|
TRANEXAMIC ACID KIT
|
Facility
|
IP
|
$184.13
|
|
|
Service Code
|
NDC 39822100001
|
| Hospital Charge Code |
25003533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$176.76 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.62
|
| Rate for Payer: Cash Price |
$92.06
|
| Rate for Payer: Cigna Commercial |
$152.83
|
| Rate for Payer: First Health Commercial |
$174.92
|
| Rate for Payer: Humana Commercial |
$156.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.03
|
| Rate for Payer: Ohio Health Group HMO |
$138.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.08
|
| Rate for Payer: PHCS Commercial |
$176.76
|
| Rate for Payer: United Healthcare All Payer |
$162.03
|
|
|
TRANS 3.5 CATH 5F
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
TRANS 3.5 CATH 5F
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
76101774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.75 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$2,213.75
|
| Rate for Payer: Anthem Medicaid |
$988.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.50
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cigna Commercial |
$2,386.25
|
| Rate for Payer: First Health Commercial |
$2,731.25
|
| Rate for Payer: Humana Commercial |
$2,443.75
|
| Rate for Payer: Humana KY Medicaid |
$988.71
|
| Rate for Payer: Kentucky WC Medicaid |
$998.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,008.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,530.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,156.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.25
|
| Rate for Payer: PHCS Commercial |
$2,760.00
|
| Rate for Payer: United Healthcare All Payer |
$2,530.00
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
76101774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.75 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$2,213.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,242.50
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cigna Commercial |
$2,386.25
|
| Rate for Payer: First Health Commercial |
$2,731.25
|
| Rate for Payer: Humana Commercial |
$2,443.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,357.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,121.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,530.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,156.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$891.25
|
| Rate for Payer: PHCS Commercial |
$2,760.00
|
| Rate for Payer: United Healthcare All Payer |
$2,530.00
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 43332
|
| Hospital Charge Code |
76101773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Aetna Commercial |
$1,922.78
|
| Rate for Payer: Anthem Medicaid |
$1,033.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,790.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$2,002.93
|
| Rate for Payer: Healthspan PPO |
$1,216.54
|
| Rate for Payer: Humana Medicaid |
$1,033.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,532.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.77
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.11
|
| Rate for Payer: Multiplan PHCS |
$1,674.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,953.00
|
| Rate for Payer: UHCCP Medicaid |
$976.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.44
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS 43332
|
| Hospital Charge Code |
76101773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.70 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,148.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,176.20
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$2,315.70
|
| Rate for Payer: First Health Commercial |
$2,650.50
|
| Rate for Payer: Humana Commercial |
$2,371.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,287.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,059.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,455.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,092.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$864.90
|
| Rate for Payer: PHCS Commercial |
$2,678.40
|
| Rate for Payer: United Healthcare All Payer |
$2,455.20
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS 43332
|
| Hospital Charge Code |
76101773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.70 |
| Max. Negotiated Rate |
$2,678.40 |
| Rate for Payer: Aetna Commercial |
$2,148.30
|
| Rate for Payer: Anthem Medicaid |
$959.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,176.20
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$2,315.70
|
| Rate for Payer: First Health Commercial |
$2,650.50
|
| Rate for Payer: Humana Commercial |
$2,371.50
|
| Rate for Payer: Humana KY Medicaid |
$959.48
|
| Rate for Payer: Kentucky WC Medicaid |
$969.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,287.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,059.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$978.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,455.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,092.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$864.90
|
| Rate for Payer: PHCS Commercial |
$2,678.40
|
| Rate for Payer: United Healthcare All Payer |
$2,455.20
|
|
|
TRANSAB ESOPH HIAT HERN RPR
|
Professional
|
Both
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
76101774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.25 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,088.38
|
| Rate for Payer: Anthem Medicaid |
$1,121.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,875.00
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cigna Commercial |
$2,175.56
|
| Rate for Payer: Healthspan PPO |
$1,321.19
|
| Rate for Payer: Humana Medicaid |
$1,121.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,664.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.26
|
| Rate for Payer: Molina Healthcare Passport |
$1,121.82
|
| Rate for Payer: Multiplan PHCS |
$1,725.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,012.50
|
| Rate for Payer: UHCCP Medicaid |
$1,006.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.04
|
|
|
TRANSAB ESOPH HIAT HERN RPR(P
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 43332
|
| Hospital Charge Code |
761P1773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Aetna Commercial |
$1,922.78
|
| Rate for Payer: Anthem Medicaid |
$1,033.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,790.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$2,002.93
|
| Rate for Payer: Healthspan PPO |
$1,216.54
|
| Rate for Payer: Humana Medicaid |
$1,033.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,532.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.77
|
| Rate for Payer: Molina Healthcare Passport |
$1,033.11
|
| Rate for Payer: Multiplan PHCS |
$1,674.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,953.00
|
| Rate for Payer: UHCCP Medicaid |
$976.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.44
|
|
|
TRANSAB ESOPH HIAT HERN RPR(P
|
Professional
|
Both
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
761P1774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.25 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,088.38
|
| Rate for Payer: Anthem Medicaid |
$1,121.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,875.00
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cash Price |
$1,437.50
|
| Rate for Payer: Cigna Commercial |
$2,175.56
|
| Rate for Payer: Healthspan PPO |
$1,321.19
|
| Rate for Payer: Humana Medicaid |
$1,121.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,664.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.26
|
| Rate for Payer: Molina Healthcare Passport |
$1,121.82
|
| Rate for Payer: Multiplan PHCS |
$1,725.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,012.50
|
| Rate for Payer: UHCCP Medicaid |
$1,006.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.04
|
|
|
TRANSBR. LUNG BX--ADDIT SITE(P
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 31632
|
| Hospital Charge Code |
410P0043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.86
|
| Rate for Payer: Anthem Medicaid |
$41.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$83.79
|
| Rate for Payer: Healthspan PPO |
$98.42
|
| Rate for Payer: Humana Medicaid |
$41.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.99
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.60
|
| Rate for Payer: UHCCP Medicaid |
$31.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.41
|
|
|
TRANSBR. LUNG BX--ADDIT SITES
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 31632
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.86
|
| Rate for Payer: Anthem Medicaid |
$41.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$83.79
|
| Rate for Payer: Healthspan PPO |
$98.42
|
| Rate for Payer: Humana Medicaid |
$41.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.99
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.60
|
| Rate for Payer: UHCCP Medicaid |
$31.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.41
|
|
|
TRANS CARE MGMT 14 DAY DISCH
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Anthem Medicaid |
$117.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$383.00
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$273.49
|
| Rate for Payer: Healthspan PPO |
$138.69
|
| Rate for Payer: Humana Medicaid |
$117.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.78
|
| Rate for Payer: Molina Healthcare Passport |
$117.43
|
| Rate for Payer: Multiplan PHCS |
$229.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$268.10
|
| Rate for Payer: UHCCP Medicaid |
$134.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.60
|
|
|
TRANS CARE MGMT 14 DAY DISCH
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.79 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$298.74
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
TRANS CARE MGMT 14 DAY DISCH
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.79 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem Medicaid |
$131.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$298.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Humana KY Medicaid |
$131.71
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$133.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
TRANS CARE MGMT 14 DAY DISC(P
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
510P0126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.43 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Anthem Medicaid |
$117.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$383.00
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$273.49
|
| Rate for Payer: Healthspan PPO |
$138.69
|
| Rate for Payer: Humana Medicaid |
$117.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.78
|
| Rate for Payer: Molina Healthcare Passport |
$117.43
|
| Rate for Payer: Multiplan PHCS |
$229.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$268.10
|
| Rate for Payer: UHCCP Medicaid |
$134.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.60
|
|
|
TRANS CARE MGMT 7 DAY DISCH
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
51000127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.09 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Anthem Medicaid |
$160.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$508.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$386.11
|
| Rate for Payer: Healthspan PPO |
$195.56
|
| Rate for Payer: Humana Medicaid |
$160.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.29
|
| Rate for Payer: Molina Healthcare Passport |
$160.09
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$355.60
|
| Rate for Payer: UHCCP Medicaid |
$177.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.69
|
|
|
TRANS CARE MGMT 7 DAY DISCH
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
51000127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
TRANS CARE MGMT 7 DAY DISCH
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
51000127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Humana KY Medicaid |
$174.70
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
TRANS CARE MGMT 7 DAY DISCH(P
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
510P0127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.09 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Anthem Medicaid |
$160.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$508.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$386.11
|
| Rate for Payer: Healthspan PPO |
$195.56
|
| Rate for Payer: Humana Medicaid |
$160.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.29
|
| Rate for Payer: Molina Healthcare Passport |
$160.09
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$355.60
|
| Rate for Payer: UHCCP Medicaid |
$177.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.69
|
|
|
TRANSCATH EMBOLIZATION
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.64 |
| Max. Negotiated Rate |
$4,538.88 |
| Rate for Payer: Aetna Commercial |
$3,640.56
|
| Rate for Payer: Anthem Medicaid |
$1,625.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,687.84
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$3,924.24
|
| Rate for Payer: First Health Commercial |
$4,491.60
|
| Rate for Payer: Humana Commercial |
$4,018.80
|
| Rate for Payer: Humana KY Medicaid |
$1,625.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,642.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,876.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,489.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,658.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,160.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.68
|
| Rate for Payer: PHCS Commercial |
$4,538.88
|
| Rate for Payer: United Healthcare All Payer |
$4,160.64
|
|
|
TRANSCATH EMBOLIZATION
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.64 |
| Max. Negotiated Rate |
$4,538.88 |
| Rate for Payer: Aetna Commercial |
$3,640.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,687.84
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$3,924.24
|
| Rate for Payer: First Health Commercial |
$4,491.60
|
| Rate for Payer: Humana Commercial |
$4,018.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,876.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,489.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,160.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.68
|
| Rate for Payer: PHCS Commercial |
$4,538.88
|
| Rate for Payer: United Healthcare All Payer |
$4,160.64
|
|
|
TRANSCATH EMBOLIZATION
|
Professional
|
Both
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,728.00
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cash Price |
$2,364.00
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.78
|
| Rate for Payer: Humana Medicaid |
$708.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.23
|
| Rate for Payer: Molina Healthcare Passport |
$708.07
|
| Rate for Payer: Multiplan PHCS |
$2,836.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,309.60
|
| Rate for Payer: UHCCP Medicaid |
$1,654.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.15
|
|
|
TRANSCATH EMBOLIZATION(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320P0176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,466.53 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.78
|
| Rate for Payer: Humana Medicaid |
$708.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.23
|
| Rate for Payer: Molina Healthcare Passport |
$708.07
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.15
|
|
