|
RENAL 2>ORDER UNILAL(P
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 36253
|
| Hospital Charge Code |
761P1457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$2,610.52 |
| 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 |
$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 |
$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 |
$342.00
|
| 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
|
|
|
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 |
$2,777.68 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,300.06
|
| 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 |
$4,038.50
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,026.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,573.13
|
| 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 |
$2,423.10 |
| 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 |
$6,461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,026.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,573.13
|
| Rate for Payer: PHCS Commercial |
$7,753.92
|
| Rate for Payer: United Healthcare All Payer |
$7,107.76
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.23 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,021.87
|
| 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 |
$5,783.25
|
| Rate for Payer: Cash Price |
$5,783.25
|
| Rate for Payer: Cigna Commercial |
$9,600.19
|
| Rate for Payer: First Health Commercial |
$10,988.17
|
| Rate for Payer: Humana Commercial |
$9,831.52
|
| Rate for Payer: Humana KY Medicaid |
$3,977.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$9,253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,062.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,980.89
|
| Rate for Payer: PHCS Commercial |
$11,103.84
|
| Rate for Payer: United Healthcare All Payer |
$10,178.52
|
|
|
RENAL FIRST ORDER BILATERAL
|
Professional
|
Both
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.46 |
| Max. Negotiated Rate |
$6,939.90 |
| Rate for Payer: Ambetter Exchange |
$333.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.46
|
| Rate for Payer: Anthem Medicaid |
$1,241.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$399.77
|
| 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 |
$1,241.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,266.43
|
| Rate for Payer: Molina Healthcare Passport |
$1,241.60
|
| Rate for Payer: Multiplan PHCS |
$6,939.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.08
|
| Rate for Payer: UHCCP Medicaid |
$312.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,254.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.14
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$11,566.50
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
76101456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,469.95 |
| 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 |
$9,600.19
|
| Rate for Payer: First Health Commercial |
$10,988.17
|
| 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 |
$9,253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,062.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,980.89
|
| Rate for Payer: PHCS Commercial |
$11,103.84
|
| Rate for Payer: United Healthcare All Payer |
$10,178.52
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,261.43 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,824.36
|
| Rate for Payer: Anthem Medicaid |
$1,261.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,861.04
|
| 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 |
$1,834.00
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cigna Commercial |
$3,044.44
|
| Rate for Payer: First Health Commercial |
$3,484.60
|
| Rate for Payer: Humana Commercial |
$3,117.80
|
| Rate for Payer: Humana KY Medicaid |
$1,261.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,007.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,706.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,286.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,227.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,751.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,191.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.92
|
| Rate for Payer: PHCS Commercial |
$3,521.28
|
| Rate for Payer: United Healthcare All Payer |
$3,227.84
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
36000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.79 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,923.69
|
| Rate for Payer: Anthem Medicaid |
$1,305.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.66
|
| 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 |
$1,898.50
|
| Rate for Payer: Cash Price |
$1,898.50
|
| Rate for Payer: Cigna Commercial |
$3,151.51
|
| Rate for Payer: First Health Commercial |
$3,607.15
|
| Rate for Payer: Humana Commercial |
$3,227.45
|
| Rate for Payer: Humana KY Medicaid |
$1,305.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,331.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,847.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,037.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,303.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,619.93
|
| Rate for Payer: PHCS Commercial |
$3,645.12
|
| Rate for Payer: United Healthcare All Payer |
$3,341.36
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,100.40 |
| Max. Negotiated Rate |
$3,521.28 |
| Rate for Payer: Aetna Commercial |
$2,824.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,861.04
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: Cigna Commercial |
$3,044.44
|
| Rate for Payer: First Health Commercial |
$3,484.60
|
| Rate for Payer: Humana Commercial |
$3,117.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,007.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,706.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,227.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,751.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,191.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.92
|
| Rate for Payer: PHCS Commercial |
$3,521.28
|
| Rate for Payer: United Healthcare All Payer |
$3,227.84
|
|
|
RENAL FIRST ORDER BILATERAL
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
36000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,139.10 |
| Max. Negotiated Rate |
$3,645.12 |
| Rate for Payer: Aetna Commercial |
$2,923.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.66
|
| Rate for Payer: Cash Price |
$1,898.50
|
| Rate for Payer: Cigna Commercial |
$3,151.51
|
| Rate for Payer: First Health Commercial |
$3,607.15
|
| Rate for Payer: Humana Commercial |
$3,227.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,847.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,037.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,303.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,619.93
|
| Rate for Payer: PHCS Commercial |
$3,645.12
|
| Rate for Payer: United Healthcare All Payer |
$3,341.36
|
|
|
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 |
$297.46 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Ambetter Exchange |
$333.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.46
|
| Rate for Payer: Anthem Medicaid |
$1,241.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$399.77
|
| 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 |
$1,241.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,266.43
|
| Rate for Payer: Molina Healthcare Passport |
$1,241.60
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.08
|
| Rate for Payer: UHCCP Medicaid |
$312.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,254.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.14
|
|
|
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 |
$2,389.95 |
| 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 |
$6,612.19
|
| 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 |
$6,373.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.89
|
| 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 |
$2,739.68 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.87
|
| 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 |
$3,983.25
|
| Rate for Payer: Cash Price |
$3,983.25
|
| Rate for Payer: Cigna Commercial |
$6,612.19
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$6,373.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.89
|
| Rate for Payer: PHCS Commercial |
$7,647.84
|
| Rate for Payer: United Healthcare All Payer |
$7,010.52
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
IP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
36000042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,069.50 |
| 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 |
$2,852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.85
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,226.00 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem Medicaid |
$1,226.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| 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 |
$1,782.50
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$2,852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.85
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Professional
|
Both
|
$8,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
76101455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.57 |
| Max. Negotiated Rate |
$5,327.93 |
| Rate for Payer: Ambetter Exchange |
$238.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.57
|
| Rate for Payer: Anthem Medicaid |
$1,128.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$238.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.67
|
| 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 |
$1,128.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$356.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$238.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,151.31
|
| Rate for Payer: Molina Healthcare Passport |
$1,128.74
|
| Rate for Payer: Multiplan PHCS |
$5,327.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.48
|
| Rate for Payer: UHCCP Medicaid |
$240.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,140.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.06
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
36000042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,268.99 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| 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 |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
IP
|
$8,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
76101455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,663.96 |
| 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 |
$7,103.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,725.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.12
|
| Rate for Payer: PHCS Commercial |
$8,524.68
|
| Rate for Payer: United Healthcare All Payer |
$7,814.29
|
|
|
RENAL FIRST ORDER UNILATERAL
|
Facility
|
OP
|
$8,879.88
|
|
|
Service Code
|
HCPCS 36251
|
| Hospital Charge Code |
76101455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.23 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,926.31
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$7,103.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,725.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.12
|
| Rate for Payer: PHCS Commercial |
$8,524.68
|
| Rate for Payer: United Healthcare All Payer |
$7,814.29
|
|
|
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 |
$228.57 |
| Max. Negotiated Rate |
$1,708.65 |
| Rate for Payer: Ambetter Exchange |
$238.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.57
|
| Rate for Payer: Anthem Medicaid |
$1,128.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$238.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.67
|
| 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 |
$1,128.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$356.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$238.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,151.31
|
| Rate for Payer: Molina Healthcare Passport |
$1,128.74
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.48
|
| Rate for Payer: UHCCP Medicaid |
$240.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,140.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.06
|
|
|
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 |
$2,063.96 |
| 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 |
$5,503.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,985.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,747.12
|
| Rate for Payer: PHCS Commercial |
$6,604.68
|
| Rate for Payer: United Healthcare All Payer |
$6,054.29
|
|
|
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 |
$2,365.99 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,366.31
|
| 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 |
$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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$5,503.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,985.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,747.12
|
| Rate for Payer: PHCS Commercial |
$6,604.68
|
| Rate for Payer: United Healthcare All Payer |
$6,054.29
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
30000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.16
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
RENAL FUNCTION PANEL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
30000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$8.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.68
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$8.68
|
| Rate for Payer: Humana Medicare Advantage |
$8.68
|
| Rate for Payer: Kentucky WC Medicaid |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
