|
CONTACT 8 EXT KIT 25CM
|
Facility
|
IP
|
$4,528.86
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.75 |
| Max. Negotiated Rate |
$4,347.71 |
| Rate for Payer: Aetna Commercial |
$3,487.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.51
|
| Rate for Payer: Cash Price |
$2,264.43
|
| Rate for Payer: Cigna Commercial |
$3,758.95
|
| Rate for Payer: First Health Commercial |
$4,302.42
|
| Rate for Payer: Humana Commercial |
$3,849.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.95
|
| Rate for Payer: PHCS Commercial |
$4,347.71
|
| Rate for Payer: United Healthcare All Payer |
$3,985.40
|
|
|
CONTACT 8 EXT KIT 25CM
|
Facility
|
OP
|
$4,528.86
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.75 |
| Max. Negotiated Rate |
$4,347.71 |
| Rate for Payer: Aetna Commercial |
$3,487.22
|
| Rate for Payer: Anthem Medicaid |
$1,557.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.51
|
| Rate for Payer: Cash Price |
$2,264.43
|
| Rate for Payer: Cigna Commercial |
$3,758.95
|
| Rate for Payer: First Health Commercial |
$4,302.42
|
| Rate for Payer: Humana Commercial |
$3,849.53
|
| Rate for Payer: Humana KY Medicaid |
$1,557.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,573.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.95
|
| Rate for Payer: PHCS Commercial |
$4,347.71
|
| Rate for Payer: United Healthcare All Payer |
$3,985.40
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem Medicaid |
$67.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Humana KY Medicaid |
$67.40
|
| Rate for Payer: Kentucky WC Medicaid |
$68.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.76
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.76
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Anthem Medicaid |
$20.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$196.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: Healthspan PPO |
$54.94
|
| Rate for Payer: Humana Medicaid |
$20.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.21
|
| Rate for Payer: Molina Healthcare Passport |
$20.79
|
| Rate for Payer: Multiplan PHCS |
$117.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.20
|
| Rate for Payer: UHCCP Medicaid |
$68.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.00
|
|
|
CONT GLUC MNTR ANALYSIS I&R(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510P0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Anthem Medicaid |
$20.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: Healthspan PPO |
$54.94
|
| Rate for Payer: Humana Medicaid |
$20.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.21
|
| Rate for Payer: Molina Healthcare Passport |
$20.79
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.00
|
|
|
CONT GLUC MNTR ANALYSIS I&R(T
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510T0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| 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 |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R(T
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510T0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| 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 |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| 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: Molina Healthcare Medicaid |
$42.45
|
| 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 |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$190.71
|
| Rate for Payer: Anthem Medicaid |
$37.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$189.89
|
| Rate for Payer: Healthspan PPO |
$166.78
|
| Rate for Payer: Humana Medicaid |
$37.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.17
|
| Rate for Payer: Molina Healthcare Passport |
$37.42
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.79
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$147.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP(T
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
510T0033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP(T
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
510T0033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$147.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Anthem Medicaid |
$40.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$262.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$74.76
|
| Rate for Payer: Humana Medicaid |
$40.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.49
|
| Rate for Payer: Molina Healthcare Passport |
$40.68
|
| Rate for Payer: Multiplan PHCS |
$157.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.40
|
| Rate for Payer: UHCCP Medicaid |
$91.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.09
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem Medicaid |
$90.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Humana KY Medicaid |
$90.10
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
CONT GLUC MNTR PT PROV EQP(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510P0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Anthem Medicaid |
$40.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.76
|
| Rate for Payer: Humana Medicaid |
$40.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.49
|
| Rate for Payer: Molina Healthcare Passport |
$40.68
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.09
|
|
|
CONT GLUC MNTR PT PROV EQP(T
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510T0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
CONT GLUC MNTR PT PROV EQP(T
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510T0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
CONTIN RENAL REPLAC THERAPY
|
Facility
|
OP
|
$1,222.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$1,173.12 |
| Rate for Payer: Aetna Commercial |
$940.94
|
| Rate for Payer: Anthem Medicaid |
$420.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$383.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$536.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.06
|
| Rate for Payer: Cash Price |
$611.00
|
| Rate for Payer: Cash Price |
$611.00
|
| Rate for Payer: Cigna Commercial |
$1,014.26
|
| Rate for Payer: First Health Commercial |
$1,160.90
|
| Rate for Payer: Humana Commercial |
$1,038.70
|
| Rate for Payer: Humana KY Medicaid |
$420.25
|
| Rate for Payer: Humana Medicare Advantage |
$383.01
|
| Rate for Payer: Kentucky WC Medicaid |
$424.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$901.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$428.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,075.36
|
| Rate for Payer: Ohio Health Group HMO |
$916.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.82
|
| Rate for Payer: PHCS Commercial |
$1,173.12
|
| Rate for Payer: United Healthcare All Payer |
$1,075.36
|
|
|
CONTIN RENAL REPLAC THERAPY
|
Facility
|
IP
|
$1,222.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$158.86 |
| Max. Negotiated Rate |
$1,173.12 |
| Rate for Payer: Aetna Commercial |
$940.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.16
|
| Rate for Payer: Cash Price |
$611.00
|
| Rate for Payer: Cigna Commercial |
$1,014.26
|
| Rate for Payer: First Health Commercial |
$1,160.90
|
| Rate for Payer: Humana Commercial |
$1,038.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$901.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,075.36
|
| Rate for Payer: Ohio Health Group HMO |
$916.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.82
|
| Rate for Payer: PHCS Commercial |
$1,173.12
|
| Rate for Payer: United Healthcare All Payer |
$1,075.36
|
|
|
CONTINUOUS NEB 1ST HR
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
41000078
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
CONTINUOUS NEB 1ST HR
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
41000078
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
CONTINUOUS NEB EA ADTL HR
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
41000079
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
CONTINUOUS NEB EA ADTL HR
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
41000079
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$23.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$23.04
|
| Rate for Payer: Kentucky WC Medicaid |
$23.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
