|
THORACENTESIS WO IMAGING
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
45000224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$477.30 |
| Max. Negotiated Rate |
$1,527.36 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.98
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cigna Commercial |
$1,320.53
|
| Rate for Payer: First Health Commercial |
$1,511.45
|
| Rate for Payer: Humana Commercial |
$1,352.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.79
|
| Rate for Payer: PHCS Commercial |
$1,527.36
|
| Rate for Payer: United Healthcare All Payer |
$1,400.08
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.30 |
| Max. Negotiated Rate |
$2,247.36 |
| Rate for Payer: Aetna Commercial |
$1,802.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,825.98
|
| 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: 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 |
$702.30
|
| 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
|
|
|
THORACENTESIS WO IMAGING
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
45000224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$547.14 |
| Max. Negotiated Rate |
$1,527.36 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Anthem Medicaid |
$547.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cigna Commercial |
$1,320.53
|
| Rate for Payer: First Health Commercial |
$1,511.45
|
| Rate for Payer: Humana Commercial |
$1,352.35
|
| Rate for Payer: Humana KY Medicaid |
$547.14
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$552.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.79
|
| Rate for Payer: PHCS Commercial |
$1,527.36
|
| Rate for Payer: United Healthcare All Payer |
$1,400.08
|
|
|
THORACENTESIS WO IMAGING
|
Professional
|
Both
|
$2,341.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
76101200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$1,404.60 |
| Rate for Payer: Ambetter Exchange |
$82.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.73
|
| Rate for Payer: Anthem Medicaid |
$684.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.58
|
| Rate for Payer: Cash Price |
$1,170.50
|
| Rate for Payer: Cash Price |
$1,170.50
|
| Rate for Payer: Cigna Commercial |
$1,012.30
|
| Rate for Payer: Healthspan PPO |
$829.32
|
| Rate for Payer: Humana Medicaid |
$684.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.41
|
| Rate for Payer: Molina Healthcare Passport |
$684.72
|
| Rate for Payer: Multiplan PHCS |
$1,404.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.87
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.98
|
|
|
THORACENTESIS WO IMAGING(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761P1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$1,012.30 |
| Rate for Payer: Ambetter Exchange |
$82.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.73
|
| Rate for Payer: Anthem Medicaid |
$684.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.58
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,012.30
|
| Rate for Payer: Healthspan PPO |
$829.32
|
| Rate for Payer: Humana Medicaid |
$684.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.41
|
| Rate for Payer: Molina Healthcare Passport |
$684.72
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.87
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.98
|
|
|
THORACENTESIS WO IMAGING(T
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761T1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.30 |
| Max. Negotiated Rate |
$1,527.36 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.98
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cigna Commercial |
$1,320.53
|
| Rate for Payer: First Health Commercial |
$1,511.45
|
| Rate for Payer: Humana Commercial |
$1,352.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.79
|
| Rate for Payer: PHCS Commercial |
$1,527.36
|
| Rate for Payer: United Healthcare All Payer |
$1,400.08
|
|
|
THORACENTESIS WO IMAGING(T
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
761T1200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.14 |
| Max. Negotiated Rate |
$1,527.36 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Anthem Medicaid |
$547.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cash Price |
$795.50
|
| Rate for Payer: Cigna Commercial |
$1,320.53
|
| Rate for Payer: First Health Commercial |
$1,511.45
|
| Rate for Payer: Humana Commercial |
$1,352.35
|
| Rate for Payer: Humana KY Medicaid |
$547.14
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$552.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.79
|
| Rate for Payer: PHCS Commercial |
$1,527.36
|
| Rate for Payer: United Healthcare All Payer |
$1,400.08
|
|
|
THORACIC LYMPHADENECTOMY
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 38746
|
| Hospital Charge Code |
76101608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
THORACIC LYMPHADENECTOMY
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 38746
|
| Hospital Charge Code |
76101608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
THORACIC LYMPHADENECTOMY
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 38746
|
| Hospital Charge Code |
76101608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$417.00
|
| Rate for Payer: Ambetter Exchange |
$201.45
|
| Rate for Payer: Anthem Medicaid |
$203.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.74
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$386.57
|
| Rate for Payer: Healthspan PPO |
$333.43
|
| Rate for Payer: Humana Medicaid |
$203.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$349.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.18
|
| Rate for Payer: Molina Healthcare Passport |
$203.12
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$261.88
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.45
|
|
|
THORACIC LYMPHADENECTOMY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 38746
|
| Hospital Charge Code |
761P1608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$417.00
|
| Rate for Payer: Ambetter Exchange |
$201.45
|
| Rate for Payer: Anthem Medicaid |
$203.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.74
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$386.57
|
| Rate for Payer: Healthspan PPO |
$333.43
|
| Rate for Payer: Humana Medicaid |
$203.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$349.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.18
|
| Rate for Payer: Molina Healthcare Passport |
$203.12
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$261.88
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.45
|
|
|
THORACOSCOPIC DIAPHRAGM PLICAT
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
76102696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
|
|
THORACOSCOPIC DIAPHRAGM PLIC(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39599
|
| Hospital Charge Code |
761P2696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
|
|
THORACOSCOP W/ESOPH MUSC EXC
|
Facility
|
OP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 32665
|
| Hospital Charge Code |
76101223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.50 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem Medicaid |
$1,060.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$2,560.55
|
| Rate for Payer: First Health Commercial |
$2,930.75
|
| Rate for Payer: Humana Commercial |
$2,622.25
|
| Rate for Payer: Humana KY Medicaid |
$1,060.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
THORACOSCOP W/ESOPH MUSC EXC
|
Facility
|
IP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 32665
|
| Hospital Charge Code |
76101223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.50 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$2,560.55
|
| Rate for Payer: First Health Commercial |
$2,930.75
|
| Rate for Payer: Humana Commercial |
$2,622.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
THORACOSCOP W/ESOPH MUSC EXC
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 32665
|
| Hospital Charge Code |
76101223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.74 |
| Max. Negotiated Rate |
$2,012.31 |
| Rate for Payer: Aetna Commercial |
$2,012.31
|
| Rate for Payer: Ambetter Exchange |
$1,159.82
|
| Rate for Payer: Anthem Medicaid |
$880.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,159.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,159.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,391.78
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$1,866.06
|
| Rate for Payer: Healthspan PPO |
$1,571.16
|
| Rate for Payer: Humana Medicaid |
$880.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,679.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,159.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$898.35
|
| Rate for Payer: Molina Healthcare Passport |
$880.74
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,507.77
|
| Rate for Payer: UHCCP Medicaid |
$1,079.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$889.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,159.82
|
|
|
THORACOSCOP W/ESOPH MUSC EX(P
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 32665
|
| Hospital Charge Code |
761P1223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.74 |
| Max. Negotiated Rate |
$2,012.31 |
| Rate for Payer: Aetna Commercial |
$2,012.31
|
| Rate for Payer: Ambetter Exchange |
$1,159.82
|
| Rate for Payer: Anthem Medicaid |
$880.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,159.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,159.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,391.78
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$1,866.06
|
| Rate for Payer: Healthspan PPO |
$1,571.16
|
| Rate for Payer: Humana Medicaid |
$880.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,679.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,159.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$898.35
|
| Rate for Payer: Molina Healthcare Passport |
$880.74
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,507.77
|
| Rate for Payer: UHCCP Medicaid |
$1,079.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$889.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,159.82
|
|
|
THORACOSCOPY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32656
|
| Hospital Charge Code |
76101219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,352.90 |
| Rate for Payer: Aetna Commercial |
$1,352.90
|
| Rate for Payer: Ambetter Exchange |
$758.36
|
| Rate for Payer: Anthem Medicaid |
$770.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$758.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$758.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$910.03
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,324.64
|
| Rate for Payer: Healthspan PPO |
$1,056.31
|
| Rate for Payer: Humana Medicaid |
$770.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,103.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$758.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$786.15
|
| Rate for Payer: Molina Healthcare Passport |
$770.74
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$985.87
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$778.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$758.36
|
|
|
THORACOSCOPY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32652
|
| Hospital Charge Code |
76101215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
THORACOSCOPY
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 32659
|
| Hospital Charge Code |
76101220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
THORACOSCOPY
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 32659
|
| Hospital Charge Code |
76101220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
THORACOSCOPY
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 32659
|
| Hospital Charge Code |
76101220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.30 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,234.04
|
| Rate for Payer: Ambetter Exchange |
$692.30
|
| Rate for Payer: Anthem Medicaid |
$757.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.76
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,208.30
|
| Rate for Payer: Healthspan PPO |
$963.51
|
| Rate for Payer: Humana Medicaid |
$757.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.15
|
| Rate for Payer: Molina Healthcare Passport |
$757.99
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$899.99
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.30
|
|
|
THORACOSCOPY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32652
|
| Hospital Charge Code |
76101215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
THORACOSCOPY
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32652
|
| Hospital Charge Code |
76101215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,014.23 |
| Max. Negotiated Rate |
$2,677.82 |
| Rate for Payer: Aetna Commercial |
$2,677.82
|
| Rate for Payer: Ambetter Exchange |
$1,564.36
|
| Rate for Payer: Anthem Medicaid |
$1,014.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,564.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,564.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,877.23
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,465.77
|
| Rate for Payer: Healthspan PPO |
$2,090.77
|
| Rate for Payer: Humana Medicaid |
$1,014.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,285.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,564.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,034.51
|
| Rate for Payer: Molina Healthcare Passport |
$1,014.23
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,033.67
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,024.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,564.36
|
|
|
THORACOSCOPY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32656
|
| Hospital Charge Code |
76101219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
