|
TAP 2.0 MM
|
Facility
|
OP
|
$1,744.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.21 |
| Max. Negotiated Rate |
$1,674.27 |
| Rate for Payer: Aetna Commercial |
$1,342.90
|
| Rate for Payer: Anthem Medicaid |
$599.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.34
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cigna Commercial |
$1,447.54
|
| Rate for Payer: First Health Commercial |
$1,656.83
|
| Rate for Payer: Humana Commercial |
$1,482.43
|
| Rate for Payer: Humana KY Medicaid |
$599.77
|
| Rate for Payer: Kentucky WC Medicaid |
$605.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.38
|
| Rate for Payer: PHCS Commercial |
$1,674.27
|
| Rate for Payer: United Healthcare All Payer |
$1,534.75
|
|
|
TAP 2.7 MM
|
Facility
|
OP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem Medicaid |
$605.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Humana KY Medicaid |
$605.13
|
| Rate for Payer: Kentucky WC Medicaid |
$611.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 2.7 MM
|
Facility
|
IP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 3.5 MM
|
Facility
|
OP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem Medicaid |
$605.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Humana KY Medicaid |
$605.13
|
| Rate for Payer: Kentucky WC Medicaid |
$611.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 3.5 MM
|
Facility
|
IP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 4.0MM
|
Facility
|
OP
|
$1,884.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.27 |
| Max. Negotiated Rate |
$1,808.88 |
| Rate for Payer: Aetna Commercial |
$1,450.87
|
| Rate for Payer: Anthem Medicaid |
$647.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.71
|
| Rate for Payer: Cash Price |
$942.12
|
| Rate for Payer: Cigna Commercial |
$1,563.93
|
| Rate for Payer: First Health Commercial |
$1,790.04
|
| Rate for Payer: Humana Commercial |
$1,601.61
|
| Rate for Payer: Humana KY Medicaid |
$647.99
|
| Rate for Payer: Kentucky WC Medicaid |
$654.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.13
|
| Rate for Payer: PHCS Commercial |
$1,808.88
|
| Rate for Payer: United Healthcare All Payer |
$1,658.14
|
|
|
TAP 4.0MM
|
Facility
|
IP
|
$1,884.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.27 |
| Max. Negotiated Rate |
$1,808.88 |
| Rate for Payer: Aetna Commercial |
$1,450.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.71
|
| Rate for Payer: Cash Price |
$942.12
|
| Rate for Payer: Cigna Commercial |
$1,563.93
|
| Rate for Payer: First Health Commercial |
$1,790.04
|
| Rate for Payer: Humana Commercial |
$1,601.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.13
|
| Rate for Payer: PHCS Commercial |
$1,808.88
|
| Rate for Payer: United Healthcare All Payer |
$1,658.14
|
|
|
TAP 4.5 MM
|
Facility
|
IP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 4.5 MM
|
Facility
|
OP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem Medicaid |
$605.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Humana KY Medicaid |
$605.13
|
| Rate for Payer: Kentucky WC Medicaid |
$611.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
TAP 6.5 MM
|
Facility
|
IP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
TAP 6.5 MM
|
Facility
|
OP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem Medicaid |
$768.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Humana KY Medicaid |
$768.55
|
| Rate for Payer: Kentucky WC Medicaid |
$776.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
TAPAZOLE 5MG TAB
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
25001489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| 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 |
$3.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| 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 |
$1.44 |
| 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 |
$3.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| 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 |
$1.51 |
| 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 |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| 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 |
$1.51 |
| 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 |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
IP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761T2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,156.50 |
| 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 |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,659.95
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
OP
|
$3,855.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761T2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,156.50 |
| 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 |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,659.95
|
| Rate for Payer: PHCS Commercial |
$3,700.80
|
| Rate for Payer: United Healthcare All Payer |
$3,392.40
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna Commercial |
$3,072.30
|
| Rate for Payer: Anthem Medicaid |
$1,372.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,112.20
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$3,311.70
|
| Rate for Payer: First Health Commercial |
$3,790.50
|
| Rate for Payer: Humana Commercial |
$3,391.50
|
| Rate for Payer: Humana KY Medicaid |
$1,372.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,386.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,944.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,511.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,992.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,753.10
|
| Rate for Payer: PHCS Commercial |
$3,830.40
|
| Rate for Payer: United Healthcare All Payer |
$3,511.20
|
|
|
TAP BLOCK BI INJECTION
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna Commercial |
$3,072.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,112.20
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$3,311.70
|
| Rate for Payer: First Health Commercial |
$3,790.50
|
| Rate for Payer: Humana Commercial |
$3,391.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,944.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,511.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,992.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,753.10
|
| Rate for Payer: PHCS Commercial |
$3,830.40
|
| Rate for Payer: United Healthcare All Payer |
$3,511.20
|
|
|
TAP BLOCK BI INJECTION
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
761P2772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$137.59 |
| Rate for Payer: Ambetter Exchange |
$57.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.42
|
| Rate for Payer: Anthem Medicaid |
$118.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.11
|
| 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 |
$118.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.45
|
| Rate for Payer: Molina Healthcare Passport |
$118.09
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.87
|
| Rate for Payer: UHCCP Medicaid |
$66.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.59
|
|
|
TAP BLOCK BI INJECTION
|
Professional
|
Both
|
$3,990.00
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
76102772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Ambetter Exchange |
$57.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.42
|
| Rate for Payer: Anthem Medicaid |
$118.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.11
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$137.59
|
| Rate for Payer: Humana Medicaid |
$118.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.45
|
| Rate for Payer: Molina Healthcare Passport |
$118.09
|
| Rate for Payer: Multiplan PHCS |
$2,394.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.87
|
| Rate for Payer: UHCCP Medicaid |
$66.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.59
|
|
|
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 |
$796.79 |
| 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 |
$2,124.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,310.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,832.63
|
| Rate for Payer: PHCS Commercial |
$2,549.74
|
| Rate for Payer: United Healthcare All Payer |
$2,337.26
|
|
|
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 |
$49.52 |
| Max. Negotiated Rate |
$1,593.59 |
| Rate for Payer: Ambetter Exchange |
$49.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.07
|
| Rate for Payer: Anthem Medicaid |
$95.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.42
|
| 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 |
$95.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.84
|
| Rate for Payer: Molina Healthcare Passport |
$95.92
|
| Rate for Payer: Multiplan PHCS |
$1,593.59
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.38
|
| Rate for Payer: UHCCP Medicaid |
$53.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.52
|
|
|
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 |
$796.79 |
| 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 |
$2,124.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,310.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,832.63
|
| 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 |
$49.52 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Ambetter Exchange |
$49.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.07
|
| Rate for Payer: Anthem Medicaid |
$95.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.42
|
| 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 |
$95.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.84
|
| Rate for Payer: Molina Healthcare Passport |
$95.92
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.38
|
| Rate for Payer: UHCCP Medicaid |
$53.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.52
|
|
