
$1,047.67
|
| Rate for Payer: United Healthcare All Payer |
$960.36
|
|
|
RENAL SHEATH
|
Facility
|
IP
|
$1,091.32
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$1,047.67 |
| Rate for Payer: Aetna Commercial |
$840.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.23
|
| Rate for Payer: Cash Price |
$545.66
|
| Rate for Payer: Cigna Commercial |
$905.80
|
| Rate for Payer: First Health Commercial |
$1,036.75
|
| Rate for Payer: Humana Commercial |
$927.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.36
|
| Rate for Payer: Ohio Health Group HMO |
$818.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.31
|
| Rate for Payer: PHCS Commercial |
$1,047.67
|
| Rate for Payer: United Healthcare All Payer |
$960.36
|
|
|
RENAL SHEATH SET AMPLATZ
|
Facility
|
OP
|
$1,549.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$1,487.28 |
| Rate for Payer: Aetna Commercial |
$1,192.92
|
| Rate for Payer: Anthem Medicaid |
$532.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.42
|
| Rate for Payer: Cash Price |
$774.62
|
| Rate for Payer: Cigna Commercial |
$1,285.88
|
| Rate for Payer: First Health Commercial |
$1,471.79
|
| Rate for Payer: Humana Commercial |
$1,316.86
|
| Rate for Payer: Humana KY Medicaid |
$532.79
|
| Rate for Payer: Kentucky WC Medicaid |
$538.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.27
|
| Rate for Payer: PHCS Commercial |
$1,487.28
|
| Rate for Payer: United Healthcare All Payer |
$1,363.34
|
|
|
RENAL SHEATH SET AMPLATZ
|
Facility
|
IP
|
$1,549.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$1,487.28 |
| Rate for Payer: Aetna Commercial |
$1,192.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.42
|
| Rate for Payer: Cash Price |
$774.62
|
| Rate for Payer: Cigna Commercial |
$1,285.88
|
| Rate for Payer: First Health Commercial |
$1,471.79
|
| Rate for Payer: Humana Commercial |
$1,316.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.27
|
| Rate for Payer: PHCS Commercial |
$1,487.28
|
| Rate for Payer: United Healthcare All Payer |
$1,363.34
|
|
|
RENAL VENOGRAPHY BILATERAL
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
32000170
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY BILATERAL
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
32000170
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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 |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY UNILATERAL
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75831
|
| Hospital Charge Code |
32000169
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY UNILATERAL
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75831
|
| Hospital Charge Code |
32000169
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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 |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENEGADE CATH 180CM
|
Facility
|
OP
|
$3,671.72
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.32 |
| Max. Negotiated Rate |
$3,524.85 |
| Rate for Payer: Aetna Commercial |
$2,827.22
|
| Rate for Payer: Anthem Medicaid |
$1,262.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,863.94
|
| Rate for Payer: Cash Price |
$1,835.86
|
| Rate for Payer: Cigna Commercial |
$3,047.53
|
| Rate for Payer: First Health Commercial |
$3,488.13
|
| Rate for Payer: Humana Commercial |
$3,120.96
|
| Rate for Payer: Humana KY Medicaid |
$1,262.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,275.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,288.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.23
|
| Rate for Payer: PHCS Commercial |
$3,524.85
|
| Rate for Payer: United Healthcare All Payer |
$3,231.11
|
|
|
RENEGADE CATH 180CM
|
Facility
|
IP
|
$3,671.72
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.32 |
| Max. Negotiated Rate |
$3,524.85 |
| Rate for Payer: Aetna Commercial |
$2,827.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,863.94
|
| Rate for Payer: Cash Price |
$1,835.86
|
| Rate for Payer: Cigna Commercial |
$3,047.53
|
| Rate for Payer: First Health Commercial |
$3,488.13
|
| Rate for Payer: Humana Commercial |
$3,120.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.23
|
| Rate for Payer: PHCS Commercial |
$3,524.85
|
| Rate for Payer: United Healthcare All Payer |
$3,231.11
|
|
|
RENEGADE STC CATH
|
Facility
|
IP
|
$3,757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$3,607.20 |
| Rate for Payer: Aetna Commercial |
$2,893.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,930.85
|
| Rate for Payer: Cash Price |
$1,878.75
|
| Rate for Payer: Cigna Commercial |
$3,118.72
|
| Rate for Payer: First Health Commercial |
$3,569.62
|
| Rate for Payer: Humana Commercial |
$3,193.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.82
|
| Rate for Payer: PHCS Commercial |
$3,607.20
|
| Rate for Payer: United Healthcare All Payer |
$3,306.60
|
|
|
RENEGADE STC CATH
|
Facility
|
OP
|
$3,757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$3,607.20 |
| Rate for Payer: Aetna Commercial |
$2,893.28
|
| Rate for Payer: Anthem Medicaid |
$1,292.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,930.85
|
| Rate for Payer: Cash Price |
$1,878.75
|
| Rate for Payer: Cigna Commercial |
$3,118.72
|
| Rate for Payer: First Health Commercial |
$3,569.62
|
| Rate for Payer: Humana Commercial |
$3,193.88
|
| Rate for Payer: Humana KY Medicaid |
$1,292.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,305.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,318.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.82
|
| Rate for Payer: PHCS Commercial |
$3,607.20
|
| Rate for Payer: United Healthcare All Payer |
$3,306.60
|
|
|
RENFLEXIS 100MG VIAL
|
Facility
|
OP
|
$1,695.39
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
25002727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$1,627.57 |
| Rate for Payer: Aetna Commercial |
$1,305.45
|
| Rate for Payer: Anthem Medicaid |
$583.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$44.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.52
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cigna Commercial |
$1,407.17
|
| Rate for Payer: First Health Commercial |
$1,610.62
|
| Rate for Payer: Humana Commercial |
$1,441.08
|
| Rate for Payer: Humana KY Medicaid |
$583.04
|
| Rate for Payer: Humana Medicare Advantage |
$31.50
|
| Rate for Payer: Kentucky WC Medicaid |
$588.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.57
|
| Rate for Payer: PHCS Commercial |
$1,627.57
|
| Rate for Payer: United Healthcare All Payer |
$1,491.94
|
|
|
RENFLEXIS 100MG VIAL
|
Facility
|
IP
|
$1,695.39
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
25002727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$1,627.57 |
| Rate for Payer: Aetna Commercial |
$1,305.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.40
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cigna Commercial |
$1,407.17
|
| Rate for Payer: First Health Commercial |
$1,610.62
|
| Rate for Payer: Humana Commercial |
$1,441.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.57
|
| Rate for Payer: PHCS Commercial |
$1,627.57
|
| Rate for Payer: United Healthcare All Payer |
$1,491.94
|
|
|
REN TIB INS PS STD 1-2*11 R
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REN TIB INS PS STD 1-2*11 R
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
