|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$70,735.53
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$47,999.11 |
| Max. Negotiated Rate |
$70,735.53 |
| Rate for Payer: Anthem Medicaid |
$47,999.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50,525.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$70,735.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$68,209.26
|
| Rate for Payer: Humana KY Medicaid |
$47,999.11
|
| Rate for Payer: Humana Medicare Advantage |
$50,525.38
|
| Rate for Payer: Kentucky WC Medicaid |
$48,479.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60,630.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$48,959.09
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,491.74
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$9,833.68 |
| Max. Negotiated Rate |
$14,491.74 |
| Rate for Payer: Anthem Medicaid |
$9,833.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,351.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,491.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,974.17
|
| Rate for Payer: Humana KY Medicaid |
$9,833.68
|
| Rate for Payer: Humana Medicare Advantage |
$10,351.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,932.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,421.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,030.35
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$18,407.13
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$12,490.55 |
| Max. Negotiated Rate |
$18,407.13 |
| Rate for Payer: Anthem Medicaid |
$12,490.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,147.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,407.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,749.73
|
| Rate for Payer: Humana KY Medicaid |
$12,490.55
|
| Rate for Payer: Humana Medicare Advantage |
$13,147.95
|
| Rate for Payer: Kentucky WC Medicaid |
$12,615.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,777.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,740.36
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$36,559.22
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$24,808.04 |
| Max. Negotiated Rate |
$36,559.22 |
| Rate for Payer: Anthem Medicaid |
$24,808.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26,113.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36,559.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$35,253.54
|
| Rate for Payer: Humana KY Medicaid |
$24,808.04
|
| Rate for Payer: Humana Medicare Advantage |
$26,113.73
|
| Rate for Payer: Kentucky WC Medicaid |
$25,056.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,304.20
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$26,120.92
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$17,724.91 |
| Max. Negotiated Rate |
$26,120.92 |
| Rate for Payer: Anthem Medicaid |
$17,724.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,657.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,120.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,188.03
|
| Rate for Payer: Humana KY Medicaid |
$17,724.91
|
| Rate for Payer: Humana Medicare Advantage |
$18,657.80
|
| Rate for Payer: Kentucky WC Medicaid |
$17,902.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,389.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,079.41
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$52,664.15
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$35,736.39 |
| Max. Negotiated Rate |
$52,664.15 |
| Rate for Payer: Anthem Medicaid |
$35,736.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37,617.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52,664.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$50,783.29
|
| Rate for Payer: Humana KY Medicaid |
$35,736.39
|
| Rate for Payer: Humana Medicare Advantage |
$37,617.25
|
| Rate for Payer: Kentucky WC Medicaid |
$36,093.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45,140.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,451.12
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,107.06
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$10,251.22 |
| Max. Negotiated Rate |
$15,107.06 |
| Rate for Payer: Anthem Medicaid |
$10,251.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,790.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,107.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,567.53
|
| Rate for Payer: Humana KY Medicaid |
$10,251.22
|
| Rate for Payer: Humana Medicare Advantage |
$10,790.76
|
| Rate for Payer: Kentucky WC Medicaid |
$10,353.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,948.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,456.25
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$12,474.95
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$8,465.15 |
| Max. Negotiated Rate |
$12,474.95 |
| Rate for Payer: Anthem Medicaid |
$8,465.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,910.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,474.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,029.42
|
| Rate for Payer: Humana KY Medicaid |
$8,465.15
|
| Rate for Payer: Humana Medicare Advantage |
$8,910.68
|
| Rate for Payer: Kentucky WC Medicaid |
$8,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,692.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,634.45
|
|
|
LYRICA 100MG CAPSULE
|
Facility
|
OP
|
$61.35
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
25000934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Humana KY Medicaid |
$21.10
|
| Rate for Payer: Kentucky WC Medicaid |
$21.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA 100MG CAPSULE
|
Facility
|
IP
|
$61.35
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
25000934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 25MG CAP
|
Facility
|
IP
|
$61.35
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
25000931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 25MG CAP
|
Facility
|
OP
|
$61.35
|
|
|
Service Code
|
NDC 60687047301
|
| Hospital Charge Code |
25000931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Humana KY Medicaid |
$21.10
|
| Rate for Payer: Kentucky WC Medicaid |
$21.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 50MG CAP
|
Facility
|
OP
|
$61.35
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
25000932
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Humana KY Medicaid |
$21.10
|
| Rate for Payer: Kentucky WC Medicaid |
$21.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 50MG CAP
|
Facility
|
IP
|
$61.35
|
|
|
Service Code
|
NDC 60687048401
|
| Hospital Charge Code |
25000932
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 75 MG CAP
|
Facility
|
OP
|
$61.35
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
25000933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Humana KY Medicaid |
$21.10
|
| Rate for Payer: Kentucky WC Medicaid |
$21.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYRICA (PREGABALIN) 75 MG CAP
|
Facility
|
IP
|
$61.35
|
|
|
Service Code
|
NDC 60687049501
|
| Hospital Charge Code |
25000933
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Professional
|
Both
|
$1,857.19
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
76101205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$1,857.19 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.61
|
| Rate for Payer: Anthem Medicaid |
$54.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,857.19
|
| Rate for Payer: Cash Price |
$928.60
|
| Rate for Payer: Cash Price |
$928.60
|
| Rate for Payer: Cigna Commercial |
$162.62
|
| Rate for Payer: Healthspan PPO |
$98.35
|
| Rate for Payer: Humana Medicaid |
$54.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.51
|
| Rate for Payer: Molina Healthcare Passport |
$54.42
|
| Rate for Payer: Multiplan PHCS |
$1,114.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,300.03
|
| Rate for Payer: UHCCP Medicaid |
$36.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.96
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
IP
|
$1,857.19
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
76101205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,782.90 |
| Rate for Payer: Aetna Commercial |
$1,430.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.61
|
| Rate for Payer: Cash Price |
$928.60
|
| Rate for Payer: Cigna Commercial |
$1,541.47
|
| Rate for Payer: First Health Commercial |
$1,764.33
|
| Rate for Payer: Humana Commercial |
$1,578.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,522.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,392.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.73
|
| Rate for Payer: PHCS Commercial |
$1,782.90
|
| Rate for Payer: United Healthcare All Payer |
$1,634.33
|
|
|
LYSE CHEST FIBRIN INIT DAY
|
Facility
|
OP
|
$1,857.19
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
76101205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,782.90 |
| Rate for Payer: Aetna Commercial |
$1,430.04
|
| Rate for Payer: Anthem Medicaid |
$638.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$928.60
|
| Rate for Payer: Cash Price |
$928.60
|
| Rate for Payer: Cigna Commercial |
$1,541.47
|
| Rate for Payer: First Health Commercial |
$1,764.33
|
| Rate for Payer: Humana Commercial |
$1,578.61
|
| Rate for Payer: Humana KY Medicaid |
$638.69
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$645.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,522.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,392.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.73
|
| Rate for Payer: PHCS Commercial |
$1,782.90
|
| Rate for Payer: United Healthcare All Payer |
$1,634.33
|
|
|
LYSE CHEST FIBRIN INIT DAY(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
761P1205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.61
|
| Rate for Payer: Anthem Medicaid |
$54.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$162.62
|
| Rate for Payer: Healthspan PPO |
$98.35
|
| Rate for Payer: Humana Medicaid |
$54.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.51
|
| Rate for Payer: Molina Healthcare Passport |
$54.42
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$36.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.96
|
|
|
LYSE CHEST FIBRIN INIT DAY(T
|
Facility
|
IP
|
$1,532.19
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
761T1205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$1,470.90 |
| Rate for Payer: Aetna Commercial |
$1,179.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.11
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cigna Commercial |
$1,271.72
|
| Rate for Payer: First Health Commercial |
$1,455.58
|
| Rate for Payer: Humana Commercial |
$1,302.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.98
|
| Rate for Payer: PHCS Commercial |
$1,470.90
|
| Rate for Payer: United Healthcare All Payer |
$1,348.33
|
|
|
LYSE CHEST FIBRIN INIT DAY(T
|
Facility
|
OP
|
$1,532.19
|
|
|
Service Code
|
HCPCS 32561
|
| Hospital Charge Code |
761T1205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$1,470.90 |
| Rate for Payer: Aetna Commercial |
$1,179.79
|
| Rate for Payer: Anthem Medicaid |
$526.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cigna Commercial |
$1,271.72
|
| Rate for Payer: First Health Commercial |
$1,455.58
|
| Rate for Payer: Humana Commercial |
$1,302.36
|
| Rate for Payer: Humana KY Medicaid |
$526.92
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$532.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.98
|
| Rate for Payer: PHCS Commercial |
$1,470.90
|
| Rate for Payer: United Healthcare All Payer |
$1,348.33
|
|
|
LYSE CHEST FIBRIN SUBQ DAY
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
76101206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
LYSE CHEST FIBRIN SUBQ DAY
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
76101206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem Medicaid |
$502.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Humana KY Medicaid |
$502.09
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$507.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
LYSE CHEST FIBRIN SUBQ DAY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 32562
|
| Hospital Charge Code |
76101206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.28
|
| Rate for Payer: Anthem Medicaid |
$48.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,460.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$144.56
|
| Rate for Payer: Healthspan PPO |
$87.43
|
| Rate for Payer: Humana Medicaid |
$48.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.67
|
| Rate for Payer: Molina Healthcare Passport |
$48.70
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.00
|
| Rate for Payer: UHCCP Medicaid |
$31.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.19
|
|
