|
PLCMT ATRICLIP DURING CABG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33999
|
| Hospital Charge Code |
76101335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Professional
|
Both
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.97 |
| Max. Negotiated Rate |
$16,100.00 |
| Rate for Payer: Aetna Commercial |
$305.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$16,100.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$6,549.88
|
| Rate for Payer: Healthspan PPO |
$4,231.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.27
|
| Rate for Payer: Multiplan PHCS |
$9,660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,270.00
|
| Rate for Payer: UHCCP Medicaid |
$174.27
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Facility
|
IP
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,093.00 |
| Max. Negotiated Rate |
$15,456.00 |
| Rate for Payer: Aetna Commercial |
$12,397.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,558.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$13,363.00
|
| Rate for Payer: First Health Commercial |
$15,295.00
|
| Rate for Payer: Humana Commercial |
$13,685.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,202.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,881.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.00
|
| Rate for Payer: PHCS Commercial |
$15,456.00
|
| Rate for Payer: United Healthcare All Payer |
$14,168.00
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Facility
|
OP
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,093.00 |
| Max. Negotiated Rate |
$15,456.00 |
| Rate for Payer: Aetna Commercial |
$12,397.00
|
| Rate for Payer: Anthem Medicaid |
$5,536.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,558.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,412.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,004.82
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$13,363.00
|
| Rate for Payer: First Health Commercial |
$15,295.00
|
| Rate for Payer: Humana Commercial |
$13,685.00
|
| Rate for Payer: Humana KY Medicaid |
$5,536.79
|
| Rate for Payer: Humana Medicare Advantage |
$8,151.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,593.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,202.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,881.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,782.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,647.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.00
|
| Rate for Payer: PHCS Commercial |
$15,456.00
|
| Rate for Payer: United Healthcare All Payer |
$14,168.00
|
|
|
PLCMT RADIOTH BAL CATH SEP(P
|
Professional
|
Both
|
$6,291.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761P0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.97 |
| Max. Negotiated Rate |
$6,549.88 |
| Rate for Payer: Aetna Commercial |
$305.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,291.00
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cigna Commercial |
$6,549.88
|
| Rate for Payer: Healthspan PPO |
$4,231.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.27
|
| Rate for Payer: Multiplan PHCS |
$3,774.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,403.70
|
| Rate for Payer: UHCCP Medicaid |
$174.27
|
|
|
PLCMT RADIOTH BAL CATH SEP(T
|
Facility
|
IP
|
$9,809.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761T0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,275.17 |
| Max. Negotiated Rate |
$9,416.64 |
| Rate for Payer: Aetna Commercial |
$7,552.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,651.02
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cigna Commercial |
$8,141.47
|
| Rate for Payer: First Health Commercial |
$9,318.55
|
| Rate for Payer: Humana Commercial |
$8,337.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,043.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,239.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.79
|
| Rate for Payer: PHCS Commercial |
$9,416.64
|
| Rate for Payer: United Healthcare All Payer |
$8,631.92
|
|
|
PLCMT RADIOTH BAL CATH SEP(T
|
Facility
|
OP
|
$9,809.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761T0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,275.17 |
| Max. Negotiated Rate |
$11,412.41 |
| Rate for Payer: Aetna Commercial |
$7,552.93
|
| Rate for Payer: Anthem Medicaid |
$3,373.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,651.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,412.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,004.82
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cigna Commercial |
$8,141.47
|
| Rate for Payer: First Health Commercial |
$9,318.55
|
| Rate for Payer: Humana Commercial |
$8,337.65
|
| Rate for Payer: Humana KY Medicaid |
$3,373.32
|
| Rate for Payer: Humana Medicare Advantage |
$8,151.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,407.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,043.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,239.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,782.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,441.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.79
|
| Rate for Payer: PHCS Commercial |
$9,416.64
|
| Rate for Payer: United Healthcare All Payer |
$8,631.92
|
|
|
PLENDIL (FELODIPINE) 10 MG TAB
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 13668013401
|
| Hospital Charge Code |
25001194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PLENDIL (FELODIPINE) 10 MG TAB
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 13668013401
|
| Hospital Charge Code |
25001194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PLENDIL (FELODIPINE) 2.5MG TAB
|
Facility
|
OP
|
$9.09
|
|
|
Service Code
|
NDC 53489036801
|
| Hospital Charge Code |
25001195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.09
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.73
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.00
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Payer |
$8.00
|
|
|
PLENDIL (FELODIPINE) 2.5MG TAB
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
NDC 53489036801
|
| Hospital Charge Code |
25001195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.09
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.00
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Payer |
$8.00
|
|
|
PLENDIL (FELODIPINE) 5MG/1TAB
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 13668013301
|
| Hospital Charge Code |
25001193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PLENDIL (FELODIPINE) 5MG/1TAB
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 13668013301
|
| Hospital Charge Code |
25001193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PLETAL (CILOSTAZOL) 100MG TAB
|
Facility
|
IP
|
$9.07
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
25001196
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.53
|
| Rate for Payer: First Health Commercial |
$8.62
|
| Rate for Payer: Humana Commercial |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.98
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.71
|
| Rate for Payer: United Healthcare All Payer |
$7.98
|
|
|
PLETAL (CILOSTAZOL) 100MG TAB
|
Facility
|
OP
|
$9.07
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
25001196
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem Medicaid |
$3.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.53
|
| Rate for Payer: First Health Commercial |
$8.62
|
| Rate for Payer: Humana Commercial |
$7.71
|
| Rate for Payer: Humana KY Medicaid |
$3.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.98
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.71
|
| Rate for Payer: United Healthcare All Payer |
$7.98
|
|
|
PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,303.66
|
|
|
Service Code
|
CPT 32556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.47 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$11,654.93
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$7,908.70 |
| Max. Negotiated Rate |
$11,654.93 |
| Rate for Payer: Anthem Medicaid |
$7,908.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,324.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,654.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,238.68
|
| Rate for Payer: Humana KY Medicaid |
$7,908.70
|
| Rate for Payer: Humana Medicare Advantage |
$8,324.95
|
| Rate for Payer: Kentucky WC Medicaid |
$7,987.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,989.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,066.88
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$18,156.78
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$12,320.67 |
| Max. Negotiated Rate |
$18,156.78 |
| Rate for Payer: Anthem Medicaid |
$12,320.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,969.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,156.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,508.33
|
| Rate for Payer: Humana KY Medicaid |
$12,320.67
|
| Rate for Payer: Humana Medicare Advantage |
$12,969.13
|
| Rate for Payer: Kentucky WC Medicaid |
$12,443.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,562.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,567.09
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$8,732.71
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$5,925.77 |
| Max. Negotiated Rate |
$8,732.71 |
| Rate for Payer: Anthem Medicaid |
$5,925.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,237.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,732.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,420.83
|
| Rate for Payer: Humana KY Medicaid |
$5,925.77
|
| Rate for Payer: Humana Medicare Advantage |
$6,237.65
|
| Rate for Payer: Kentucky WC Medicaid |
$5,985.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,485.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,044.28
|
|
|
PLEURAL FL CELL CT/DIFF
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
PLEURAL FL CELL CT/DIFF
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
761P1182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,323.49
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,256.23
|
| Rate for Payer: Healthspan PPO |
$1,033.34
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,323.49
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,256.23
|
| Rate for Payer: Healthspan PPO |
$1,033.34
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
|
