|
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 |
$2,002.93 |
| Rate for Payer: Aetna Commercial |
$1,922.78
|
| Rate for Payer: Ambetter Exchange |
$1,090.96
|
| Rate for Payer: Anthem Medicaid |
$1,033.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,090.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,309.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,090.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.96
|
| 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 |
$1,418.25
|
| Rate for Payer: UHCCP Medicaid |
$976.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,090.96
|
|
|
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 |
$837.00 |
| 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 |
$2,232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,427.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,925.10
|
| 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
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
76101774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.50 |
| 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 |
$998.77
|
| 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 |
$2,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,501.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.75
|
| 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
|
$2,875.00
|
|
|
Service Code
|
HCPCS 43333
|
| Hospital Charge Code |
76101774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.25 |
| Max. Negotiated Rate |
$2,175.56 |
| Rate for Payer: Aetna Commercial |
$2,088.38
|
| Rate for Payer: Ambetter Exchange |
$1,198.89
|
| Rate for Payer: Anthem Medicaid |
$1,121.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,198.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,198.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,438.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,198.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,198.89
|
| 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 |
$1,558.56
|
| Rate for Payer: UHCCP Medicaid |
$1,006.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,198.89
|
|
|
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 |
$862.50 |
| 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 |
$2,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,501.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,983.75
|
| 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
|
$2,790.00
|
|
|
Service Code
|
HCPCS 43332
|
| Hospital Charge Code |
76101773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.00 |
| 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 |
$2,232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,427.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,925.10
|
| Rate for Payer: PHCS Commercial |
$2,678.40
|
| Rate for Payer: United Healthcare All Payer |
$2,455.20
|
|
|
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 |
$2,175.56 |
| Rate for Payer: Aetna Commercial |
$2,088.38
|
| Rate for Payer: Ambetter Exchange |
$1,198.89
|
| Rate for Payer: Anthem Medicaid |
$1,121.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,198.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,198.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,438.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,198.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,198.89
|
| 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 |
$1,558.56
|
| Rate for Payer: UHCCP Medicaid |
$1,006.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,198.89
|
|
|
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 |
$2,002.93 |
| Rate for Payer: Aetna Commercial |
$1,922.78
|
| Rate for Payer: Ambetter Exchange |
$1,090.96
|
| Rate for Payer: Anthem Medicaid |
$1,033.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,090.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,309.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,090.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.96
|
| 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 |
$1,418.25
|
| Rate for Payer: UHCCP Medicaid |
$976.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,043.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,090.96
|
|
|
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 |
$98.42 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Ambetter Exchange |
$45.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.86
|
| Rate for Payer: Anthem Medicaid |
$53.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.14
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.37
|
| Rate for Payer: Molina Healthcare Passport |
$53.30
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$31.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.12
|
|
|
TRANSBR. LUNG BX--ADDIT SITES
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 31632
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$37.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$37.14
|
| Rate for Payer: Kentucky WC Medicaid |
$37.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
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 |
$98.42 |
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Ambetter Exchange |
$45.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.86
|
| Rate for Payer: Anthem Medicaid |
$53.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.14
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.37
|
| Rate for Payer: Molina Healthcare Passport |
$53.30
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$31.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.12
|
|
|
TRANSBR. LUNG BX--ADDIT SITES
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 31632
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
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 |
$119.07 |
| 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 |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$298.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| 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 |
$119.07
|
| 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 |
$142.88
|
| 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 |
$306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.27
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
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 |
$114.90 |
| 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 |
$306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.27
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
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 |
$130.96 |
| Max. Negotiated Rate |
$273.49 |
| Rate for Payer: Ambetter Exchange |
$130.96
|
| Rate for Payer: Anthem Medicaid |
$167.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$130.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.15
|
| 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 |
$167.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$130.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.77
|
| Rate for Payer: Molina Healthcare Passport |
$167.42
|
| Rate for Payer: Multiplan PHCS |
$229.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.25
|
| Rate for Payer: UHCCP Medicaid |
$134.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$130.96
|
|
|
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 |
$130.96 |
| Max. Negotiated Rate |
$273.49 |
| Rate for Payer: Ambetter Exchange |
$130.96
|
| Rate for Payer: Anthem Medicaid |
$167.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$130.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.15
|
| 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 |
$167.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$130.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.77
|
| Rate for Payer: Molina Healthcare Passport |
$167.42
|
| Rate for Payer: Multiplan PHCS |
$229.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.25
|
| Rate for Payer: UHCCP Medicaid |
$134.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$130.96
|
|
|
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 |
$177.80 |
| Max. Negotiated Rate |
$386.11 |
| Rate for Payer: Ambetter Exchange |
$178.06
|
| Rate for Payer: Anthem Medicaid |
$226.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.67
|
| 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 |
$226.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.45
|
| Rate for Payer: Molina Healthcare Passport |
$226.91
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$231.48
|
| Rate for Payer: UHCCP Medicaid |
$177.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.06
|
|
|
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 |
$152.40 |
| 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 |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| 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 |
$119.07 |
| 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 |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| 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 |
$119.07
|
| 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 |
$142.88
|
| 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 |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| 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 |
$177.80 |
| Max. Negotiated Rate |
$386.11 |
| Rate for Payer: Ambetter Exchange |
$178.06
|
| Rate for Payer: Anthem Medicaid |
$226.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.67
|
| 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 |
$226.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.45
|
| Rate for Payer: Molina Healthcare Passport |
$226.91
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$231.48
|
| Rate for Payer: UHCCP Medicaid |
$177.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.06
|
|
|
TRANSCATH EMBOLIZATION
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,418.40 |
| 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 |
$3,782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,113.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,262.32
|
| 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 |
$3,309.60 |
| Rate for Payer: Aetna Commercial |
$1,466.53
|
| Rate for Payer: Anthem Medicaid |
$708.07
|
| 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 |
$833.77
|
| 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
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
32000176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,418.40 |
| 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 |
$3,782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,113.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,262.32
|
| Rate for Payer: PHCS Commercial |
$4,538.88
|
| Rate for Payer: United Healthcare All Payer |
$4,160.64
|
|
|
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: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,425.37
|
| Rate for Payer: Healthspan PPO |
$833.77
|
| 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
|
|
|
TRANSCATH EMBOLIZATION(T
|
Facility
|
OP
|
$4,503.00
|
|
|
Service Code
|
HCPCS 75894
|
| Hospital Charge Code |
320T0176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,350.90 |
| Max. Negotiated Rate |
$4,322.88 |
| Rate for Payer: Aetna Commercial |
$3,467.31
|
| Rate for Payer: Anthem Medicaid |
$1,548.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,512.34
|
| Rate for Payer: Cash Price |
$2,251.50
|
| Rate for Payer: Cigna Commercial |
$3,737.49
|
| Rate for Payer: First Health Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial |
$3,827.55
|
| Rate for Payer: Humana KY Medicaid |
$1,548.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,564.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,692.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,323.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,962.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,917.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,107.07
|
| Rate for Payer: PHCS Commercial |
$4,322.88
|
| Rate for Payer: United Healthcare All Payer |
$3,962.64
|
|
