|
US spinal canal and contents
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
40200107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.10 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$789.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.83
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
US spinal canal and contents
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
40200107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem Medicaid |
$311.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Humana KY Medicaid |
$311.92
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$315.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$789.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.83
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
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 |
$212.99 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Ambetter Exchange |
$163.84
|
| Rate for Payer: Anthem Medicaid |
$86.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$163.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.84
|
| 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 |
$212.99
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.84
|
|
|
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 |
$194.10 |
| 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 |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.43
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
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 |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$504.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.43
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
USTAR TIBAL AUG #3 5MM
|
Facility
|
OP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem Medicaid |
$1,429.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Humana KY Medicaid |
$1,429.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,443.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
USTAR TIBAL AUG #3 5MM
|
Facility
|
IP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
USTEKINUMAB 130MG/26ML VIAL
|
Facility
|
IP
|
$3,869.66
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
25002403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,160.90 |
| Max. Negotiated Rate |
$3,714.87 |
| Rate for Payer: Aetna Commercial |
$2,979.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.33
|
| Rate for Payer: Cash Price |
$1,934.83
|
| Rate for Payer: Cigna Commercial |
$3,211.82
|
| Rate for Payer: First Health Commercial |
$3,676.18
|
| Rate for Payer: Humana Commercial |
$3,289.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,173.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.07
|
| Rate for Payer: PHCS Commercial |
$3,714.87
|
| Rate for Payer: United Healthcare All Payer |
$3,405.30
|
|
|
USTEKINUMAB 130MG/26ML VIAL
|
Facility
|
OP
|
$3,869.66
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
25002403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$3,714.87 |
| Rate for Payer: Aetna Commercial |
$2,979.64
|
| Rate for Payer: Anthem Medicaid |
$1,330.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.94
|
| Rate for Payer: Cash Price |
$1,934.83
|
| Rate for Payer: Cash Price |
$1,934.83
|
| Rate for Payer: Cigna Commercial |
$3,211.82
|
| Rate for Payer: First Health Commercial |
$3,676.18
|
| Rate for Payer: Humana Commercial |
$3,289.21
|
| Rate for Payer: Humana KY Medicaid |
$1,330.78
|
| Rate for Payer: Humana Medicare Advantage |
$13.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,173.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.07
|
| Rate for Payer: PHCS Commercial |
$3,714.87
|
| Rate for Payer: United Healthcare All Payer |
$3,405.30
|
|
|
US THERAPY 15 MINUTES 1
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
42000015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
US THERAPY 15 MINUTES 1
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
42000015
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$48.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$48.83
|
| Rate for Payer: Kentucky WC Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
US THORACENTESIS
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$1,061.40 |
| Rate for Payer: Ambetter Exchange |
$101.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$442.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.34
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: Healthspan PPO |
$536.94
|
| Rate for Payer: Humana Medicaid |
$442.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.78
|
| Rate for Payer: Molina Healthcare Passport |
$442.92
|
| Rate for Payer: Multiplan PHCS |
$1,061.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.53
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$447.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.95
|
|
|
US THORACENTESIS
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem Medicaid |
$608.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Humana KY Medicaid |
$608.36
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$614.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
US THORACENTESIS
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
76102776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.70 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
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 |
$536.94 |
| Rate for Payer: Ambetter Exchange |
$101.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$442.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.34
|
| 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 |
$442.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.78
|
| Rate for Payer: Molina Healthcare Passport |
$442.92
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.53
|
| Rate for Payer: UHCCP Medicaid |
$68.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$447.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.95
|
|
|
US THORACENTESIS (T
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T2776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.24 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna Commercial |
$746.13
|
| Rate for Payer: Anthem Medicaid |
$333.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$804.27
|
| Rate for Payer: First Health Commercial |
$920.55
|
| Rate for Payer: Humana Commercial |
$823.65
|
| Rate for Payer: Humana KY Medicaid |
$333.24
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$336.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$794.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$852.72
|
| Rate for Payer: Ohio Health Group HMO |
$726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.61
|
| Rate for Payer: PHCS Commercial |
$930.24
|
| Rate for Payer: United Healthcare All Payer |
$852.72
|
|
|
US THORACENTESIS (T
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
761T2776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna Commercial |
$746.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.82
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$804.27
|
| Rate for Payer: First Health Commercial |
$920.55
|
| Rate for Payer: Humana Commercial |
$823.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$794.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$852.72
|
| Rate for Payer: Ohio Health Group HMO |
$726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.61
|
| Rate for Payer: PHCS Commercial |
$930.24
|
| Rate for Payer: United Healthcare All Payer |
$852.72
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
45000283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$46.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$47.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$46.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$46.77
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$47.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
92000002
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Ambetter Exchange |
$10.39
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$81.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.51
|
| Rate for Payer: UHCCP Medicaid |
$47.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.39
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Ambetter Exchange |
$10.39
|
| Rate for Payer: Anthem Medicaid |
$14.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.43
|
| Rate for Payer: Molina Healthcare Passport |
$14.15
|
| Rate for Payer: Multiplan PHCS |
$81.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.51
|
| Rate for Payer: UHCCP Medicaid |
$47.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.39
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40200002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
45000283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
