|
CPT TOTAL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
30001827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$6.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.51
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$6.51
|
| Rate for Payer: Humana Medicare Advantage |
$6.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
CREATINE MB FRACTION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
30000295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.78
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
CREATINE MB FRACTION
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
30000295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$11.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.55
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| 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 |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.78
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
CREATININE - BLOOD
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
30000296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
CREATININE - BLOOD
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
30000296
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem Medicaid |
$5.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| 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 |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30000297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$68.16 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.01
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$58.93
|
| Rate for Payer: First Health Commercial |
$67.45
|
| Rate for Payer: Humana Commercial |
$60.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.48
|
| Rate for Payer: Ohio Health Group HMO |
$53.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.99
|
| Rate for Payer: PHCS Commercial |
$68.16
|
| Rate for Payer: United Healthcare All Payer |
$62.48
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30000297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$68.16 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$58.93
|
| Rate for Payer: First Health Commercial |
$67.45
|
| Rate for Payer: Humana Commercial |
$60.35
|
| 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 |
$58.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.48
|
| Rate for Payer: Ohio Health Group HMO |
$53.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.99
|
| Rate for Payer: PHCS Commercial |
$68.16
|
| Rate for Payer: United Healthcare All Payer |
$62.48
|
|
|
CREATION ARTER FISTULA
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
76101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| 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 |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
CREATION ARTER FISTULA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
76101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| 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 |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$917.45
|
| Rate for Payer: Ambetter Exchange |
$741.46
|
| Rate for Payer: Anthem Medicaid |
$628.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$741.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$741.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$889.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.46
|
| 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 |
$963.90
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$741.46
|
|
|
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 |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$917.45
|
| Rate for Payer: Ambetter Exchange |
$741.46
|
| Rate for Payer: Anthem Medicaid |
$628.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$741.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$741.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$889.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.46
|
| 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 |
$963.90
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$741.46
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.00 |
| 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 |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| 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 |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.78 |
| Max. Negotiated Rate |
$1,054.97 |
| Rate for Payer: Aetna Commercial |
$1,054.97
|
| Rate for Payer: Ambetter Exchange |
$624.80
|
| Rate for Payer: Anthem Medicaid |
$552.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$624.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$624.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$749.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$624.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.80
|
| 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 |
$812.24
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$624.80
|
|
|
CREATION OF ARTERIOVENOUS FIST
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
76101509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| 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 |
$567.43
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| 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 |
$1,054.97 |
| Rate for Payer: Aetna Commercial |
$1,054.97
|
| Rate for Payer: Ambetter Exchange |
$624.80
|
| Rate for Payer: Anthem Medicaid |
$552.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$624.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$624.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$749.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$624.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.80
|
| 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 |
$812.24
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$624.80
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$6,992.66
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
|
|
CREON 12-38-60 CAPSULE DR
|
Facility
|
IP
|
$12.29
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$11.68
|
| Rate for Payer: Humana Commercial |
$10.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.82
|
| Rate for Payer: Ohio Health Group HMO |
$9.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.48
|
| Rate for Payer: PHCS Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Payer |
$10.82
|
|
|
CREON 12-38-60 CAPSULE DR
|
Facility
|
OP
|
$12.29
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Anthem Medicaid |
$4.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$11.68
|
| Rate for Payer: Humana Commercial |
$10.45
|
| Rate for Payer: Humana KY Medicaid |
$4.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.82
|
| Rate for Payer: Ohio Health Group HMO |
$9.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.48
|
| Rate for Payer: PHCS Commercial |
$11.80
|
| Rate for Payer: United Healthcare All Payer |
$10.82
|
|
|
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 |
$7.53 |
| 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 |
$20.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.32
|
| Rate for Payer: PHCS Commercial |
$24.10
|
| Rate for Payer: United Healthcare All Payer |
$22.09
|
|
|
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 |
$7.53 |
| 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 |
$20.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.32
|
| Rate for Payer: PHCS Commercial |
$24.10
|
| Rate for Payer: United Healthcare All Payer |
$22.09
|
|
|
CREON 36/114/180K CAPSULE.DR
|
Facility
|
IP
|
$29.91
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.33
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cigna Commercial |
$24.83
|
| Rate for Payer: First Health Commercial |
$28.41
|
| Rate for Payer: Humana Commercial |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.32
|
| Rate for Payer: Ohio Health Group HMO |
$22.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.64
|
| Rate for Payer: PHCS Commercial |
$28.71
|
| Rate for Payer: United Healthcare All Payer |
$26.32
|
|
|
CREON 36/114/180K CAPSULE.DR
|
Facility
|
OP
|
$29.91
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Anthem Medicaid |
$10.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.33
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cigna Commercial |
$24.83
|
| Rate for Payer: First Health Commercial |
$28.41
|
| Rate for Payer: Humana Commercial |
$25.42
|
| Rate for Payer: Humana KY Medicaid |
$10.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.32
|
| Rate for Payer: Ohio Health Group HMO |
$22.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.64
|
| Rate for Payer: PHCS Commercial |
$28.71
|
| Rate for Payer: United Healthcare All Payer |
$26.32
|
|
|
CREON 6-19-30K CAPSULE DR
|
Facility
|
OP
|
$10.15
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem Medicaid |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Humana KY Medicaid |
$3.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.00
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
CREON 6-19-30K CAPSULE DR
|
Facility
|
IP
|
$10.15
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.92
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.42
|
| Rate for Payer: First Health Commercial |
$9.64
|
| Rate for Payer: Humana Commercial |
$8.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.93
|
| Rate for Payer: Ohio Health Group HMO |
$7.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.00
|
| Rate for Payer: PHCS Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Payer |
$8.93
|
|
|
CRESEMBA(ISAV) 1MG (372MG/5ML)
|
Facility
|
OP
|
$974.38
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$935.40 |
| Rate for Payer: Aetna Commercial |
$750.27
|
| Rate for Payer: Anthem Medicaid |
$335.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$487.19
|
| Rate for Payer: Cash Price |
$487.19
|
| Rate for Payer: Cigna Commercial |
$808.74
|
| Rate for Payer: First Health Commercial |
$925.66
|
| Rate for Payer: Humana Commercial |
$828.22
|
| Rate for Payer: Humana KY Medicaid |
$335.09
|
| Rate for Payer: Humana Medicare Advantage |
$1.01
|
| Rate for Payer: Kentucky WC Medicaid |
$338.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$798.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$341.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$857.45
|
| Rate for Payer: Ohio Health Group HMO |
$730.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$779.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.32
|
| Rate for Payer: PHCS Commercial |
$935.40
|
| Rate for Payer: United Healthcare All Payer |
$857.45
|
|
