|
THROMBOLYTIC ART THERAPY
|
Professional
|
Both
|
$7,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
76101536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.91 |
| Max. Negotiated Rate |
$7,837.41 |
| Rate for Payer: Anthem Medicaid |
$327.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,837.41
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cash Price |
$3,918.70
|
| Rate for Payer: Cigna Commercial |
$757.21
|
| Rate for Payer: Healthspan PPO |
$386.89
|
| Rate for Payer: Humana Medicaid |
$327.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$514.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.47
|
| Rate for Payer: Molina Healthcare Passport |
$327.91
|
| Rate for Payer: Multiplan PHCS |
$4,702.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,486.19
|
| Rate for Payer: UHCCP Medicaid |
$2,743.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.19
|
|
|
THROMBOLYTIC ART THERAPY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761P1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.91 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$327.91
|
| 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: Cigna Commercial |
$757.21
|
| Rate for Payer: Healthspan PPO |
$386.89
|
| Rate for Payer: Humana Medicaid |
$327.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$514.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.47
|
| Rate for Payer: Molina Healthcare Passport |
$327.91
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.19
|
|
|
THROMBOLYTIC ART THERAPY(T
|
Facility
|
OP
|
$6,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761T1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$888.86 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$5,264.81
|
| Rate for Payer: Anthem Medicaid |
$2,351.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,333.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$3,418.70
|
| Rate for Payer: Cash Price |
$3,418.70
|
| Rate for Payer: Cigna Commercial |
$5,675.05
|
| Rate for Payer: First Health Commercial |
$6,495.54
|
| Rate for Payer: Humana Commercial |
$5,811.80
|
| Rate for Payer: Humana KY Medicaid |
$2,351.39
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,375.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,606.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,046.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,398.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,016.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,128.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,367.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$888.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,119.60
|
| Rate for Payer: PHCS Commercial |
$6,563.91
|
| Rate for Payer: United Healthcare All Payer |
$6,016.92
|
|
|
THROMBOLYTIC ART THERAPY(T
|
Facility
|
IP
|
$6,837.41
|
|
|
Service Code
|
HCPCS 37211
|
| Hospital Charge Code |
761T1536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$888.86 |
| Max. Negotiated Rate |
$6,563.91 |
| Rate for Payer: Aetna Commercial |
$5,264.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,333.18
|
| Rate for Payer: Cash Price |
$3,418.70
|
| Rate for Payer: Cigna Commercial |
$5,675.05
|
| Rate for Payer: First Health Commercial |
$6,495.54
|
| Rate for Payer: Humana Commercial |
$5,811.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,606.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,046.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,051.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,016.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,128.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,367.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$888.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,119.60
|
| Rate for Payer: PHCS Commercial |
$6,563.91
|
| Rate for Payer: United Healthcare All Payer |
$6,016.92
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761P1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$750.00 |
| 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: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
OP
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.64 |
| Max. Negotiated Rate |
$2,626.23 |
| Rate for Payer: Aetna Commercial |
$2,106.46
|
| Rate for Payer: Anthem Medicaid |
$940.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,133.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cigna Commercial |
$2,270.60
|
| Rate for Payer: First Health Commercial |
$2,598.88
|
| Rate for Payer: Humana Commercial |
$2,325.31
|
| Rate for Payer: Humana KY Medicaid |
$940.79
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$950.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,243.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,018.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$959.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,051.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.05
|
| Rate for Payer: PHCS Commercial |
$2,626.23
|
| Rate for Payer: United Healthcare All Payer |
$2,407.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Professional
|
Both
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,735.66 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,735.66
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,641.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,914.96
|
| Rate for Payer: UHCCP Medicaid |
$957.48
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
IP
|
$2,735.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
76101236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.64 |
| Max. Negotiated Rate |
$2,626.23 |
| Rate for Payer: Aetna Commercial |
$2,106.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,133.81
|
| Rate for Payer: Cash Price |
$1,367.83
|
| Rate for Payer: Cigna Commercial |
$2,270.60
|
| Rate for Payer: First Health Commercial |
$2,598.88
|
| Rate for Payer: Humana Commercial |
$2,325.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,243.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,018.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,051.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$547.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.05
|
| Rate for Payer: PHCS Commercial |
$2,626.23
|
| Rate for Payer: United Healthcare All Payer |
$2,407.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
IP
|
$1,985.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761T1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.14 |
| Max. Negotiated Rate |
$1,906.23 |
| Rate for Payer: Aetna Commercial |
$1,528.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.81
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cigna Commercial |
$1,648.10
|
| Rate for Payer: First Health Commercial |
$1,886.38
|
| Rate for Payer: Humana Commercial |
$1,687.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.55
|
| Rate for Payer: PHCS Commercial |
$1,906.23
|
| Rate for Payer: United Healthcare All Payer |
$1,747.38
|
|
|
THROMBOLYTICCHESTUBEPLEURALCAV
|
Facility
|
OP
|
$1,985.66
|
|
|
Service Code
|
HCPCS 32999
|
| Hospital Charge Code |
761T1236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.14 |
| Max. Negotiated Rate |
$1,906.23 |
| Rate for Payer: Aetna Commercial |
$1,528.96
|
| Rate for Payer: Anthem Medicaid |
$682.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cash Price |
$992.83
|
| Rate for Payer: Cigna Commercial |
$1,648.10
|
| Rate for Payer: First Health Commercial |
$1,886.38
|
| Rate for Payer: Humana Commercial |
$1,687.81
|
| Rate for Payer: Humana KY Medicaid |
$682.87
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.55
|
| Rate for Payer: PHCS Commercial |
$1,906.23
|
| Rate for Payer: United Healthcare All Payer |
$1,747.38
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Professional
|
Both
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$4,497.00 |
| Rate for Payer: Anthem Medicaid |
$289.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,497.00
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$668.49
|
| Rate for Payer: Healthspan PPO |
$341.62
|
| Rate for Payer: Humana Medicaid |
$289.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.29
|
| Rate for Payer: Molina Healthcare Passport |
$289.50
|
| Rate for Payer: Multiplan PHCS |
$2,698.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,147.90
|
| Rate for Payer: UHCCP Medicaid |
$1,573.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.40
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
OP
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.61 |
| Max. Negotiated Rate |
$4,317.12 |
| Rate for Payer: Aetna Commercial |
$3,462.69
|
| Rate for Payer: Anthem Medicaid |
$1,546.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$3,732.51
|
| Rate for Payer: First Health Commercial |
$4,272.15
|
| Rate for Payer: Humana Commercial |
$3,822.45
|
| Rate for Payer: Humana KY Medicaid |
$1,546.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.07
|
| Rate for Payer: PHCS Commercial |
$4,317.12
|
| Rate for Payer: United Healthcare All Payer |
$3,957.36
|
|
|
THROMBOLYTIC VENOUS THERAPY
|
Facility
|
IP
|
$4,497.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
76101537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.61 |
| Max. Negotiated Rate |
$4,317.12 |
| Rate for Payer: Aetna Commercial |
$3,462.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.66
|
| Rate for Payer: Cash Price |
$2,248.50
|
| Rate for Payer: Cigna Commercial |
$3,732.51
|
| Rate for Payer: First Health Commercial |
$4,272.15
|
| Rate for Payer: Humana Commercial |
$3,822.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.07
|
| Rate for Payer: PHCS Commercial |
$4,317.12
|
| Rate for Payer: United Healthcare All Payer |
$3,957.36
|
|
|
THROMBOLYTIC VENOUS THERAPY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761P1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Anthem Medicaid |
$289.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$668.49
|
| Rate for Payer: Healthspan PPO |
$341.62
|
| Rate for Payer: Humana Medicaid |
$289.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.29
|
| Rate for Payer: Molina Healthcare Passport |
$289.50
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.40
|
|
|
THROMBOLYTIC VENOUS THERAPY(T
|
Facility
|
IP
|
$3,597.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761T1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.61 |
| Max. Negotiated Rate |
$3,453.12 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,079.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.07
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
|
THROMBOLYTIC VENOUS THERAPY(T
|
Facility
|
OP
|
$3,597.00
|
|
|
Service Code
|
HCPCS 37212
|
| Hospital Charge Code |
761T1537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.61 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,769.69
|
| Rate for Payer: Anthem Medicaid |
$1,237.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,805.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$2,985.51
|
| Rate for Payer: First Health Commercial |
$3,417.15
|
| Rate for Payer: Humana Commercial |
$3,057.45
|
| Rate for Payer: Humana KY Medicaid |
$1,237.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,249.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,949.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,654.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,165.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.07
|
| Rate for Payer: PHCS Commercial |
$3,453.12
|
| Rate for Payer: United Healthcare All Payer |
$3,165.36
|
|
|
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD
|
Facility
|
OP
|
$8.41
|
|
|
Service Code
|
CPT 85730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.01
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.21
|
|
|
THRUWAY STRAIGHT 190CM .018
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
THRUWAY STRAIGHT 190CM .018
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
THRUWAY WIRE .018 300CM ST
|
Facility
|
OP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
THRUWAY WIRE .018 300CM ST
|
Facility
|
IP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
TH SMOKING CESSATION
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
51000300
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$37.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.48
|
| Rate for Payer: Anthem Medicaid |
$20.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.00
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$36.48
|
| Rate for Payer: Healthspan PPO |
$30.62
|
| Rate for Payer: Humana Medicaid |
$20.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.79
|
| Rate for Payer: Molina Healthcare Passport |
$20.38
|
| Rate for Payer: Multiplan PHCS |
$52.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.90
|
| Rate for Payer: UHCCP Medicaid |
$30.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.58
|
|
|
TH TRANS CARE MGMT 14 DAY DISC
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
51000299
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Anthem Medicaid |
$117.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$383.00
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$273.49
|
| Rate for Payer: Healthspan PPO |
$138.69
|
| Rate for Payer: Humana Medicaid |
$117.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.78
|
| Rate for Payer: Molina Healthcare Passport |
$117.43
|
| Rate for Payer: Multiplan PHCS |
$229.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$268.10
|
| Rate for Payer: UHCCP Medicaid |
$134.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.60
|
|
|
TH TRANS CARE MGMT 7 DAY DISCH
|
Professional
|
Both
|
$487.23
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
51000189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.09 |
| Max. Negotiated Rate |
$487.23 |
| Rate for Payer: Anthem Medicaid |
$160.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.23
|
| Rate for Payer: Cash Price |
$243.62
|
| Rate for Payer: Cash Price |
$243.62
|
| Rate for Payer: Cigna Commercial |
$386.11
|
| Rate for Payer: Healthspan PPO |
$195.56
|
| Rate for Payer: Humana Medicaid |
$160.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.29
|
| Rate for Payer: Molina Healthcare Passport |
$160.09
|
| Rate for Payer: Multiplan PHCS |
$292.34
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$341.06
|
| Rate for Payer: UHCCP Medicaid |
$170.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.69
|
|
|
THYROGLOBULIN ANTIBODY
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
30001221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$47.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$47.11
|
| Rate for Payer: Humana Medicare Advantage |
$15.91
|
| Rate for Payer: Kentucky WC Medicaid |
$47.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
