|
THIN PREP PAP SMEAR-SCRN G0123
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
30001870
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$20.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.26
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$20.26
|
| Rate for Payer: Humana Medicare Advantage |
$20.26
|
| Rate for Payer: Kentucky WC Medicaid |
$20.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
THIN PREP PAP SMEAR-SCRN G0123
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
30001870
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
THIN/REG MODERATE WRINKLE
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200669
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
THIN/REG THICK MOD/SEV WRINKLE
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200670
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
THIOPURINE METABOLITES
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
THIOPURINE METABOLITES
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
THIOPURINE METABOLITES
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Ambetter Exchange |
$18.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.37
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Healthspan PPO |
$11.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.64
|
| Rate for Payer: Multiplan PHCS |
$119.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.23
|
| Rate for Payer: UHCCP Medicaid |
$69.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.64
|
|
|
TH NURSING FAC CARE SUBSEQ
|
Professional
|
Both
|
$202.63
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$121.58 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Ambetter Exchange |
$69.48
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.38
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$121.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.32
|
| Rate for Payer: UHCCP Medicaid |
$70.92
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.48
|
|
|
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 |
$62.61 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Ambetter Exchange |
$37.24
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$37.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.24
|
| 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 |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.24
|
|
|
THORACENTESIS COMPPROC US
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
THORACENTESIS COMPPROC US
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem Medicaid |
$492.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Humana KY Medicaid |
$492.46
|
| Rate for Payer: Kentucky WC Medicaid |
$497.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$502.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
THORACENTESIS COMPPROC US
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$859.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$501.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
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: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| 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 |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
THORACENTESIS COMPPROC US(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
|
THORACENTESIS COMPPROC US(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem Medicaid |
$423.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Humana KY Medicaid |
$423.68
|
| Rate for Payer: Kentucky WC Medicaid |
$428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$432.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$799.76
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$799.76 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
|
|
THORACENTESIS W IMAGING
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$1,081.80 |
| Rate for Payer: Ambetter Exchange |
$101.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$442.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.34
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$442.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.78
|
| Rate for Payer: Molina Healthcare Passport |
$442.92
|
| Rate for Payer: Multiplan PHCS |
$1,081.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.53
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$447.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.95
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna Commercial |
$1,388.31
|
| Rate for Payer: Anthem Medicaid |
$620.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$1,496.49
|
| Rate for Payer: First Health Commercial |
$1,712.85
|
| Rate for Payer: Humana Commercial |
$1,532.55
|
| Rate for Payer: Humana KY Medicaid |
$620.05
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$626.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,244.07
|
| Rate for Payer: PHCS Commercial |
$1,730.88
|
| Rate for Payer: United Healthcare All Payer |
$1,586.64
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
45000225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
45000225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.93 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem Medicaid |
$344.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Humana KY Medicaid |
$344.93
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$348.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$351.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
THORACENTESIS W IMAGING
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76101201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.90 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna Commercial |
$1,388.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.34
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$1,496.49
|
| Rate for Payer: First Health Commercial |
$1,712.85
|
| Rate for Payer: Humana Commercial |
$1,532.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,244.07
|
| Rate for Payer: PHCS Commercial |
$1,730.88
|
| Rate for Payer: United Healthcare All Payer |
$1,586.64
|
|
|
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 |
$536.94 |
| Rate for Payer: Ambetter Exchange |
$101.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$442.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.34
|
| 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 |
$442.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.78
|
| Rate for Payer: Molina Healthcare Passport |
$442.92
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.53
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$447.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.95
|
|
|
THORACENTESIS W IMAGING(T
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T1201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.93 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem Medicaid |
$344.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Humana KY Medicaid |
$344.93
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$348.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$351.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
THORACENTESIS W IMAGING(T
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T1201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$2,247.36 |
| Rate for Payer: Aetna Commercial |
$1,802.57
|
| Rate for Payer: Anthem Medicaid |
$805.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,825.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,170.50
|
| Rate for Payer: Cash Price |
$1,170.50
|
| Rate for Payer: Cigna Commercial |
$1,943.03
|
| Rate for Payer: First Health Commercial |
$2,223.95
|
| Rate for Payer: Humana Commercial |
$1,989.85
|
| Rate for Payer: Humana KY Medicaid |
$805.07
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$813.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,919.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,727.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$821.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,060.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,755.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,036.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.29
|
| Rate for Payer: PHCS Commercial |
$2,247.36
|
| Rate for Payer: United Healthcare All Payer |
$2,060.08
|
|
