|
DIABETIC EDUCATION - OP
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
94200013
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.90 |
| 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 |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| 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 |
$45.90 |
| 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 |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| 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 |
$82.80 |
| 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 |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| 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 |
$82.80 |
| 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 |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
DIAGNOSTIC BONE MARROW; ASPIRATION(S)
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 38220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
DIAGNOSTIC PAP SMEAR PROCEDURE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001422
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.30 |
| 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 |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| 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 |
$18.19 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$18.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.19
|
| 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 |
$18.19
|
| Rate for Payer: Humana Medicare Advantage |
$18.19
|
| Rate for Payer: Kentucky WC Medicaid |
$18.37
|
| 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 |
$21.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.55
|
| 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 |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Facility
|
IP
|
$5,182.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.60 |
| Max. Negotiated Rate |
$4,974.72 |
| Rate for Payer: Aetna Commercial |
$3,990.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.96
|
| Rate for Payer: Cash Price |
$2,591.00
|
| Rate for Payer: Cigna Commercial |
$4,301.06
|
| Rate for Payer: First Health Commercial |
$4,922.90
|
| Rate for Payer: Humana Commercial |
$4,404.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,249.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,824.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,560.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,508.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,575.58
|
| Rate for Payer: PHCS Commercial |
$4,974.72
|
| Rate for Payer: United Healthcare All Payer |
$4,560.16
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Professional
|
Both
|
$5,182.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.47 |
| Max. Negotiated Rate |
$3,109.20 |
| Rate for Payer: Aetna Commercial |
$452.60
|
| Rate for Payer: Ambetter Exchange |
$242.01
|
| 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 Individual/Medicaid |
$242.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.41
|
| Rate for Payer: Cash Price |
$2,591.00
|
| Rate for Payer: Cash Price |
$2,591.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$242.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.24
|
| Rate for Payer: Molina Healthcare Passport |
$223.76
|
| Rate for Payer: Multiplan PHCS |
$3,109.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$314.61
|
| Rate for Payer: UHCCP Medicaid |
$207.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.01
|
|
|
DIALYSIS CATHETER PLACEMENT
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
76101474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,782.09 |
| Max. Negotiated Rate |
$4,974.72 |
| Rate for Payer: Aetna Commercial |
$3,990.14
|
| Rate for Payer: Anthem Medicaid |
$1,782.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,591.00
|
| Rate for Payer: Cash Price |
$2,591.00
|
| Rate for Payer: Cigna Commercial |
$4,301.06
|
| Rate for Payer: First Health Commercial |
$4,922.90
|
| Rate for Payer: Humana Commercial |
$4,404.70
|
| Rate for Payer: Humana KY Medicaid |
$1,782.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,800.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,249.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,824.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,817.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,560.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,508.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,575.58
|
| Rate for Payer: PHCS Commercial |
$4,974.72
|
| Rate for Payer: United Healthcare All Payer |
$4,560.16
|
|
|
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: Ambetter Exchange |
$242.01
|
| 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 Individual/Medicaid |
$242.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$242.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.01
|
| 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 |
$314.61
|
| Rate for Payer: UHCCP Medicaid |
$207.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.01
|
|
|
DIALYSIS CATHETER PLACEMENT(T
|
Facility
|
OP
|
$4,407.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
761T1474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,515.57 |
| Max. Negotiated Rate |
$4,230.72 |
| Rate for Payer: Aetna Commercial |
$3,393.39
|
| Rate for Payer: Anthem Medicaid |
$1,515.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,437.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,203.50
|
| Rate for Payer: Cash Price |
$2,203.50
|
| Rate for Payer: Cigna Commercial |
$3,657.81
|
| Rate for Payer: First Health Commercial |
$4,186.65
|
| Rate for Payer: Humana Commercial |
$3,745.95
|
| Rate for Payer: Humana KY Medicaid |
$1,515.57
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,530.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,613.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,252.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,545.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,878.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,525.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,834.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.83
|
| Rate for Payer: PHCS Commercial |
$4,230.72
|
| Rate for Payer: United Healthcare All Payer |
$3,878.16
|
|
|
DIALYSIS CATHETER PLACEMENT(T
|
Facility
|
IP
|
$4,407.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
761T1474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,322.10 |
| Max. Negotiated Rate |
$4,230.72 |
| Rate for Payer: Aetna Commercial |
$3,393.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,437.46
|
| Rate for Payer: Cash Price |
$2,203.50
|
| Rate for Payer: Cigna Commercial |
$3,657.81
|
| Rate for Payer: First Health Commercial |
$4,186.65
|
| Rate for Payer: Humana Commercial |
$3,745.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,613.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,252.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,878.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,525.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,834.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.83
|
| Rate for Payer: PHCS Commercial |
$4,230.72
|
| Rate for Payer: United Healthcare All Payer |
$3,878.16
|
|
|
DIALYSIS CIRCUIT EMBOLJ
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 36909
|
| Hospital Charge Code |
76101522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
DIALYSIS CIRCUIT EMBOLJ
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 36909
|
| Hospital Charge Code |
76101522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$139.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$139.28
|
| Rate for Payer: Kentucky WC Medicaid |
$140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
DIALYSIS CIRCUIT EMBOLJ
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 36909
|
| Hospital Charge Code |
76101522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$1,478.42 |
| Rate for Payer: Ambetter Exchange |
$187.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.27
|
| Rate for Payer: Anthem Medicaid |
$1,449.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.58
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$297.08
|
| Rate for Payer: Humana Medicaid |
$1,449.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,478.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,449.43
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.29
|
| Rate for Payer: UHCCP Medicaid |
$159.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,463.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.15
|
|
|
DIALYSIS CIRCUIT EMBOLJ(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 36909
|
| Hospital Charge Code |
761P1522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$1,478.42 |
| Rate for Payer: Ambetter Exchange |
$187.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.27
|
| Rate for Payer: Anthem Medicaid |
$1,449.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.58
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$297.08
|
| Rate for Payer: Humana Medicaid |
$1,449.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,478.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,449.43
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.29
|
| Rate for Payer: UHCCP Medicaid |
$159.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,463.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.15
|
|
|
DIALYSIS ONE EVALUATION
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
76103012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$108.33
|
| Rate for Payer: Ambetter Exchange |
$80.62
|
| Rate for Payer: Anthem Medicaid |
$73.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.74
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Healthspan PPO |
$88.65
|
| Rate for Payer: Humana Medicaid |
$73.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.04
|
| Rate for Payer: Molina Healthcare Passport |
$73.57
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.81
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.62
|
|
|
DIALYSIS ONE EVALUATION (P
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
761P3012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$108.33
|
| Rate for Payer: Ambetter Exchange |
$80.62
|
| Rate for Payer: Anthem Medicaid |
$73.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.74
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Healthspan PPO |
$88.65
|
| Rate for Payer: Humana Medicaid |
$73.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.04
|
| Rate for Payer: Molina Healthcare Passport |
$73.57
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.81
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.62
|
|
|
DIALYSIS PROCEDURE
|
Professional
|
Both
|
$3,490.20
|
|
|
Service Code
|
HCPCS 90999
|
| Hospital Charge Code |
88000003
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,443.14 |
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,094.12
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,443.14
|
| Rate for Payer: UHCCP Medicaid |
$1,221.57
|
|
|
DIALYSIS PROCEDURE
|
Facility
|
OP
|
$3,490.20
|
|
|
Service Code
|
HCPCS 90999
|
| Hospital Charge Code |
88000003
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$1,047.06 |
| Max. Negotiated Rate |
$3,350.59 |
| Rate for Payer: Aetna Commercial |
$2,687.45
|
| Rate for Payer: Anthem Medicaid |
$1,200.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,722.36
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cigna Commercial |
$2,896.87
|
| Rate for Payer: First Health Commercial |
$3,315.69
|
| Rate for Payer: Humana Commercial |
$2,966.67
|
| Rate for Payer: Humana KY Medicaid |
$1,200.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,071.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,617.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,792.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,036.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,408.24
|
| Rate for Payer: PHCS Commercial |
$3,350.59
|
| Rate for Payer: United Healthcare All Payer |
$3,071.38
|
|
|
DIALYSIS PROCEDURE
|
Facility
|
IP
|
$3,490.20
|
|
|
Service Code
|
HCPCS 90999
|
| Hospital Charge Code |
88000003
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$1,047.06 |
| Max. Negotiated Rate |
$3,350.59 |
| Rate for Payer: Aetna Commercial |
$2,687.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,722.36
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cigna Commercial |
$2,896.87
|
| Rate for Payer: First Health Commercial |
$3,315.69
|
| Rate for Payer: Humana Commercial |
$2,966.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,071.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,617.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,792.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,036.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,408.24
|
| Rate for Payer: PHCS Commercial |
$3,350.59
|
| Rate for Payer: United Healthcare All Payer |
$3,071.38
|
|
|
DIALYSIS PROCEDURE(P
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 90999
|
| Hospital Charge Code |
880P0003
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,526.00 |
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,308.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,526.00
|
| Rate for Payer: UHCCP Medicaid |
$763.00
|
|
|
DIALYSIS PROCEDURE(T
|
Facility
|
IP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 90999
|
| Hospital Charge Code |
880T0003
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$393.06 |
| Max. Negotiated Rate |
$1,257.79 |
| Rate for Payer: Aetna Commercial |
$1,008.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,021.96
|
| Rate for Payer: Cash Price |
$655.10
|
| Rate for Payer: Cigna Commercial |
$1,087.47
|
| Rate for Payer: First Health Commercial |
$1,244.69
|
| Rate for Payer: Humana Commercial |
$1,113.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,074.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$966.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,152.98
|
| Rate for Payer: Ohio Health Group HMO |
$982.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,048.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$904.04
|
| Rate for Payer: PHCS Commercial |
$1,257.79
|
| Rate for Payer: United Healthcare All Payer |
$1,152.98
|
|
