|
TTE W W/O FOL W/CON STRESS (T
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
483T0014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$2,390.40 |
| Rate for Payer: Aetna Commercial |
$1,917.30
|
| Rate for Payer: Anthem Medicaid |
$856.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,942.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,245.00
|
| Rate for Payer: Cash Price |
$1,245.00
|
| Rate for Payer: Cigna Commercial |
$2,066.70
|
| Rate for Payer: First Health Commercial |
$2,365.50
|
| Rate for Payer: Humana Commercial |
$2,116.50
|
| Rate for Payer: Humana KY Medicaid |
$856.31
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$865.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,041.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,837.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$873.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,191.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$771.90
|
| Rate for Payer: PHCS Commercial |
$2,390.40
|
| Rate for Payer: United Healthcare All Payer |
$2,191.20
|
|
|
TTE W W/O FOL W/CON STRESS (T
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
483T0014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$2,390.40 |
| Rate for Payer: Aetna Commercial |
$1,917.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,942.20
|
| Rate for Payer: Cash Price |
$1,245.00
|
| Rate for Payer: Cigna Commercial |
$2,066.70
|
| Rate for Payer: First Health Commercial |
$2,365.50
|
| Rate for Payer: Humana Commercial |
$2,116.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,041.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,837.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,191.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,867.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$771.90
|
| Rate for Payer: PHCS Commercial |
$2,390.40
|
| Rate for Payer: United Healthcare All Payer |
$2,191.20
|
|
|
TUBAL AT TIME OF C-SECTION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
76102246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
TUBAL AT TIME OF C-SECTION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
76102246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
TUBAL AT TIME OF C-SECTION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
76102246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.52 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$121.13
|
| Rate for Payer: Anthem Medicaid |
$33.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$119.21
|
| Rate for Payer: Healthspan PPO |
$117.29
|
| Rate for Payer: Humana Medicaid |
$33.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.19
|
| Rate for Payer: Molina Healthcare Passport |
$33.52
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.86
|
|
|
TUBAL AT TIME OF C-SECTION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
761P2246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.52 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$121.13
|
| Rate for Payer: Anthem Medicaid |
$33.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$119.21
|
| Rate for Payer: Healthspan PPO |
$117.29
|
| Rate for Payer: Humana Medicaid |
$33.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.19
|
| Rate for Payer: Molina Healthcare Passport |
$33.52
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.86
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,938.90
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,384.93 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
|
|
TUBOPLASTY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58760
|
| Hospital Charge Code |
76102259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
TUBOPLASTY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58760
|
| Hospital Charge Code |
76102259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
TUBOPLASTY
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58760
|
| Hospital Charge Code |
76102259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,255.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,223.89
|
| Rate for Payer: Healthspan PPO |
$1,215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,056.82
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
|
|
TUBOPLASTY(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58760
|
| Hospital Charge Code |
761P2259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,255.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,223.89
|
| Rate for Payer: Healthspan PPO |
$1,215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,056.82
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
|
|
TUBOUTERINE IMPLANTATION
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58752
|
| Hospital Charge Code |
76102258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,390.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,332.43
|
| Rate for Payer: Healthspan PPO |
$1,346.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.00
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
|
|
TUBOUTERINE IMPLANTATION
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58752
|
| Hospital Charge Code |
76102258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
TUBOUTERINE IMPLANTATION
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58752
|
| Hospital Charge Code |
76102258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
TUBOUTERINE IMPLANTATION(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 58752
|
| Hospital Charge Code |
761P2258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,390.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,332.43
|
| Rate for Payer: Healthspan PPO |
$1,346.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.00
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
|
|
TUCKS WIPES 40 COUNT
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
25001607
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
TUCKS WIPES 40 COUNT
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
25001607
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
TUMOR IMAGING LIMITED AREA
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
34000033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.56 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.72
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
TUMOR IMAGING LIMITED AREA
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
34000033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.56 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem Medicaid |
$760.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Humana KY Medicaid |
$760.71
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$768.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.72
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
TUMOR IMAGING LIMITED AREA
|
Professional
|
Both
|
$2,212.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
34000033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$2,212.00 |
| Rate for Payer: Aetna Commercial |
$274.80
|
| Rate for Payer: Anthem Medicaid |
$193.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,212.00
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Healthspan PPO |
$274.66
|
| Rate for Payer: Humana Medicaid |
$193.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.83
|
| Rate for Payer: Molina Healthcare Passport |
$193.95
|
| Rate for Payer: Multiplan PHCS |
$1,327.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,548.40
|
| Rate for Payer: UHCCP Medicaid |
$774.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.89
|
|
|
TUMOR IMAGING LIMITED AREA(P
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
340P0033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna Commercial |
$274.80
|
| Rate for Payer: Anthem Medicaid |
$193.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$598.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Healthspan PPO |
$274.66
|
| Rate for Payer: Humana Medicaid |
$193.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.83
|
| Rate for Payer: Molina Healthcare Passport |
$193.95
|
| Rate for Payer: Multiplan PHCS |
$358.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$418.60
|
| Rate for Payer: UHCCP Medicaid |
$209.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.89
|
|
|
TUMOR IMAGING LIMITED AREA(T
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
340T0033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,549.44 |
| Rate for Payer: Aetna Commercial |
$1,242.78
|
| Rate for Payer: Anthem Medicaid |
$555.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cigna Commercial |
$1,339.62
|
| Rate for Payer: First Health Commercial |
$1,533.30
|
| Rate for Payer: Humana Commercial |
$1,371.90
|
| Rate for Payer: Humana KY Medicaid |
$555.05
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$560.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,323.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,191.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$566.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,420.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,210.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.34
|
| Rate for Payer: PHCS Commercial |
$1,549.44
|
| Rate for Payer: United Healthcare All Payer |
$1,420.32
|
|
|
TUMOR IMAGING LIMITED AREA(T
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
340T0033
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,549.44 |
| Rate for Payer: Aetna Commercial |
$1,242.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.92
|
| Rate for Payer: Cash Price |
$807.00
|
| Rate for Payer: Cigna Commercial |
$1,339.62
|
| Rate for Payer: First Health Commercial |
$1,533.30
|
| Rate for Payer: Humana Commercial |
$1,371.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,323.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,191.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,420.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,210.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.34
|
| Rate for Payer: PHCS Commercial |
$1,549.44
|
| Rate for Payer: United Healthcare All Payer |
$1,420.32
|
|
|
TUMOR IMAGING WHOLE BODY
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
TUMOR IMAGING WHOLE BODY
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
