|
US URINE CAPACITY MEASURE(T
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920T0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402T0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920T0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402T0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US VASCULAR ACCESS
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna Commercial |
$58.14
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.00
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$51.43
|
| Rate for Payer: Healthspan PPO |
$54.48
|
| Rate for Payer: Humana Medicaid |
$24.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.36
|
| Rate for Payer: Molina Healthcare Passport |
$24.86
|
| Rate for Payer: Multiplan PHCS |
$120.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.70
|
| Rate for Payer: UHCCP Medicaid |
$70.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
|
|
US VASCULAR ACCESS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
US VASCULAR ACCESS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$69.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Humana KY Medicaid |
$69.12
|
| Rate for Payer: Kentucky WC Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
US VASCULAR ACCESS(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402P0067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$58.14
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$51.43
|
| Rate for Payer: Healthspan PPO |
$54.48
|
| Rate for Payer: Humana Medicaid |
$24.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.36
|
| Rate for Payer: Molina Healthcare Passport |
$24.86
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
|
|
US VASCULAR ACCESS(T
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$50.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$50.21
|
| Rate for Payer: Kentucky WC Medicaid |
$50.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
US VASCULAR ACCESS(T
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
US - VENA CAVA
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem Medicaid |
$369.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Humana KY Medicaid |
$369.35
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$373.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
US - VENA CAVA
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
US - VENA CAVA
|
Professional
|
Both
|
$1,074.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.71 |
| Max. Negotiated Rate |
$1,074.00 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: Anthem Medicaid |
$85.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,074.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: Healthspan PPO |
$186.27
|
| Rate for Payer: Humana Medicaid |
$85.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.10
|
| Rate for Payer: Molina Healthcare Passport |
$85.39
|
| Rate for Payer: Multiplan PHCS |
$644.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$751.80
|
| Rate for Payer: UHCCP Medicaid |
$375.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.24
|
|
|
US - VENA CAVA(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402P0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.71 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna Commercial |
$198.79
|
| Rate for Payer: Anthem Medicaid |
$85.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: Healthspan PPO |
$186.27
|
| Rate for Payer: Humana Medicaid |
$85.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.10
|
| Rate for Payer: Molina Healthcare Passport |
$85.39
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.24
|
|
|
US - VENA CAVA(T
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402T0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
US - VENA CAVA(T
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
402T0026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem Medicaid |
$317.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Humana KY Medicaid |
$317.76
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$321.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$20,845.03
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$14,144.84 |
| Max. Negotiated Rate |
$20,845.03 |
| Rate for Payer: Anthem Medicaid |
$14,144.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,889.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,845.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,100.57
|
| Rate for Payer: Humana KY Medicaid |
$14,144.84
|
| Rate for Payer: Humana Medicare Advantage |
$14,889.31
|
| Rate for Payer: Kentucky WC Medicaid |
$14,286.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,867.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,427.74
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$13,593.31
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$9,224.03 |
| Max. Negotiated Rate |
$13,593.31 |
| Rate for Payer: Anthem Medicaid |
$9,224.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,709.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,593.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,107.84
|
| Rate for Payer: Humana KY Medicaid |
$9,224.03
|
| Rate for Payer: Humana Medicare Advantage |
$9,709.51
|
| Rate for Payer: Kentucky WC Medicaid |
$9,316.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,651.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,408.52
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$20,904.69
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$14,185.32 |
| Max. Negotiated Rate |
$20,904.69 |
| Rate for Payer: Anthem Medicaid |
$14,185.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,931.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,904.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,158.09
|
| Rate for Payer: Humana KY Medicaid |
$14,185.32
|
| Rate for Payer: Humana Medicare Advantage |
$14,931.92
|
| Rate for Payer: Kentucky WC Medicaid |
$14,327.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,918.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,469.03
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$42,304.23
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$28,706.44 |
| Max. Negotiated Rate |
$42,304.23 |
| Rate for Payer: Anthem Medicaid |
$28,706.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30,217.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$42,304.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$40,793.37
|
| Rate for Payer: Humana KY Medicaid |
$28,706.44
|
| Rate for Payer: Humana Medicare Advantage |
$30,217.31
|
| Rate for Payer: Kentucky WC Medicaid |
$28,993.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,260.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,280.57
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$15,199.48
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$10,313.93 |
| Max. Negotiated Rate |
$15,199.48 |
| Rate for Payer: Anthem Medicaid |
$10,313.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,856.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,199.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,656.64
|
| Rate for Payer: Humana KY Medicaid |
$10,313.93
|
| Rate for Payer: Humana Medicare Advantage |
$10,856.77
|
| Rate for Payer: Kentucky WC Medicaid |
$10,417.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,028.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,520.21
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$23,089.91
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$15,668.15 |
| Max. Negotiated Rate |
$23,089.91 |
| Rate for Payer: Anthem Medicaid |
$15,668.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,492.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,089.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,265.27
|
| Rate for Payer: Humana KY Medicaid |
$15,668.15
|
| Rate for Payer: Humana Medicare Advantage |
$16,492.79
|
| Rate for Payer: Kentucky WC Medicaid |
$15,824.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,791.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,981.51
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$45,473.26
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$30,856.86 |
| Max. Negotiated Rate |
$45,473.26 |
| Rate for Payer: Anthem Medicaid |
$30,856.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32,480.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45,473.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$43,849.22
|
| Rate for Payer: Humana KY Medicaid |
$30,856.86
|
| Rate for Payer: Humana Medicare Advantage |
$32,480.90
|
| Rate for Payer: Kentucky WC Medicaid |
$31,165.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38,977.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,473.99
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$15,963.36
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$10,832.28 |
| Max. Negotiated Rate |
$15,963.36 |
| Rate for Payer: Anthem Medicaid |
$10,832.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,402.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,963.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,393.24
|
| Rate for Payer: Humana KY Medicaid |
$10,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$11,402.40
|
| Rate for Payer: Kentucky WC Medicaid |
$10,940.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,682.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,048.93
|
|
|
UTERINE MANIPULATOR/INJECTOR
|
Facility
|
IP
|
$3,523.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.09 |
| Max. Negotiated Rate |
$3,382.79 |
| Rate for Payer: Aetna Commercial |
$2,713.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,748.52
|
| Rate for Payer: Cash Price |
$1,761.87
|
| Rate for Payer: Cigna Commercial |
$2,924.70
|
| Rate for Payer: First Health Commercial |
$3,347.55
|
| Rate for Payer: Humana Commercial |
$2,995.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,889.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,100.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,642.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.36
|
| Rate for Payer: PHCS Commercial |
$3,382.79
|
| Rate for Payer: United Healthcare All Payer |
$3,100.89
|
|
