|
TH NURSING FAC CARE SUBSEQ
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
51000187
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Healthspan PPO |
$46.54
|
| Rate for Payer: Humana Medicaid |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.11
|
| Rate for Payer: Molina Healthcare Passport |
$34.42
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
|
|
THORACENTESIS COMPPROC US
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
THORACENTESIS COMPPROC US
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
THORACENTESIS COMPPROC US
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,397.00
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$838.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.90
|
| Rate for Payer: UHCCP Medicaid |
$488.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
THORACENTESIS COMPPROC US(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
THORACENTESIS COMPPROC US(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
THORACENTESIS COMPPROC US(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$760.54
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.24 |
| Max. Negotiated Rate |
$760.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.46 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.02
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
45000225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
THORACENTESIS W IMAGING
|
Professional
|
Both
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,742.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$1,045.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,219.40
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
45000225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.46 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem Medicaid |
$599.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Humana KY Medicaid |
$599.07
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$605.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.02
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
THORACENTESIS W IMAGING(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761P1201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
THORACENTESIS W IMAGING(T
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T1201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$323.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Humana KY Medicaid |
$323.95
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
THORACENTESIS W IMAGING(T
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T1201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
45000224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
45000224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
THORACENTESIS WO IMAGING
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$2,244.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.73
|
| Rate for Payer: Anthem Medicaid |
$73.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,244.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$1,012.30
|
| Rate for Payer: Healthspan PPO |
$829.32
|
| Rate for Payer: Humana Medicaid |
$73.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.48
|
| Rate for Payer: Molina Healthcare Passport |
$73.02
|
| Rate for Payer: Multiplan PHCS |
$1,346.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,570.80
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.75
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.72 |
| Max. Negotiated Rate |
$2,154.24 |
| Rate for Payer: Aetna Commercial |
$1,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,750.32
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$1,862.52
|
| Rate for Payer: First Health Commercial |
$2,131.80
|
| Rate for Payer: Humana Commercial |
$1,907.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,656.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$673.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,683.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.64
|
| Rate for Payer: PHCS Commercial |
$2,154.24
|
| Rate for Payer: United Healthcare All Payer |
$1,974.72
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.72 |
| Max. Negotiated Rate |
$2,154.24 |
| Rate for Payer: Aetna Commercial |
$1,727.88
|
| Rate for Payer: Anthem Medicaid |
$771.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,750.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$1,862.52
|
| Rate for Payer: First Health Commercial |
$2,131.80
|
| Rate for Payer: Humana Commercial |
$1,907.40
|
| Rate for Payer: Humana KY Medicaid |
$771.71
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$779.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,656.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$787.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,683.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.64
|
| Rate for Payer: PHCS Commercial |
$2,154.24
|
| Rate for Payer: United Healthcare All Payer |
$1,974.72
|
|
|
THORACENTESIS WO IMAGING(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761P1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$1,012.30 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.73
|
| Rate for Payer: Anthem Medicaid |
$73.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,012.30
|
| Rate for Payer: Healthspan PPO |
$829.32
|
| Rate for Payer: Humana Medicaid |
$73.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.48
|
| Rate for Payer: Molina Healthcare Passport |
$73.02
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.75
|
|
|
THORACENTESIS WO IMAGING(T
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761T1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,150.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.32
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,240.02
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: Humana Commercial |
$1,269.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,314.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.14
|
| Rate for Payer: PHCS Commercial |
$1,434.24
|
| Rate for Payer: United Healthcare All Payer |
$1,314.72
|
|
|
THORACENTESIS WO IMAGING(T
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761T1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,150.38
|
| Rate for Payer: Anthem Medicaid |
$513.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,240.02
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: Humana Commercial |
$1,269.90
|
| Rate for Payer: Humana KY Medicaid |
$513.79
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$519.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,314.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.14
|
| Rate for Payer: PHCS Commercial |
$1,434.24
|
| Rate for Payer: United Healthcare All Payer |
$1,314.72
|
|
|
THORACIC LYMPHADENECTOMY
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 38746
|
| Hospital Charge Code |
76101608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.12 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$417.00
|
| Rate for Payer: Anthem Medicaid |
$203.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$386.57
|
| Rate for Payer: Healthspan PPO |
$333.43
|
| Rate for Payer: Humana Medicaid |
$203.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$349.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.18
|
| Rate for Payer: Molina Healthcare Passport |
$203.12
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.15
|
|
