|
ESPHG TOT W/THRCM(P
|
Professional
|
Both
|
$2,955.00
|
|
|
Service Code
|
HCPCS 43112
|
| Hospital Charge Code |
761P1719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,034.25 |
| Max. Negotiated Rate |
$4,185.09 |
| Rate for Payer: Aetna Commercial |
$4,123.50
|
| Rate for Payer: Ambetter Exchange |
$3,219.30
|
| Rate for Payer: Anthem Medicaid |
$1,553.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,219.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,219.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,863.16
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cigna Commercial |
$3,875.20
|
| Rate for Payer: Healthspan PPO |
$3,477.42
|
| Rate for Payer: Humana Medicaid |
$1,553.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,571.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,219.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,219.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,584.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,553.86
|
| Rate for Payer: Multiplan PHCS |
$1,773.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,185.09
|
| Rate for Payer: UHCCP Medicaid |
$1,034.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,569.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,219.30
|
|
|
ESRD HOME PT SERV P MO 20+
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 90966
|
| Hospital Charge Code |
76102991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$353.86
|
| Rate for Payer: Ambetter Exchange |
$276.55
|
| Rate for Payer: Anthem Medicaid |
$179.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.86
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$313.34
|
| Rate for Payer: Healthspan PPO |
$289.58
|
| Rate for Payer: Humana Medicaid |
$179.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.79
|
| Rate for Payer: Molina Healthcare Passport |
$179.21
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.51
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.55
|
|
|
ESRD SERV 1 VISIT P MO 20+
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 90962
|
| Hospital Charge Code |
76102990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.06 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Ambetter Exchange |
$190.27
|
| Rate for Payer: Anthem Medicaid |
$129.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.32
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$228.98
|
| Rate for Payer: Healthspan PPO |
$211.59
|
| Rate for Payer: Humana Medicaid |
$129.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.64
|
| Rate for Payer: Molina Healthcare Passport |
$129.06
|
| Rate for Payer: Multiplan PHCS |
$294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.35
|
| Rate for Payer: UHCCP Medicaid |
$171.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$130.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.27
|
|
|
ESRD SRV 2-3 VSTS P MO 20+
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 90961
|
| Hospital Charge Code |
76102989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.88 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$357.61
|
| Rate for Payer: Ambetter Exchange |
$276.55
|
| Rate for Payer: Anthem Medicaid |
$181.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.86
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Healthspan PPO |
$292.64
|
| Rate for Payer: Humana Medicaid |
$181.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$304.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.52
|
| Rate for Payer: Molina Healthcare Passport |
$181.88
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.51
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.55
|
|
|
ESRD SRV 4 VISITS P MO 20+
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 90960
|
| Hospital Charge Code |
76102988
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$442.83
|
| Rate for Payer: Ambetter Exchange |
$333.50
|
| Rate for Payer: Anthem Medicaid |
$227.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$400.20
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$392.26
|
| Rate for Payer: Healthspan PPO |
$362.39
|
| Rate for Payer: Humana Medicaid |
$227.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.82
|
| Rate for Payer: Molina Healthcare Passport |
$227.27
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.55
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.50
|
|
|
ESRD SVC PR DAY PT 20+
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 90970
|
| Hospital Charge Code |
76102992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$12.53
|
| Rate for Payer: Ambetter Exchange |
$9.10
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.92
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: Healthspan PPO |
$10.26
|
| Rate for Payer: Humana Medicaid |
$6.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$6.35
|
| Rate for Payer: Molina Healthcare Passport |
$6.23
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.83
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.10
|
|
|
ESSURE (TUBAL)
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58565
|
| Hospital Charge Code |
76102239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,375.60 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
ESSURE (TUBAL)
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58565
|
| Hospital Charge Code |
76102239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.83 |
| Max. Negotiated Rate |
$2,725.21 |
| Rate for Payer: Aetna Commercial |
$684.40
|
| Rate for Payer: Ambetter Exchange |
$430.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.83
|
| Rate for Payer: Anthem Medicaid |
$338.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$430.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.10
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,390.39
|
| Rate for Payer: Healthspan PPO |
$2,725.21
|
| Rate for Payer: Humana Medicaid |
$338.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$430.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.39
|
| Rate for Payer: Molina Healthcare Passport |
$338.62
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.20
|
| Rate for Payer: UHCCP Medicaid |
$347.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$430.92
|
|
|
ESSURE (TUBAL)
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58565
|
| Hospital Charge Code |
76102239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
ESSURE (TUBAL)(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58565
|
| Hospital Charge Code |
761P2239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.83 |
| Max. Negotiated Rate |
$2,725.21 |
| Rate for Payer: Aetna Commercial |
$684.40
|
| Rate for Payer: Ambetter Exchange |
$430.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.83
|
| Rate for Payer: Anthem Medicaid |
$338.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$430.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.10
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,390.39
|
| Rate for Payer: Healthspan PPO |
$2,725.21
|
| Rate for Payer: Humana Medicaid |
$338.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$430.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.39
|
| Rate for Payer: Molina Healthcare Passport |
$338.62
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.20
|
| Rate for Payer: UHCCP Medicaid |
$347.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$430.92
|
|
|
ESTABLISH ACCESS TO ARTERY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 36100
|
| Hospital Charge Code |
76101436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
ESTABLISH ACCESS TO ARTERY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 36100
|
| Hospital Charge Code |
76101436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
ESTABLISH ACCESS TO ARTERY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 36100
|
| Hospital Charge Code |
76101436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.03 |
| Max. Negotiated Rate |
$832.86 |
| Rate for Payer: Aetna Commercial |
$276.53
|
| Rate for Payer: Ambetter Exchange |
$143.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$111.03
|
| Rate for Payer: Anthem Medicaid |
$165.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.12
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$258.91
|
| Rate for Payer: Healthspan PPO |
$832.86
|
| Rate for Payer: Humana Medicaid |
$165.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$215.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.18
|
| Rate for Payer: Molina Healthcare Passport |
$165.86
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.46
|
| Rate for Payer: UHCCP Medicaid |
$116.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.43
|
|
|
ESTABLISH ACCESS TO ARTERY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 36100
|
| Hospital Charge Code |
761P1436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.03 |
| Max. Negotiated Rate |
$832.86 |
| Rate for Payer: Aetna Commercial |
$276.53
|
| Rate for Payer: Ambetter Exchange |
$143.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$111.03
|
| Rate for Payer: Anthem Medicaid |
$165.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.12
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$258.91
|
| Rate for Payer: Healthspan PPO |
$832.86
|
| Rate for Payer: Humana Medicaid |
$165.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$215.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.18
|
| Rate for Payer: Molina Healthcare Passport |
$165.86
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.46
|
| Rate for Payer: UHCCP Medicaid |
$116.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.43
|
|
|
EST PT HIGH LEVEL 4
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
51000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
EST PT HIGH LEVEL 4
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
51000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem Medicaid |
$166.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Humana KY Medicaid |
$166.10
|
| Rate for Payer: Kentucky WC Medicaid |
$167.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
EST PT HIGH LEVEL 4
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
51000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$109.62
|
| Rate for Payer: Ambetter Exchange |
$91.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.49
|
| Rate for Payer: Anthem Medicaid |
$67.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.90
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$136.31
|
| Rate for Payer: Healthspan PPO |
$106.96
|
| Rate for Payer: Humana Medicaid |
$67.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.44
|
| Rate for Payer: Molina Healthcare Passport |
$67.10
|
| Rate for Payer: Multiplan PHCS |
$289.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.05
|
| Rate for Payer: UHCCP Medicaid |
$51.96
|
| Rate for Payer: United Healthcare Non-Options |
$75.50
|
| Rate for Payer: United Healthcare Options |
$61.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.58
|
|
|
EST PT HIGH LEVEL 4
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem Medicaid |
$166.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Humana KY Medicaid |
$166.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$167.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
EST PT HIGH LEVEL 4
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
EST PT HIGH LEVEL 4(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
510P0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$136.31 |
| Rate for Payer: Aetna Commercial |
$109.62
|
| Rate for Payer: Ambetter Exchange |
$91.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.49
|
| Rate for Payer: Anthem Medicaid |
$67.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.90
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$136.31
|
| Rate for Payer: Healthspan PPO |
$106.96
|
| Rate for Payer: Humana Medicaid |
$67.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.44
|
| Rate for Payer: Molina Healthcare Passport |
$67.10
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.05
|
| Rate for Payer: UHCCP Medicaid |
$51.96
|
| Rate for Payer: United Healthcare Non-Options |
$75.50
|
| Rate for Payer: United Healthcare Options |
$61.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.58
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
EST PT HIGH LEVEL 5
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$361.20 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Ambetter Exchange |
$135.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$98.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.37
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Healthspan PPO |
$144.98
|
| Rate for Payer: Humana Medicaid |
$98.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.36
|
| Rate for Payer: Molina Healthcare Passport |
$98.39
|
| Rate for Payer: Multiplan PHCS |
$361.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.90
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: United Healthcare Non-Options |
$107.40
|
| Rate for Payer: United Healthcare Options |
$87.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.31
|
|
