|
THP-ZOFRAN-ODT 4MG TABLET
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 57237007530
|
| Hospital Charge Code |
25001543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.33
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.01
|
| Rate for Payer: Ohio Health Group HMO |
$3.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Payer |
$4.01
|
|
|
THREADED ROD 6*250MM
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.13
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
THREADED ROD 6*250MM
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.13
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
THREADER
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
THREADER
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
76101517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$556.80 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
76101519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Anthem Medicaid |
$251.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$569.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$605.90
|
| Rate for Payer: First Health Commercial |
$693.50
|
| Rate for Payer: Humana Commercial |
$620.50
|
| Rate for Payer: Humana KY Medicaid |
$251.05
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$253.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$598.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$538.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$256.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$642.40
|
| Rate for Payer: Ohio Health Group HMO |
$547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$226.30
|
| Rate for Payer: PHCS Commercial |
$700.80
|
| Rate for Payer: United Healthcare All Payer |
$642.40
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
76101518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
76101517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem Medicaid |
$199.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Humana KY Medicaid |
$199.46
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$201.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
76101519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$700.80 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$569.40
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$605.90
|
| Rate for Payer: First Health Commercial |
$693.50
|
| Rate for Payer: Humana Commercial |
$620.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$598.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$538.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$642.40
|
| Rate for Payer: Ohio Health Group HMO |
$547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$226.30
|
| Rate for Payer: PHCS Commercial |
$700.80
|
| Rate for Payer: United Healthcare All Payer |
$642.40
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
76101518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem Medicaid |
$218.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Humana KY Medicaid |
$218.38
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
76101519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.46 |
| Max. Negotiated Rate |
$836.65 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$408.46
|
| Rate for Payer: Anthem Medicaid |
$409.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$730.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$836.65
|
| Rate for Payer: Humana Medicaid |
$409.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.26
|
| Rate for Payer: Molina Healthcare Passport |
$409.08
|
| Rate for Payer: Multiplan PHCS |
$438.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.00
|
| Rate for Payer: UHCCP Medicaid |
$428.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$413.17
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
76101517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.83 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$278.83
|
| Rate for Payer: Anthem Medicaid |
$279.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$571.18
|
| Rate for Payer: Humana Medicaid |
$279.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.87
|
| Rate for Payer: Molina Healthcare Passport |
$279.28
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$292.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.07
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
76101518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$716.93 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$350.00
|
| Rate for Payer: Anthem Medicaid |
$350.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$716.93
|
| Rate for Payer: Humana Medicaid |
$350.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.56
|
| Rate for Payer: Molina Healthcare Passport |
$350.55
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.06
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 36904
|
| Hospital Charge Code |
761P1517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.83 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$278.83
|
| Rate for Payer: Anthem Medicaid |
$279.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$571.18
|
| Rate for Payer: Humana Medicaid |
$279.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.87
|
| Rate for Payer: Molina Healthcare Passport |
$279.28
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$292.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.07
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
761P1519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.46 |
| Max. Negotiated Rate |
$836.65 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$408.46
|
| Rate for Payer: Anthem Medicaid |
$409.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$730.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$836.65
|
| Rate for Payer: Humana Medicaid |
$409.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.26
|
| Rate for Payer: Molina Healthcare Passport |
$409.08
|
| Rate for Payer: Multiplan PHCS |
$438.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.00
|
| Rate for Payer: UHCCP Medicaid |
$428.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$413.17
|
|
|
THRMBC/NFS DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 36905
|
| Hospital Charge Code |
761P1518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$716.93 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$350.00
|
| Rate for Payer: Anthem Medicaid |
$350.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$716.93
|
| Rate for Payer: Humana Medicaid |
$350.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.56
|
| Rate for Payer: Molina Healthcare Passport |
$350.55
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.06
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT AXI
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35305
|
| Hospital Charge Code |
76101383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$955.83 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,172.16
|
| Rate for Payer: Anthem Medicaid |
$955.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,020.81
|
| Rate for Payer: Healthspan PPO |
$2,135.64
|
| Rate for Payer: Humana Medicaid |
$955.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,689.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.95
|
| Rate for Payer: Molina Healthcare Passport |
$955.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.39
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT AXI
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35305
|
| Hospital Charge Code |
761P1383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$955.83 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,172.16
|
| Rate for Payer: Anthem Medicaid |
$955.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,020.81
|
| Rate for Payer: Healthspan PPO |
$2,135.64
|
| Rate for Payer: Humana Medicaid |
$955.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,689.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.95
|
| Rate for Payer: Molina Healthcare Passport |
$955.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.39
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT AXI
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35305
|
| Hospital Charge Code |
76101383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT AXI
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35305
|
| Hospital Charge Code |
76101383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT ILI
|
Professional
|
Both
|
$2,960.00
|
|
|
Service Code
|
HCPCS 35355
|
| Hospital Charge Code |
76101387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.63 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna Commercial |
$1,847.93
|
| Rate for Payer: Anthem Medicaid |
$929.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,960.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cigna Commercial |
$1,767.05
|
| Rate for Payer: Healthspan PPO |
$1,816.88
|
| Rate for Payer: Humana Medicaid |
$929.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.22
|
| Rate for Payer: Molina Healthcare Passport |
$929.63
|
| Rate for Payer: Multiplan PHCS |
$1,776.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,072.00
|
| Rate for Payer: UHCCP Medicaid |
$1,036.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$938.93
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT ILI
|
Professional
|
Both
|
$2,960.00
|
|
|
Service Code
|
HCPCS 35355
|
| Hospital Charge Code |
761P1387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.63 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna Commercial |
$1,847.93
|
| Rate for Payer: Anthem Medicaid |
$929.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,960.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cigna Commercial |
$1,767.05
|
| Rate for Payer: Healthspan PPO |
$1,816.88
|
| Rate for Payer: Humana Medicaid |
$929.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.22
|
| Rate for Payer: Molina Healthcare Passport |
$929.63
|
| Rate for Payer: Multiplan PHCS |
$1,776.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,072.00
|
| Rate for Payer: UHCCP Medicaid |
$1,036.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$938.93
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT ILI
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
HCPCS 35355
|
| Hospital Charge Code |
76101387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$2,841.60 |
| Rate for Payer: Aetna Commercial |
$2,279.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,308.80
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cigna Commercial |
$2,456.80
|
| Rate for Payer: First Health Commercial |
$2,812.00
|
| Rate for Payer: Humana Commercial |
$2,516.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,427.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,184.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$888.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,604.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.60
|
| Rate for Payer: PHCS Commercial |
$2,841.60
|
| Rate for Payer: United Healthcare All Payer |
$2,604.80
|
|
|
THRMBNDRTRCTMY W/PATCHGRFT ILI
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
HCPCS 35355
|
| Hospital Charge Code |
76101387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$2,841.60 |
| Rate for Payer: Aetna Commercial |
$2,279.20
|
| Rate for Payer: Anthem Medicaid |
$1,017.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,308.80
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cigna Commercial |
$2,456.80
|
| Rate for Payer: First Health Commercial |
$2,812.00
|
| Rate for Payer: Humana Commercial |
$2,516.00
|
| Rate for Payer: Humana KY Medicaid |
$1,017.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,028.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,427.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,184.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$888.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,038.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,604.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.60
|
| Rate for Payer: PHCS Commercial |
$2,841.60
|
| Rate for Payer: United Healthcare All Payer |
$2,604.80
|
|
