|
US URINE CAPACITY MEASURE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920P0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Ambetter Exchange |
$10.39
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.51
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.39
|
|
|
US URINE CAPACITY MEASURE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402P0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Ambetter Exchange |
$10.39
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.51
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.39
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402T0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920T0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920T0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
US URINE CAPACITY MEASURE(T
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402T0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
US VASCULAR ACCESS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$60.30 |
| 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 |
$160.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.69
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
US VASCULAR ACCESS
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
US VASCULAR ACCESS
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$58.14
|
| Rate for Payer: Ambetter Exchange |
$34.87
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$34.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.87
|
| 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 |
$45.33
|
| Rate for Payer: UHCCP Medicaid |
$70.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.87
|
|
|
US VASCULAR ACCESS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$60.30 |
| 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 |
$160.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.69
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
US VASCULAR ACCESS
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
US VASCULAR ACCESS
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
40200067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna Commercial |
$58.14
|
| Rate for Payer: Ambetter Exchange |
$34.87
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.84
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$34.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.36
|
| Rate for Payer: Molina Healthcare Passport |
$24.86
|
| Rate for Payer: Multiplan PHCS |
$123.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.33
|
| Rate for Payer: UHCCP Medicaid |
$72.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.87
|
|
|
US VASCULAR ACCESS (P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402P0114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$58.14
|
| Rate for Payer: Ambetter Exchange |
$34.87
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$34.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.87
|
| 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 |
$45.33
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.87
|
|
|
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: Ambetter Exchange |
$34.87
|
| Rate for Payer: Anthem Medicaid |
$24.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$34.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.87
|
| 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 |
$45.33
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.87
|
|
|
US VASCULAR ACCESS (T
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.80 |
| 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 |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
US VASCULAR ACCESS (T
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.80 |
| 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 |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
US VASCULAR ACCESS(T
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$51.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.78
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Humana KY Medicaid |
$51.93
|
| Rate for Payer: Kentucky WC Medicaid |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.19
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
US VASCULAR ACCESS(T
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
402T0067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.78
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.19
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
UTERINE MANIPULATOR/INJECTOR
|
Facility
|
OP
|
$3,418.29
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.49 |
| Max. Negotiated Rate |
$3,281.56 |
| Rate for Payer: Aetna Commercial |
$2,632.08
|
| Rate for Payer: Anthem Medicaid |
$1,175.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.27
|
| Rate for Payer: Cash Price |
$1,709.14
|
| Rate for Payer: Cigna Commercial |
$2,837.18
|
| Rate for Payer: First Health Commercial |
$3,247.38
|
| Rate for Payer: Humana Commercial |
$2,905.55
|
| Rate for Payer: Humana KY Medicaid |
$1,175.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,803.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,008.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,734.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.62
|
| Rate for Payer: PHCS Commercial |
$3,281.56
|
| Rate for Payer: United Healthcare All Payer |
$3,008.10
|
|
|
UTERINE MANIPULATOR/INJECTOR
|
Facility
|
IP
|
$3,418.29
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.49 |
| Max. Negotiated Rate |
$3,281.56 |
| Rate for Payer: Aetna Commercial |
$2,632.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.27
|
| Rate for Payer: Cash Price |
$1,709.14
|
| Rate for Payer: Cigna Commercial |
$2,837.18
|
| Rate for Payer: First Health Commercial |
$3,247.38
|
| Rate for Payer: Humana Commercial |
$2,905.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,803.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,008.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,734.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.62
|
| Rate for Payer: PHCS Commercial |
$3,281.56
|
| Rate for Payer: United Healthcare All Payer |
$3,008.10
|
|
|
V40SLEVE 4MM TAPER 5X40
|
Facility
|
OP
|
$1,987.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.11 |
| Max. Negotiated Rate |
$1,907.56 |
| Rate for Payer: Aetna Commercial |
$1,530.02
|
| Rate for Payer: Anthem Medicaid |
$683.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.89
|
| Rate for Payer: Cash Price |
$993.52
|
| Rate for Payer: Cigna Commercial |
$1,649.24
|
| Rate for Payer: First Health Commercial |
$1,887.69
|
| Rate for Payer: Humana Commercial |
$1,688.98
|
| Rate for Payer: Humana KY Medicaid |
$683.34
|
| Rate for Payer: Kentucky WC Medicaid |
$690.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.06
|
| Rate for Payer: PHCS Commercial |
$1,907.56
|
| Rate for Payer: United Healthcare All Payer |
$1,748.60
|
|
|
V40SLEVE 4MM TAPER 5X40
|
Facility
|
IP
|
$1,987.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.11 |
| Max. Negotiated Rate |
$1,907.56 |
| Rate for Payer: Aetna Commercial |
$1,530.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.89
|
| Rate for Payer: Cash Price |
$993.52
|
| Rate for Payer: Cigna Commercial |
$1,649.24
|
| Rate for Payer: First Health Commercial |
$1,887.69
|
| Rate for Payer: Humana Commercial |
$1,688.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.06
|
| Rate for Payer: PHCS Commercial |
$1,907.56
|
| Rate for Payer: United Healthcare All Payer |
$1,748.60
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
