|
TAP 2.7 MM
|
Facility
|
OP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem Medicaid |
$609.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Humana KY Medicaid |
$609.85
|
| Rate for Payer: Kentucky WC Medicaid |
$616.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 2.7 MM
|
Facility
|
IP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 3.5 MM
|
Facility
|
IP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 3.5 MM
|
Facility
|
OP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem Medicaid |
$609.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Humana KY Medicaid |
$609.85
|
| Rate for Payer: Kentucky WC Medicaid |
$616.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 4.0MM
|
Facility
|
OP
|
$1,888.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$1,812.60 |
| Rate for Payer: Aetna Commercial |
$1,453.85
|
| Rate for Payer: Anthem Medicaid |
$649.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.73
|
| Rate for Payer: Cash Price |
$944.06
|
| Rate for Payer: Cigna Commercial |
$1,567.14
|
| Rate for Payer: First Health Commercial |
$1,793.71
|
| Rate for Payer: Humana Commercial |
$1,604.90
|
| Rate for Payer: Humana KY Medicaid |
$649.32
|
| Rate for Payer: Kentucky WC Medicaid |
$655.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.32
|
| Rate for Payer: PHCS Commercial |
$1,812.60
|
| Rate for Payer: United Healthcare All Payer |
$1,661.55
|
|
|
TAP 4.0MM
|
Facility
|
IP
|
$1,888.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$1,812.60 |
| Rate for Payer: Aetna Commercial |
$1,453.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.73
|
| Rate for Payer: Cash Price |
$944.06
|
| Rate for Payer: Cigna Commercial |
$1,567.14
|
| Rate for Payer: First Health Commercial |
$1,793.71
|
| Rate for Payer: Humana Commercial |
$1,604.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.32
|
| Rate for Payer: PHCS Commercial |
$1,812.60
|
| Rate for Payer: United Healthcare All Payer |
$1,661.55
|
|
|
TAP 4.5 MM
|
Facility
|
IP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 4.5 MM
|
Facility
|
OP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem Medicaid |
$609.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Humana KY Medicaid |
$609.85
|
| Rate for Payer: Kentucky WC Medicaid |
$616.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
TAP 6.5 MM
|
Facility
|
IP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
TAP 6.5 MM
|
Facility
|
OP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem Medicaid |
$760.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Humana KY Medicaid |
$760.36
|
| Rate for Payer: Kentucky WC Medicaid |
$768.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
TAPAZOLE 5MG TAB
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
25001489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
TAPAZOLE 5MG TAB
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
25001489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
TAPAZOLE (METHIMAZOL 10MG/1TAB
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 60687068001
|
| Hospital Charge Code |
25001488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
TAPAZOLE (METHIMAZOL 10MG/1TAB
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 60687068001
|
| Hospital Charge Code |
25001488
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
TAP BLOCK BI INJECTION
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$3,890.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.42
|
| Rate for Payer: Anthem Medicaid |
$64.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,890.00
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$137.59
|
| Rate for Payer: Humana Medicaid |
$64.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.82
|
| Rate for Payer: Molina Healthcare Passport |
$64.53
|
| Rate for Payer: Multiplan PHCS |
$2,334.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,723.00
|
| Rate for Payer: UHCCP Medicaid |
$66.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.18
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
IP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761T2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$3,700.80 |
| Rate for Payer: Aetna Commercial |
$2,968.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.90
|
| Rate for Payer: Cash Price |
$1,927.50
|
| Rate for Payer: Cigna Commercial |
$3,199.65
|
| Rate for Payer: First Health Commercial |
$3,662.25
|
| Rate for Payer: Humana Commercial |
$3,276.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,844.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.05
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
TAP BLOCK BI INJECTION
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761P2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$137.59 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.42
|
| Rate for Payer: Anthem Medicaid |
$64.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$137.59
|
| Rate for Payer: Humana Medicaid |
$64.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.82
|
| Rate for Payer: Molina Healthcare Passport |
$64.53
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.50
|
| Rate for Payer: UHCCP Medicaid |
$66.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.18
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.70 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,205.90
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.70 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,205.90
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
OP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761T2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$3,700.80 |
| Rate for Payer: Aetna Commercial |
$2,968.35
|
| Rate for Payer: Anthem Medicaid |
$1,325.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.90
|
| Rate for Payer: Cash Price |
$1,927.50
|
| Rate for Payer: Cigna Commercial |
$3,199.65
|
| Rate for Payer: First Health Commercial |
$3,662.25
|
| Rate for Payer: Humana Commercial |
$3,276.75
|
| Rate for Payer: Humana KY Medicaid |
$1,325.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,844.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.05
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
TAP BLOCK UNIL BY INJECTION
|
Professional
|
Both
|
$2,655.98
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
76102325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$2,655.98 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.07
|
| Rate for Payer: Anthem Medicaid |
$51.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,655.98
|
| Rate for Payer: Cash Price |
$1,327.99
|
| Rate for Payer: Cash Price |
$1,327.99
|
| Rate for Payer: Cigna Commercial |
$109.69
|
| Rate for Payer: Humana Medicaid |
$51.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.45
|
| Rate for Payer: Molina Healthcare Passport |
$51.42
|
| Rate for Payer: Multiplan PHCS |
$1,593.59
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,859.19
|
| Rate for Payer: UHCCP Medicaid |
$53.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.93
|
|
|
TAP BLOCK UNIL BY INJECTION
|
Facility
|
OP
|
$2,655.98
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
76102325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.28 |
| Max. Negotiated Rate |
$2,549.74 |
| Rate for Payer: Aetna Commercial |
$2,045.10
|
| Rate for Payer: Anthem Medicaid |
$913.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,071.66
|
| Rate for Payer: Cash Price |
$1,327.99
|
| Rate for Payer: Cigna Commercial |
$2,204.46
|
| Rate for Payer: First Health Commercial |
$2,523.18
|
| Rate for Payer: Humana Commercial |
$2,257.58
|
| Rate for Payer: Humana KY Medicaid |
$913.39
|
| Rate for Payer: Kentucky WC Medicaid |
$922.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,177.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$931.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,337.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,991.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.35
|
| Rate for Payer: PHCS Commercial |
$2,549.74
|
| Rate for Payer: United Healthcare All Payer |
$2,337.26
|
|
|
TAP BLOCK UNIL BY INJECTION
|
Facility
|
IP
|
$2,655.98
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
76102325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.28 |
| Max. Negotiated Rate |
$2,549.74 |
| Rate for Payer: Aetna Commercial |
$2,045.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,071.66
|
| Rate for Payer: Cash Price |
$1,327.99
|
| Rate for Payer: Cigna Commercial |
$2,204.46
|
| Rate for Payer: First Health Commercial |
$2,523.18
|
| Rate for Payer: Humana Commercial |
$2,257.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,177.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,337.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,991.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$823.35
|
| Rate for Payer: PHCS Commercial |
$2,549.74
|
| Rate for Payer: United Healthcare All Payer |
$2,337.26
|
|
|
TAP BLOCK UNIL BY INJECTION(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
761P2325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.07
|
| Rate for Payer: Anthem Medicaid |
$51.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$109.69
|
| Rate for Payer: Humana Medicaid |
$51.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.45
|
| Rate for Payer: Molina Healthcare Passport |
$51.42
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.00
|
| Rate for Payer: UHCCP Medicaid |
$53.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.93
|
|
|
TAP BLOCK UNIL BY INJECTION(T
|
Facility
|
IP
|
$2,395.98
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
761T2325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.48 |
| Max. Negotiated Rate |
$2,300.14 |
| Rate for Payer: Aetna Commercial |
$1,844.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.86
|
| Rate for Payer: Cash Price |
$1,197.99
|
| Rate for Payer: Cigna Commercial |
$1,988.66
|
| Rate for Payer: First Health Commercial |
$2,276.18
|
| Rate for Payer: Humana Commercial |
$2,036.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,768.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,108.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.75
|
| Rate for Payer: PHCS Commercial |
$2,300.14
|
| Rate for Payer: United Healthcare All Payer |
$2,108.46
|
|
