|
THYROIDECTOMY(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60240
|
| Hospital Charge Code |
761P2275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.92 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,437.38
|
| Rate for Payer: Ambetter Exchange |
$871.43
|
| Rate for Payer: Anthem Medicaid |
$790.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$871.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$871.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,045.72
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,363.13
|
| Rate for Payer: Healthspan PPO |
$1,212.16
|
| Rate for Payer: Humana Medicaid |
$790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,252.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$871.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$871.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$806.74
|
| Rate for Payer: Molina Healthcare Passport |
$790.92
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,132.86
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$798.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$871.43
|
|
|
THYROIDECTOMY(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 60271
|
| Hospital Charge Code |
761P2278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.80 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,556.24
|
| Rate for Payer: Ambetter Exchange |
$1,002.26
|
| Rate for Payer: Anthem Medicaid |
$795.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,002.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,002.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,202.71
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,479.69
|
| Rate for Payer: Healthspan PPO |
$1,312.40
|
| Rate for Payer: Humana Medicaid |
$795.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,002.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$811.72
|
| Rate for Payer: Molina Healthcare Passport |
$795.80
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,302.94
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$803.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,002.26
|
|
|
THYROIDECTOMY - REMOVAL OF AL
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60260
|
| Hospital Charge Code |
76102277
|
|
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
|
|
|
THYROIDECTOMY - REMOVAL OF AL
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60260
|
| Hospital Charge Code |
76102277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.67 |
| Max. Negotiated Rate |
$1,615.27 |
| Rate for Payer: Aetna Commercial |
$1,615.27
|
| Rate for Payer: Ambetter Exchange |
$1,032.68
|
| Rate for Payer: Anthem Medicaid |
$517.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,032.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,032.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,239.22
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,529.63
|
| Rate for Payer: Healthspan PPO |
$1,362.19
|
| Rate for Payer: Humana Medicaid |
$517.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,410.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,032.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.02
|
| Rate for Payer: Molina Healthcare Passport |
$517.67
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,342.48
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$522.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,032.68
|
|
|
THYROIDECTOMY - REMOVAL OF AL
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60260
|
| Hospital Charge Code |
76102277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,100.00
|
| 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: Humana Medicare Advantage |
$5,465.95
|
| 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 |
$6,559.14
|
| 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
|
|
|
THYROIDECTOMY - REMOVAL OF A(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60260
|
| Hospital Charge Code |
761P2277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.67 |
| Max. Negotiated Rate |
$1,615.27 |
| Rate for Payer: Aetna Commercial |
$1,615.27
|
| Rate for Payer: Ambetter Exchange |
$1,032.68
|
| Rate for Payer: Anthem Medicaid |
$517.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,032.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,032.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,239.22
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,529.63
|
| Rate for Payer: Healthspan PPO |
$1,362.19
|
| Rate for Payer: Humana Medicaid |
$517.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,410.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,032.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.02
|
| Rate for Payer: Molina Healthcare Passport |
$517.67
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,342.48
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$522.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,032.68
|
|
|
THYROIDECTOMY, TOTAL OR COMPLETE
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 60240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
THYROIDECTOMY - TOTAL OR SUB(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
761P2276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.97 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,933.71
|
| Rate for Payer: Ambetter Exchange |
$1,250.85
|
| Rate for Payer: Anthem Medicaid |
$879.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,250.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,501.02
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$1,826.04
|
| Rate for Payer: Healthspan PPO |
$1,630.73
|
| Rate for Payer: Humana Medicaid |
$879.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,697.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,250.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$897.57
|
| Rate for Payer: Molina Healthcare Passport |
$879.97
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,626.11
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$888.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,250.85
|
|
|
THYROIDECTOMY - TOTAL OR SUBT
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
76102276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,203.65 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
THYROIDECTOMY - TOTAL OR SUBT
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
76102276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.97 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,933.71
|
| Rate for Payer: Ambetter Exchange |
$1,250.85
|
| Rate for Payer: Anthem Medicaid |
$879.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,250.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,501.02
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$1,826.04
|
| Rate for Payer: Healthspan PPO |
$1,630.73
|
| Rate for Payer: Humana Medicaid |
$879.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,697.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,250.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$897.57
|
| Rate for Payer: Molina Healthcare Passport |
$879.97
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,626.11
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$888.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,250.85
|
|
|
THYROIDECTOMY - TOTAL OR SUBT
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
76102276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
|
Facility
|
OP
|
$7,652.33
|
|
|
Service Code
|
CPT 60252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.95 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
|
|
THYROID IMAGING W/BLOOD FLO(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340P0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$394.13 |
| Rate for Payer: Ambetter Exchange |
$190.56
|
| Rate for Payer: Anthem Medicaid |
$186.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.67
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$394.13
|
| Rate for Payer: Healthspan PPO |
$268.05
|
| Rate for Payer: Humana Medicaid |
$186.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.29
|
| Rate for Payer: Molina Healthcare Passport |
$186.56
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.73
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.56
|
|
|
THYROID IMAGING W/BLOOD FLO(T
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340T0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,199.04 |
| Rate for Payer: Aetna Commercial |
$961.73
|
| Rate for Payer: Anthem Medicaid |
$429.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$974.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$1,036.67
|
| Rate for Payer: First Health Commercial |
$1,186.55
|
| Rate for Payer: Humana Commercial |
$1,061.65
|
| Rate for Payer: Humana KY Medicaid |
$429.53
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$433.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,024.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$921.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,099.12
|
| Rate for Payer: Ohio Health Group HMO |
$936.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.81
|
| Rate for Payer: PHCS Commercial |
$1,199.04
|
| Rate for Payer: United Healthcare All Payer |
$1,099.12
|
|
|
THYROID IMAGING W/BLOOD FLO(T
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340T0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$374.70 |
| Max. Negotiated Rate |
$1,199.04 |
| Rate for Payer: Aetna Commercial |
$961.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$974.22
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$1,036.67
|
| Rate for Payer: First Health Commercial |
$1,186.55
|
| Rate for Payer: Humana Commercial |
$1,061.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,024.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$921.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,099.12
|
| Rate for Payer: Ohio Health Group HMO |
$936.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.81
|
| Rate for Payer: PHCS Commercial |
$1,199.04
|
| Rate for Payer: United Healthcare All Payer |
$1,099.12
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem Medicaid |
$472.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Humana KY Medicaid |
$472.52
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$824.40 |
| Rate for Payer: Ambetter Exchange |
$190.56
|
| Rate for Payer: Anthem Medicaid |
$186.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.67
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$394.13
|
| Rate for Payer: Healthspan PPO |
$268.05
|
| Rate for Payer: Humana Medicaid |
$186.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.29
|
| Rate for Payer: Molina Healthcare Passport |
$186.56
|
| Rate for Payer: Multiplan PHCS |
$824.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.73
|
| Rate for Payer: UHCCP Medicaid |
$480.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.56
|
|
|
TIB ALL PLY GII P/S SZ 11MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 11MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 13MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 13MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 15MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 15MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 11MM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
