|
THORACOSCOPY REMOVE SEGMENT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 32669
|
| Hospital Charge Code |
76101227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$2,533.82 |
| Rate for Payer: Ambetter Exchange |
$1,263.16
|
| Rate for Payer: Anthem Medicaid |
$1,091.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,263.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,263.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,515.79
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$2,533.82
|
| Rate for Payer: Healthspan PPO |
$1,357.02
|
| Rate for Payer: Humana Medicaid |
$1,091.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,831.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,263.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,113.76
|
| Rate for Payer: Molina Healthcare Passport |
$1,091.92
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,642.11
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,102.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,263.16
|
|
|
THORACOSCOPY REMOVE SEGMENT
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 32669
|
| Hospital Charge Code |
76101227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
THORACOSCOPY REMOVE SEGMENT(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 32669
|
| Hospital Charge Code |
761P1227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$2,533.82 |
| Rate for Payer: Ambetter Exchange |
$1,263.16
|
| Rate for Payer: Anthem Medicaid |
$1,091.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,263.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,263.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,515.79
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$2,533.82
|
| Rate for Payer: Healthspan PPO |
$1,357.02
|
| Rate for Payer: Humana Medicaid |
$1,091.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,831.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,263.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,113.76
|
| Rate for Payer: Molina Healthcare Passport |
$1,091.92
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,642.11
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,102.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,263.16
|
|
|
THORACOSCOPY SURG BULLAE
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32655
|
| Hospital Charge Code |
76101218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
THORACOSCOPY SURG BULLAE
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32655
|
| Hospital Charge Code |
76101218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$1,569.07 |
| Rate for Payer: Aetna Commercial |
$1,569.07
|
| Rate for Payer: Ambetter Exchange |
$901.51
|
| Rate for Payer: Anthem Medicaid |
$785.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$901.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$901.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,081.81
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,476.59
|
| Rate for Payer: Healthspan PPO |
$1,225.08
|
| Rate for Payer: Humana Medicaid |
$785.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,317.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$901.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$901.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$801.59
|
| Rate for Payer: Molina Healthcare Passport |
$785.87
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,171.96
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$793.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$901.51
|
|
|
THORACOSCOPY SURG BULLAE
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32655
|
| Hospital Charge Code |
76101218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
THORACOSCOPY SURG BULLAE(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32655
|
| Hospital Charge Code |
761P1218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$1,569.07 |
| Rate for Payer: Aetna Commercial |
$1,569.07
|
| Rate for Payer: Ambetter Exchange |
$901.51
|
| Rate for Payer: Anthem Medicaid |
$785.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$901.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$901.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,081.81
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,476.59
|
| Rate for Payer: Healthspan PPO |
$1,225.08
|
| Rate for Payer: Humana Medicaid |
$785.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,317.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$901.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$901.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$801.59
|
| Rate for Payer: Molina Healthcare Passport |
$785.87
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,171.96
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$793.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$901.51
|
|
|
THORACOSCOPY SURG W/PART PULMO
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 32651
|
| Hospital Charge Code |
76101214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
THORACOSCOPY SURG W/PART PULMO
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 32651
|
| Hospital Charge Code |
76101214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.03 |
| Max. Negotiated Rate |
$1,764.78 |
| Rate for Payer: Aetna Commercial |
$1,764.78
|
| Rate for Payer: Ambetter Exchange |
$1,031.96
|
| Rate for Payer: Anthem Medicaid |
$728.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,031.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,238.35
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,635.74
|
| Rate for Payer: Healthspan PPO |
$1,377.89
|
| Rate for Payer: Humana Medicaid |
$728.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,503.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,031.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$742.59
|
| Rate for Payer: Molina Healthcare Passport |
$728.03
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,341.55
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$735.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,031.96
|
|
|
THORACOSCOPY SURG W/PART PULMO
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 32651
|
| Hospital Charge Code |
761P1214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.03 |
| Max. Negotiated Rate |
$1,764.78 |
| Rate for Payer: Aetna Commercial |
$1,764.78
|
| Rate for Payer: Ambetter Exchange |
$1,031.96
|
| Rate for Payer: Anthem Medicaid |
$728.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,031.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,238.35
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,635.74
|
| Rate for Payer: Healthspan PPO |
$1,377.89
|
| Rate for Payer: Humana Medicaid |
$728.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,503.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,031.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$742.59
|
| Rate for Payer: Molina Healthcare Passport |
$728.03
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,341.55
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$735.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,031.96
|
|
|
THORACOSCOPY SURG W/PART PULMO
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 32651
|
| Hospital Charge Code |
76101214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
THORACOSCOPY SURG W/PLEURODESI
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32650
|
| Hospital Charge Code |
761P1213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$1,128.88 |
| Rate for Payer: Aetna Commercial |
$1,128.88
|
| Rate for Payer: Ambetter Exchange |
$629.93
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$629.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$629.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$755.92
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,102.18
|
| Rate for Payer: Healthspan PPO |
$881.40
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$920.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$629.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$818.91
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$629.93
|
|
|
THORACOSCOPY SURG W/PLEURODESI
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32650
|
| Hospital Charge Code |
76101213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
THORACOSCOPY SURG W/PLEURODESI
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32650
|
| Hospital Charge Code |
76101213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$1,128.88 |
| Rate for Payer: Aetna Commercial |
$1,128.88
|
| Rate for Payer: Ambetter Exchange |
$629.93
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$629.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$629.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$755.92
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,102.18
|
| Rate for Payer: Healthspan PPO |
$881.40
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$920.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$629.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$818.91
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$629.93
|
|
|
THORACOSCOPY SURG W/PLEURODESI
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32650
|
| Hospital Charge Code |
76101213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
THORACOSCOPY W/BX INFILTRATE
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 32607
|
| Hospital Charge Code |
76101210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.11 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem Medicaid |
$177.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Humana KY Medicaid |
$177.11
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$178.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
THORACOSCOPY W/BX INFILTRATE
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 32607
|
| Hospital Charge Code |
76101210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
THORACOSCOPY W/BX INFILTRATE
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 32607
|
| Hospital Charge Code |
76101210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$584.45 |
| Rate for Payer: Ambetter Exchange |
$289.75
|
| Rate for Payer: Anthem Medicaid |
$251.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$289.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$289.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$347.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$584.45
|
| Rate for Payer: Healthspan PPO |
$313.17
|
| Rate for Payer: Humana Medicaid |
$251.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$422.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$289.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.92
|
| Rate for Payer: Molina Healthcare Passport |
$251.88
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$376.68
|
| Rate for Payer: UHCCP Medicaid |
$180.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$289.75
|
|
|
THORACOSCOPY W/BX INFILTRAT(P
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 32607
|
| Hospital Charge Code |
761P1210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$584.45 |
| Rate for Payer: Ambetter Exchange |
$289.75
|
| Rate for Payer: Anthem Medicaid |
$251.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$289.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$289.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$347.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$584.45
|
| Rate for Payer: Healthspan PPO |
$313.17
|
| Rate for Payer: Humana Medicaid |
$251.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$422.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$289.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.92
|
| Rate for Payer: Molina Healthcare Passport |
$251.88
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$376.68
|
| Rate for Payer: UHCCP Medicaid |
$180.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$289.75
|
|
|
THORACOSCOPY W/BX MED SPACE
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 32606
|
| Hospital Charge Code |
76101209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
THORACOSCOPY W/BX MED SPACE
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 32606
|
| Hospital Charge Code |
76101209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
THORACOSCOPY W/BX MED SPACE
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 32606
|
| Hospital Charge Code |
76101209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.84 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$802.51
|
| Rate for Payer: Ambetter Exchange |
$435.03
|
| Rate for Payer: Anthem Medicaid |
$365.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$435.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$435.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$522.04
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: Healthspan PPO |
$626.58
|
| Rate for Payer: Humana Medicaid |
$365.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$435.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.16
|
| Rate for Payer: Molina Healthcare Passport |
$365.84
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.54
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$435.03
|
|
|
THORACOSCOPY W/BX MED SPACE(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 32606
|
| Hospital Charge Code |
761P1209
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.84 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$802.51
|
| Rate for Payer: Ambetter Exchange |
$435.03
|
| Rate for Payer: Anthem Medicaid |
$365.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$435.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$435.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$522.04
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: Healthspan PPO |
$626.58
|
| Rate for Payer: Humana Medicaid |
$365.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$435.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.16
|
| Rate for Payer: Molina Healthcare Passport |
$365.84
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.54
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$435.03
|
|
|
THORACOSCOPY W/BX NODULE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 32608
|
| Hospital Charge Code |
76101211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
THORACOSCOPY W/BX NODULE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 32608
|
| Hospital Charge Code |
76101211
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$9,619.76
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,543.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
