|
US spinal canal and contents(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
402P0107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Anthem Medicaid |
$86.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: Healthspan PPO |
$176.62
|
| Rate for Payer: Humana Medicaid |
$86.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.65
|
| Rate for Payer: Molina Healthcare Passport |
$86.91
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.00
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.78
|
|
|
US spinal canal and contents(T
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
402T0107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.11 |
| Max. Negotiated Rate |
$621.12 |
| Rate for Payer: Aetna Commercial |
$498.19
|
| Rate for Payer: Anthem Medicaid |
$222.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$504.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$537.01
|
| Rate for Payer: First Health Commercial |
$614.65
|
| Rate for Payer: Humana Commercial |
$549.95
|
| Rate for Payer: Humana KY Medicaid |
$222.50
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$224.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$477.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$569.36
|
| Rate for Payer: Ohio Health Group HMO |
$485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.57
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
US spinal canal and contents(T
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
402T0107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.11 |
| Max. Negotiated Rate |
$621.12 |
| Rate for Payer: Aetna Commercial |
$498.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$504.66
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$537.01
|
| Rate for Payer: First Health Commercial |
$614.65
|
| Rate for Payer: Humana Commercial |
$549.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$477.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$569.36
|
| Rate for Payer: Ohio Health Group HMO |
$485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.57
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
USTAR TIBAL AUG #3 5MM
|
Facility
|
IP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
USTAR TIBAL AUG #3 5MM
|
Facility
|
OP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem Medicaid |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Humana KY Medicaid |
$1,448.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
USTEKINUMAB 130MG/26ML VIAL
|
Facility
|
IP
|
$3,774.51
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
25002403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.69 |
| Max. Negotiated Rate |
$3,623.53 |
| Rate for Payer: Aetna Commercial |
$2,906.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.12
|
| Rate for Payer: Cash Price |
$1,887.26
|
| Rate for Payer: Cigna Commercial |
$3,132.84
|
| Rate for Payer: First Health Commercial |
$3,585.78
|
| Rate for Payer: Humana Commercial |
$3,208.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.10
|
| Rate for Payer: PHCS Commercial |
$3,623.53
|
| Rate for Payer: United Healthcare All Payer |
$3,321.57
|
|
|
USTEKINUMAB 130MG/26ML VIAL
|
Facility
|
OP
|
$3,774.51
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
25002403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$3,623.53 |
| Rate for Payer: Aetna Commercial |
$2,906.37
|
| Rate for Payer: Anthem Medicaid |
$1,298.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.04
|
| Rate for Payer: Cash Price |
$1,887.26
|
| Rate for Payer: Cash Price |
$1,887.26
|
| Rate for Payer: Cigna Commercial |
$3,132.84
|
| Rate for Payer: First Health Commercial |
$3,585.78
|
| Rate for Payer: Humana Commercial |
$3,208.33
|
| Rate for Payer: Humana KY Medicaid |
$1,298.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,321.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.10
|
| Rate for Payer: PHCS Commercial |
$3,623.53
|
| Rate for Payer: United Healthcare All Payer |
$3,321.57
|
|
|
US THERAPY 15 MINUTES 1
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
42000015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.74
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.23
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
US THERAPY 15 MINUTES 1
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
42000015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem Medicaid |
$45.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.74
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Humana KY Medicaid |
$45.74
|
| Rate for Payer: Kentucky WC Medicaid |
$46.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.23
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
US THORACENTESIS
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.46 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.02
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
US THORACENTESIS
|
Professional
|
Both
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,742.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$1,045.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,219.40
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
US THORACENTESIS
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.46 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem Medicaid |
$599.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Humana KY Medicaid |
$599.07
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$605.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.02
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
US THORACENTESIS (P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761P2776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$91.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$91.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.29
|
| Rate for Payer: Molina Healthcare Passport |
$91.46
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.37
|
|
|
US THORACENTESIS (T
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T2776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$323.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Humana KY Medicaid |
$323.95
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
US THORACENTESIS (T
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T2776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.46 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.02
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
45000283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
45000283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
US URINE CAPACITY MEASURE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
920P0002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
|
|
US URINE CAPACITY MEASURE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
402P0002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$26.59
|
| Rate for Payer: Healthspan PPO |
$26.80
|
| Rate for Payer: Humana Medicaid |
$14.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
|
