|
DIABETA (GLYBURIDE) 2.5MG/1TAB
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 93834301
|
| Hospital Charge Code |
25000549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DIABETA (GLYBURIDE) 5 5MG/1TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 72241004005
|
| Hospital Charge Code |
25000550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
DIABETA (GLYBURIDE) 5 5MG/1TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 72241004005
|
| Hospital Charge Code |
25000550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
DIABETES EDUC GROUP 30MIN
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200012
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
DIABETES EDUC GROUP 30MIN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200012
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
DIABETES EDUC IND 30MIN
|
Professional
|
Both
|
$112.00
|
|
| Hospital Charge Code |
94200011
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$112.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Multiplan PHCS |
$67.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.40
|
| Rate for Payer: UHCCP Medicaid |
$39.20
|
|
|
DIABETES EDUC IND 30MIN
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200011
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
DIABETES EDUC IND 30MIN
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200011
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$10,521.39
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$7,139.52 |
| Max. Negotiated Rate |
$10,521.39 |
| Rate for Payer: Anthem Medicaid |
$7,139.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,515.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,521.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,145.63
|
| Rate for Payer: Humana KY Medicaid |
$7,139.52
|
| Rate for Payer: Humana Medicare Advantage |
$7,515.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,210.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,018.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,282.31
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$16,954.20
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$11,504.63 |
| Max. Negotiated Rate |
$16,954.20 |
| Rate for Payer: Anthem Medicaid |
$11,504.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,110.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,954.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,348.69
|
| Rate for Payer: Humana KY Medicaid |
$11,504.63
|
| Rate for Payer: Humana Medicare Advantage |
$12,110.14
|
| Rate for Payer: Kentucky WC Medicaid |
$11,619.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,532.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,734.73
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$7,282.14
|
|
|
Service Code
|
MSDRG 639
|
| Min. Negotiated Rate |
$4,941.45 |
| Max. Negotiated Rate |
$7,282.14 |
| Rate for Payer: Anthem Medicaid |
$4,941.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,201.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,282.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,022.07
|
| Rate for Payer: Humana KY Medicaid |
$4,941.45
|
| Rate for Payer: Humana Medicare Advantage |
$5,201.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,990.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,241.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,040.28
|
|
|
DIABETIC EDUCATION - OP
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
94200013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem Medicaid |
$52.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| 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 |
$52.62
|
| Rate for Payer: Kentucky WC Medicaid |
$53.15
|
| 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: Molina Healthcare Medicaid |
$53.67
|
| 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
|
|
|
DIABETIC EDUCATION - OP
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
94200013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| 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
|
|
|
DIAB SMT IND MCD PER SESSION
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS S9460
|
| Hospital Charge Code |
94200017
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
DIAB SMT IND MCD PER SESSION
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS S9460
|
| Hospital Charge Code |
94200017
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
DIAGNOSTIC BONE MARROW; ASPIRATION(S)
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 38220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
DIAGNOSTIC PAP SMEAR PROCEDURE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001422
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
DIAGNOSTIC PAP SMEAR PROCEDURE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001422
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$17.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.76
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$17.76
|
| Rate for Payer: Humana Medicare Advantage |
$17.31
|
| Rate for Payer: Kentucky WC Medicaid |
$17.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Facility
|
IP
|
$4,913.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$638.69 |
| Max. Negotiated Rate |
$4,716.48 |
| Rate for Payer: Aetna Commercial |
$3,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.14
|
| Rate for Payer: Cash Price |
$2,456.50
|
| Rate for Payer: Cigna Commercial |
$4,077.79
|
| Rate for Payer: First Health Commercial |
$4,667.35
|
| Rate for Payer: Humana Commercial |
$4,176.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.03
|
| Rate for Payer: PHCS Commercial |
$4,716.48
|
| Rate for Payer: United Healthcare All Payer |
$4,323.44
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Professional
|
Both
|
$4,913.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.47 |
| Max. Negotiated Rate |
$4,913.00 |
| Rate for Payer: Aetna Commercial |
$452.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$197.47
|
| Rate for Payer: Anthem Medicaid |
$223.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,913.00
|
| Rate for Payer: Cash Price |
$2,456.50
|
| Rate for Payer: Cash Price |
$2,456.50
|
| Rate for Payer: Cigna Commercial |
$423.58
|
| Rate for Payer: Healthspan PPO |
$954.18
|
| Rate for Payer: Humana Medicaid |
$223.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$362.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.24
|
| Rate for Payer: Molina Healthcare Passport |
$223.76
|
| Rate for Payer: Multiplan PHCS |
$2,947.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,439.10
|
| Rate for Payer: UHCCP Medicaid |
$207.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.00
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Facility
|
OP
|
$4,913.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$638.69 |
| Max. Negotiated Rate |
$4,716.48 |
| Rate for Payer: Aetna Commercial |
$3,783.01
|
| Rate for Payer: Anthem Medicaid |
$1,689.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,456.50
|
| Rate for Payer: Cash Price |
$2,456.50
|
| Rate for Payer: Cigna Commercial |
$4,077.79
|
| Rate for Payer: First Health Commercial |
$4,667.35
|
| Rate for Payer: Humana Commercial |
$4,176.05
|
| Rate for Payer: Humana KY Medicaid |
$1,689.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.03
|
| Rate for Payer: PHCS Commercial |
$4,716.48
|
| Rate for Payer: United Healthcare All Payer |
$4,323.44
|
|
|
DIALYSIS CATHETER PLACEMENT(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
761P1474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.47 |
| Max. Negotiated Rate |
$954.18 |
| Rate for Payer: Aetna Commercial |
$452.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$197.47
|
| Rate for Payer: Anthem Medicaid |
$223.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$423.58
|
| Rate for Payer: Healthspan PPO |
$954.18
|
| Rate for Payer: Humana Medicaid |
$223.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$362.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.24
|
| Rate for Payer: Molina Healthcare Passport |
$223.76
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$207.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.00
|
|
|
DIALYSIS CATHETER PLACEMENT(T
|
Facility
|
OP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
761T1474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem Medicaid |
$1,423.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Humana KY Medicaid |
$1,423.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
|
DIALYSIS CATHETER PLACEMENT(T
|
Facility
|
IP
|
$4,138.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
761T1474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.94 |
| Max. Negotiated Rate |
$3,972.48 |
| Rate for Payer: Aetna Commercial |
$3,186.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.64
|
| Rate for Payer: Cash Price |
$2,069.00
|
| Rate for Payer: Cigna Commercial |
$3,434.54
|
| Rate for Payer: First Health Commercial |
$3,931.10
|
| Rate for Payer: Humana Commercial |
$3,517.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,393.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.78
|
| Rate for Payer: PHCS Commercial |
$3,972.48
|
| Rate for Payer: United Healthcare All Payer |
$3,641.44
|
|
