|
THORACOTOMY
|
Facility
|
IP
|
$3,248.00
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
45000222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$422.24 |
| Max. Negotiated Rate |
$3,118.08 |
| Rate for Payer: Aetna Commercial |
$2,500.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.44
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cigna Commercial |
$2,695.84
|
| Rate for Payer: First Health Commercial |
$3,085.60
|
| Rate for Payer: Humana Commercial |
$2,760.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.88
|
| Rate for Payer: PHCS Commercial |
$3,118.08
|
| Rate for Payer: United Healthcare All Payer |
$2,858.24
|
|
|
THORACOTOMY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32120
|
| Hospital Charge Code |
76101176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
THORACOTOMY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32120
|
| Hospital Charge Code |
76101176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.55 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,427.30
|
| Rate for Payer: Anthem Medicaid |
$577.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,344.52
|
| Rate for Payer: Healthspan PPO |
$1,114.40
|
| Rate for Payer: Humana Medicaid |
$577.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,205.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$589.10
|
| Rate for Payer: Molina Healthcare Passport |
$577.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$583.33
|
|
|
THORACOTOMY
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 32100
|
| Hospital Charge Code |
76101174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
THORACOTOMY
|
Facility
|
IP
|
$6,355.50
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
76101180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$826.22 |
| Max. Negotiated Rate |
$6,101.28 |
| Rate for Payer: Aetna Commercial |
$4,893.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,957.29
|
| Rate for Payer: Cash Price |
$3,177.75
|
| Rate for Payer: Cigna Commercial |
$5,275.06
|
| Rate for Payer: First Health Commercial |
$6,037.72
|
| Rate for Payer: Humana Commercial |
$5,402.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,211.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,690.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,906.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,592.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,766.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,271.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,970.20
|
| Rate for Payer: PHCS Commercial |
$6,101.28
|
| Rate for Payer: United Healthcare All Payer |
$5,592.84
|
|
|
THORACOTOMY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32120
|
| Hospital Charge Code |
76101176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
THORACOTOMY
|
Facility
|
OP
|
$3,248.00
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
45000222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$422.24 |
| Max. Negotiated Rate |
$3,118.08 |
| Rate for Payer: Aetna Commercial |
$2,500.96
|
| Rate for Payer: Anthem Medicaid |
$1,116.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.44
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cigna Commercial |
$2,695.84
|
| Rate for Payer: First Health Commercial |
$3,085.60
|
| Rate for Payer: Humana Commercial |
$2,760.80
|
| Rate for Payer: Humana KY Medicaid |
$1,116.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.88
|
| Rate for Payer: PHCS Commercial |
$3,118.08
|
| Rate for Payer: United Healthcare All Payer |
$2,858.24
|
|
|
THORACOTOMY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32141
|
| Hospital Charge Code |
76101178
|
|
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
|
|
|
THORACOTOMY
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 32100
|
| Hospital Charge Code |
76101174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,609.01
|
| Rate for Payer: Anthem Medicaid |
$648.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,523.27
|
| Rate for Payer: Healthspan PPO |
$1,256.27
|
| Rate for Payer: Humana Medicaid |
$648.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.96
|
| Rate for Payer: Molina Healthcare Passport |
$648.00
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$654.48
|
|
|
THORACOTOMY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32141
|
| Hospital Charge Code |
76101178
|
|
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
|
|
|
THORACOTOMY
|
Professional
|
Both
|
$6,355.50
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
76101180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$491.04 |
| Max. Negotiated Rate |
$6,355.50 |
| Rate for Payer: Aetna Commercial |
$1,253.08
|
| Rate for Payer: Anthem Medicaid |
$491.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,355.50
|
| Rate for Payer: Cash Price |
$3,177.75
|
| Rate for Payer: Cash Price |
$3,177.75
|
| Rate for Payer: Cigna Commercial |
$1,156.43
|
| Rate for Payer: Healthspan PPO |
$978.37
|
| Rate for Payer: Humana Medicaid |
$491.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,068.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$500.86
|
| Rate for Payer: Molina Healthcare Passport |
$491.04
|
| Rate for Payer: Multiplan PHCS |
$3,813.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,448.85
|
| Rate for Payer: UHCCP Medicaid |
$2,224.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$495.95
|
|
|
THORACOTOMY - MAJOR; WITH CON
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 32110
|
| Hospital Charge Code |
76101175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.64 |
| Max. Negotiated Rate |
$2,422.18 |
| Rate for Payer: Aetna Commercial |
$2,422.18
|
| Rate for Payer: Anthem Medicaid |
$702.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,101.00
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$2,282.33
|
| Rate for Payer: Healthspan PPO |
$1,891.17
|
| Rate for Payer: Humana Medicaid |
$702.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,011.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$716.69
|
| Rate for Payer: Molina Healthcare Passport |
$702.64
|
| Rate for Payer: Multiplan PHCS |
$1,260.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.70
|
| Rate for Payer: UHCCP Medicaid |
$735.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$709.67
|
|
|
THORACOTOMY - MAJOR; WITH CON
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 32110
|
| Hospital Charge Code |
76101175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$2,016.96 |
| Rate for Payer: Aetna Commercial |
$1,617.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.78
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$1,743.83
|
| Rate for Payer: First Health Commercial |
$1,995.95
|
| Rate for Payer: Humana Commercial |
$1,785.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.31
|
| Rate for Payer: PHCS Commercial |
$2,016.96
|
| Rate for Payer: United Healthcare All Payer |
$1,848.88
|
|
|
THORACOTOMY - MAJOR; WITH CON
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 32110
|
| Hospital Charge Code |
76101175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$2,016.96 |
| Rate for Payer: Aetna Commercial |
$1,617.77
|
| Rate for Payer: Anthem Medicaid |
$722.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.78
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$1,743.83
|
| Rate for Payer: First Health Commercial |
$1,995.95
|
| Rate for Payer: Humana Commercial |
$1,785.85
|
| Rate for Payer: Humana KY Medicaid |
$722.53
|
| Rate for Payer: Kentucky WC Medicaid |
$729.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.31
|
| Rate for Payer: PHCS Commercial |
$2,016.96
|
| Rate for Payer: United Healthcare All Payer |
$1,848.88
|
|
|
THORACOTOMY - MAJOR; WITH CO(P
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 32110
|
| Hospital Charge Code |
761P1175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.64 |
| Max. Negotiated Rate |
$2,422.18 |
| Rate for Payer: Aetna Commercial |
$2,422.18
|
| Rate for Payer: Anthem Medicaid |
$702.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,101.00
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$2,282.33
|
| Rate for Payer: Healthspan PPO |
$1,891.17
|
| Rate for Payer: Humana Medicaid |
$702.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,011.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$716.69
|
| Rate for Payer: Molina Healthcare Passport |
$702.64
|
| Rate for Payer: Multiplan PHCS |
$1,260.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.70
|
| Rate for Payer: UHCCP Medicaid |
$735.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$709.67
|
|
|
THORACOTOMY(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32141
|
| Hospital Charge Code |
761P1178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.66 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$2,431.74
|
| Rate for Payer: Anthem Medicaid |
$777.66
|
| 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 |
$2,182.21
|
| Rate for Payer: Healthspan PPO |
$1,898.64
|
| Rate for Payer: Humana Medicaid |
$777.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,117.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.21
|
| Rate for Payer: Molina Healthcare Passport |
$777.66
|
| 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 |
$785.44
|
|
|
THORACOTOMY(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
761P1180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$491.04 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,253.08
|
| Rate for Payer: Anthem Medicaid |
$491.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,156.43
|
| Rate for Payer: Healthspan PPO |
$978.37
|
| Rate for Payer: Humana Medicaid |
$491.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,068.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$500.86
|
| Rate for Payer: Molina Healthcare Passport |
$491.04
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$495.95
|
|
|
THORACOTOMY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32120
|
| Hospital Charge Code |
761P1176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.55 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,427.30
|
| Rate for Payer: Anthem Medicaid |
$577.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,344.52
|
| Rate for Payer: Healthspan PPO |
$1,114.40
|
| Rate for Payer: Humana Medicaid |
$577.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,205.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$589.10
|
| Rate for Payer: Molina Healthcare Passport |
$577.55
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$583.33
|
|
|
THORACOTOMY(P
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 32100
|
| Hospital Charge Code |
761P1174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,609.01
|
| Rate for Payer: Anthem Medicaid |
$648.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,523.27
|
| Rate for Payer: Healthspan PPO |
$1,256.27
|
| Rate for Payer: Humana Medicaid |
$648.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.96
|
| Rate for Payer: Molina Healthcare Passport |
$648.00
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$654.48
|
|
|
THORACOTOMY(T
|
Facility
|
OP
|
$3,955.50
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
761T1180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.22 |
| Max. Negotiated Rate |
$3,797.28 |
| Rate for Payer: Aetna Commercial |
$3,045.74
|
| Rate for Payer: Anthem Medicaid |
$1,360.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,085.29
|
| Rate for Payer: Cash Price |
$1,977.75
|
| Rate for Payer: Cigna Commercial |
$3,283.06
|
| Rate for Payer: First Health Commercial |
$3,757.72
|
| Rate for Payer: Humana Commercial |
$3,362.18
|
| Rate for Payer: Humana KY Medicaid |
$1,360.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,243.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,919.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,186.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,387.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,480.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,966.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.20
|
| Rate for Payer: PHCS Commercial |
$3,797.28
|
| Rate for Payer: United Healthcare All Payer |
$3,480.84
|
|
|
THORACOTOMY(T
|
Facility
|
IP
|
$3,955.50
|
|
|
Service Code
|
HCPCS 32160
|
| Hospital Charge Code |
761T1180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.22 |
| Max. Negotiated Rate |
$3,797.28 |
| Rate for Payer: Aetna Commercial |
$3,045.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,085.29
|
| Rate for Payer: Cash Price |
$1,977.75
|
| Rate for Payer: Cigna Commercial |
$3,283.06
|
| Rate for Payer: First Health Commercial |
$3,757.72
|
| Rate for Payer: Humana Commercial |
$3,362.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,243.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,919.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,186.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,480.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,966.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.20
|
| Rate for Payer: PHCS Commercial |
$3,797.28
|
| Rate for Payer: United Healthcare All Payer |
$3,480.84
|
|
|
THORAZINE 100MG TABLET
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
25002702
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Anthem Medicaid |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.75
|
| Rate for Payer: Humana Commercial |
$8.72
|
| Rate for Payer: Humana KY Medicaid |
$3.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.03
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.85
|
| Rate for Payer: United Healthcare All Payer |
$9.03
|
|
|
THORAZINE 100MG TABLET
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
25002702
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.75
|
| Rate for Payer: Humana Commercial |
$8.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.03
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.85
|
| Rate for Payer: United Healthcare All Payer |
$9.03
|
|
|
THORAZINE(CHLORPROMA 25MG/1TAB
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
25001527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
THORAZINE(CHLORPROMA 25MG/1TAB
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 69238105601
|
| Hospital Charge Code |
25001527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
