|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$66,314.78
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$44,999.32 |
| Max. Negotiated Rate |
$66,314.78 |
| Rate for Payer: Anthem Medicaid |
$44,999.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47,367.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66,314.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$63,946.40
|
| Rate for Payer: Humana KY Medicaid |
$44,999.32
|
| Rate for Payer: Humana Medicare Advantage |
$47,367.70
|
| Rate for Payer: Kentucky WC Medicaid |
$45,449.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56,841.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,899.30
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$44,322.15
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$30,075.75 |
| Max. Negotiated Rate |
$44,322.15 |
| Rate for Payer: Anthem Medicaid |
$30,075.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31,658.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$44,322.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$42,739.22
|
| Rate for Payer: Humana KY Medicaid |
$30,075.75
|
| Rate for Payer: Humana Medicare Advantage |
$31,658.68
|
| Rate for Payer: Kentucky WC Medicaid |
$30,376.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,990.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,677.26
|
|
|
CREATINE MB FRACTION
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
30000295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem Medicaid |
$11.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.55
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Humana KY Medicaid |
$11.55
|
| Rate for Payer: Humana Medicare Advantage |
$11.55
|
| Rate for Payer: Kentucky WC Medicaid |
$11.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.43
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
CREATINE MB FRACTION
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
30000295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.86
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.43
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
CREATININE - BLOOD
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
30000296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
CREATININE - BLOOD
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
30000296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$5.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Humana KY Medicaid |
$5.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.12
|
| Rate for Payer: Kentucky WC Medicaid |
$5.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30000297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| 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
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30000297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$33.50
|
| 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 |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| 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 |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| 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
|
|
|
CREATION ARTER FISTULA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
76101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
CREATION ARTER FISTULA
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
76101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
CREATION ARTER FISTULA
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
76101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$628.76 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$917.45
|
| Rate for Payer: Anthem Medicaid |
$628.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$875.81
|
| Rate for Payer: Healthspan PPO |
$733.58
|
| Rate for Payer: Humana Medicaid |
$628.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,091.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.34
|
| Rate for Payer: Molina Healthcare Passport |
$628.76
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.05
|
|
|
CREATION ARTER FISTULA(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
761P1508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$628.76 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$917.45
|
| Rate for Payer: Anthem Medicaid |
$628.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$875.81
|
| Rate for Payer: Healthspan PPO |
$733.58
|
| Rate for Payer: Humana Medicaid |
$628.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,091.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.34
|
| Rate for Payer: Molina Healthcare Passport |
$628.76
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.05
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.44
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
761P1509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.78 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,054.97
|
| Rate for Payer: Anthem Medicaid |
$552.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,005.74
|
| Rate for Payer: Healthspan PPO |
$843.55
|
| Rate for Payer: Humana Medicaid |
$552.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$563.84
|
| Rate for Payer: Molina Healthcare Passport |
$552.78
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.31
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.78 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,054.97
|
| Rate for Payer: Anthem Medicaid |
$552.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,005.74
|
| Rate for Payer: Healthspan PPO |
$843.55
|
| Rate for Payer: Humana Medicaid |
$552.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$563.84
|
| Rate for Payer: Molina Healthcare Passport |
$552.78
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.31
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$6,652.97
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,752.12 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
|
|
CREON 12-38-60 CAPSULE DR
|
Facility
|
IP
|
$12.15
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.48
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.54
|
| Rate for Payer: Humana Commercial |
$10.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.69
|
| Rate for Payer: Ohio Health Group HMO |
$9.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.77
|
| Rate for Payer: PHCS Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Payer |
$10.69
|
|
|
CREON 12-38-60 CAPSULE DR
|
Facility
|
OP
|
$12.15
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Anthem Medicaid |
$4.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.48
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.54
|
| Rate for Payer: Humana Commercial |
$10.33
|
| Rate for Payer: Humana KY Medicaid |
$4.18
|
| Rate for Payer: Kentucky WC Medicaid |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.69
|
| Rate for Payer: Ohio Health Group HMO |
$9.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.77
|
| Rate for Payer: PHCS Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Payer |
$10.69
|
|
|
CREON 24-76-120K CAPSULE DR
|
Facility
|
OP
|
$25.10
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Anthem Medicaid |
$8.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.58
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cigna Commercial |
$20.83
|
| Rate for Payer: First Health Commercial |
$23.84
|
| Rate for Payer: Humana Commercial |
$21.34
|
| Rate for Payer: Humana KY Medicaid |
$8.63
|
| Rate for Payer: Kentucky WC Medicaid |
$8.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.09
|
| Rate for Payer: Ohio Health Group HMO |
$18.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.78
|
| Rate for Payer: PHCS Commercial |
$24.10
|
| Rate for Payer: United Healthcare All Payer |
$22.09
|
|
|
CREON 24-76-120K CAPSULE DR
|
Facility
|
IP
|
$25.10
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002523
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.58
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cigna Commercial |
$20.83
|
| Rate for Payer: First Health Commercial |
$23.84
|
| Rate for Payer: Humana Commercial |
$21.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.09
|
| Rate for Payer: Ohio Health Group HMO |
$18.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.78
|
| Rate for Payer: PHCS Commercial |
$24.10
|
| Rate for Payer: United Healthcare All Payer |
$22.09
|
|
|
CREON 36/114/180K CAPSULE.DR
|
Facility
|
IP
|
$29.50
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$28.32 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.01
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: First Health Commercial |
$28.02
|
| Rate for Payer: Humana Commercial |
$25.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.96
|
| Rate for Payer: Ohio Health Group HMO |
$22.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.14
|
| Rate for Payer: PHCS Commercial |
$28.32
|
| Rate for Payer: United Healthcare All Payer |
$25.96
|
|
|
CREON 36/114/180K CAPSULE.DR
|
Facility
|
OP
|
$29.50
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$28.32 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Anthem Medicaid |
$10.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.01
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: First Health Commercial |
$28.02
|
| Rate for Payer: Humana Commercial |
$25.08
|
| Rate for Payer: Humana KY Medicaid |
$10.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.96
|
| Rate for Payer: Ohio Health Group HMO |
$22.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.14
|
| Rate for Payer: PHCS Commercial |
$28.32
|
| Rate for Payer: United Healthcare All Payer |
$25.96
|
|
|
CREON 6-19-30K CAPSULE DR
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: First Health Commercial |
$9.58
|
| Rate for Payer: Humana Commercial |
$8.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.87
|
| Rate for Payer: Ohio Health Group HMO |
$7.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
|
CREON 6-19-30K CAPSULE DR
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Aetna Commercial |
$7.76
|
| Rate for Payer: Anthem Medicaid |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.86
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: First Health Commercial |
$9.58
|
| Rate for Payer: Humana Commercial |
$8.57
|
| Rate for Payer: Humana KY Medicaid |
$3.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.87
|
| Rate for Payer: Ohio Health Group HMO |
$7.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Payer |
$8.87
|
|
