|
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 |
$1,460.83 |
| Rate for Payer: Aetna Commercial |
$1,460.83
|
| Rate for Payer: Ambetter Exchange |
$850.56
|
| Rate for Payer: Anthem Medicaid |
$625.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$850.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,020.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$850.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$850.56
|
| 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 |
$1,105.73
|
| Rate for Payer: UHCCP Medicaid |
$765.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$632.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$850.56
|
|
|
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 |
$752.45 |
| Max. Negotiated Rate |
$16,806.64 |
| Rate for Payer: Aetna Commercial |
$1,684.76
|
| Rate for Payer: Anthem Medicaid |
$752.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,004.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,706.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,806.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,206.40
|
| 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 |
$12,004.74
|
| 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 |
$14,405.69
|
| 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 |
$1,750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,903.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,509.72
|
| Rate for Payer: PHCS Commercial |
$2,100.48
|
| Rate for Payer: United Healthcare All Payer |
$1,925.44
|
|
|
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 |
$773.77 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| 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 |
$773.77
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| 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 |
$11,603.71
|
| 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 |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| 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 |
$1,350.00 |
| Rate for Payer: Ambetter Exchange |
$330.86
|
| Rate for Payer: Anthem Medicaid |
$283.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.03
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$330.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.86
|
| 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 |
$430.12
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.86
|
|
|
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 |
$675.00 |
| 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 |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMV&REPLC PM GEN DUAL LEAD(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 |
$1,350.00 |
| Rate for Payer: Ambetter Exchange |
$330.86
|
| Rate for Payer: Anthem Medicaid |
$283.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.03
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$330.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.86
|
| 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 |
$430.12
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.86
|
|
|
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 |
$683.72 |
| Rate for Payer: Ambetter Exchange |
$346.83
|
| Rate for Payer: Anthem Medicaid |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.83
|
| 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 |
$450.88
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.83
|
|
|
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 |
$683.72 |
| Rate for Payer: Ambetter Exchange |
$346.83
|
| Rate for Payer: Anthem Medicaid |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.83
|
| 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 |
$450.88
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.83
|
|
|
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 |
$343.90 |
| Max. Negotiated Rate |
$24,669.92 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,621.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,669.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,788.85
|
| 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 |
$17,621.37
|
| 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 |
$21,145.64
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
RENAGEL (20mg) 400 MG TAB
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
HCPCS J0603
|
| Hospital Charge Code |
25001305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| 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 |
$8.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.74
|
| Rate for Payer: PHCS Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Payer |
$9.87
|
|
|
RENAGEL (20mg) 400 MG TAB
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
HCPCS J0603
|
| Hospital Charge Code |
25001305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| 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 |
$8.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.74
|
| Rate for Payer: PHCS Commercial |
$10.77
|
| Rate for Payer: United Healthcare All Payer |
$9.87
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
OP
|
$3,419.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
76101458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,175.79 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,632.63
|
| Rate for Payer: Anthem Medicaid |
$1,175.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,709.50
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,735.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.11
|
| Rate for Payer: PHCS Commercial |
$3,282.24
|
| Rate for Payer: United Healthcare All Payer |
$3,008.72
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
IP
|
$3,419.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
76101458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,025.70 |
| 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 |
$2,735.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,974.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.11
|
| Rate for Payer: PHCS Commercial |
$3,282.24
|
| Rate for Payer: United Healthcare All Payer |
$3,008.72
|
|
|
RENAL 2>ORDER BILATERAL
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 36254
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,115.40 |
| 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 |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| 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 |
$1,278.62 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem Medicaid |
$1,278.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,859.00
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| 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 |
$1,115.40 |
| 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 |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| 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 |
36000045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,278.62 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem Medicaid |
$1,278.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,859.00
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.38 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$4,861.78
|
| Rate for Payer: Anthem Medicaid |
$2,171.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,924.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,157.00
|
| Rate for Payer: Cash Price |
$3,157.00
|
| Rate for Payer: Cigna Commercial |
$5,240.62
|
| Rate for Payer: First Health Commercial |
$5,998.30
|
| Rate for Payer: Humana Commercial |
$5,366.90
|
| Rate for Payer: Humana KY Medicaid |
$2,171.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,193.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,177.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,659.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,214.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,556.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,735.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,051.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,493.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.66
|
| Rate for Payer: PHCS Commercial |
$6,061.44
|
| Rate for Payer: United Healthcare All Payer |
$5,556.32
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,830.00 |
| 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 |
$4,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,307.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,209.00
|
| Rate for Payer: PHCS Commercial |
$5,856.00
|
| Rate for Payer: United Healthcare All Payer |
$5,368.00
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$8,647.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
76101457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,973.70 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,522.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.43
|
| Rate for Payer: PHCS Commercial |
$8,301.12
|
| Rate for Payer: United Healthcare All Payer |
$7,609.36
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,894.20 |
| Max. Negotiated Rate |
$6,061.44 |
| Rate for Payer: Aetna Commercial |
$4,861.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,924.92
|
| Rate for Payer: Cash Price |
$3,157.00
|
| Rate for Payer: Cigna Commercial |
$5,240.62
|
| Rate for Payer: First Health Commercial |
$5,998.30
|
| Rate for Payer: Humana Commercial |
$5,366.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,177.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,659.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,894.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,556.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,735.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,051.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,493.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.66
|
| Rate for Payer: PHCS Commercial |
$6,061.44
|
| Rate for Payer: United Healthcare All Payer |
$5,556.32
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
IP
|
$8,647.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
76101457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,594.10 |
| 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 |
$6,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,522.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,966.43
|
| Rate for Payer: PHCS Commercial |
$8,301.12
|
| Rate for Payer: United Healthcare All Payer |
$7,609.36
|
|
|
RENAL 2>ORDER UNILAL
|
Facility
|
OP
|
$6,100.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,097.79 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$4,697.00
|
| Rate for Payer: Anthem Medicaid |
$2,097.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,758.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$4,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,307.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,209.00
|
| 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 |
$317.42 |
| Max. Negotiated Rate |
$5,188.20 |
| Rate for Payer: Ambetter Exchange |
$329.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$317.42
|
| Rate for Payer: Anthem Medicaid |
$1,725.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$329.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$329.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.23
|
| 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 |
$1,725.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$329.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,759.87
|
| Rate for Payer: Molina Healthcare Passport |
$1,725.36
|
| Rate for Payer: Multiplan PHCS |
$5,188.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$428.17
|
| Rate for Payer: UHCCP Medicaid |
$333.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,742.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$329.36
|
|
