|
HC NURSING FACILITY CARE SUBSQ
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000302
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Ambetter Exchange |
$69.48
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.38
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.32
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.48
|
|
|
HCTZ 12.5 MG CAP
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 60687068301
|
| Hospital Charge Code |
25000756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
HCTZ 12.5 MG CAP
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 60687068301
|
| Hospital Charge Code |
25000756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
HCU CRITICAL CARE ROOM RATE
|
Facility
|
IP
|
$3,658.00
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
HCU RECOVERY CARE
|
Facility
|
IP
|
$2,089.00
|
|
| Hospital Charge Code |
71000004
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$626.70 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,817.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.41
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
HCU RECOVERY CARE
|
Facility
|
OP
|
$2,089.00
|
|
| Hospital Charge Code |
71000004
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$626.70 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem Medicaid |
$718.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Humana KY Medicaid |
$718.41
|
| Rate for Payer: Kentucky WC Medicaid |
$725.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,817.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.41
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
HCU ROOM RATE
|
Facility
|
IP
|
$3,658.00
|
|
| Hospital Charge Code |
21000001
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
HCV RNA DETECT/QUANT S
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
30001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
HCV RNA DETECT/QUANT S
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
30001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
HDL CHOLESTEROL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
30000445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.19
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.19
|
| Rate for Payer: Humana Medicare Advantage |
$8.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HDL CHOLESTEROL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
30000445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Professional
|
Both
|
$4,193.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$2,515.80 |
| Rate for Payer: Ambetter Exchange |
$224.94
|
| Rate for Payer: Anthem Medicaid |
$167.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$224.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$224.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$269.93
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cigna Commercial |
$353.41
|
| Rate for Payer: Humana Medicaid |
$167.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$224.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.19
|
| Rate for Payer: Molina Healthcare Passport |
$167.83
|
| Rate for Payer: Multiplan PHCS |
$2,515.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$292.42
|
| Rate for Payer: UHCCP Medicaid |
$1,467.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$224.94
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Facility
|
IP
|
$4,193.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,257.90 |
| Max. Negotiated Rate |
$4,025.28 |
| Rate for Payer: Aetna Commercial |
$3,228.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,270.54
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cigna Commercial |
$3,480.19
|
| Rate for Payer: First Health Commercial |
$3,983.35
|
| Rate for Payer: Humana Commercial |
$3,564.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,689.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,647.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.17
|
| Rate for Payer: PHCS Commercial |
$4,025.28
|
| Rate for Payer: United Healthcare All Payer |
$3,689.84
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Facility
|
OP
|
$4,193.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$4,025.28 |
| Rate for Payer: Aetna Commercial |
$3,228.61
|
| Rate for Payer: Anthem Medicaid |
$1,441.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$242.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,270.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$340.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.04
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cigna Commercial |
$3,480.19
|
| Rate for Payer: First Health Commercial |
$3,983.35
|
| Rate for Payer: Humana Commercial |
$3,564.05
|
| Rate for Payer: Humana KY Medicaid |
$1,441.97
|
| Rate for Payer: Humana Medicare Advantage |
$242.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,689.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,647.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.17
|
| Rate for Payer: PHCS Commercial |
$4,025.28
|
| Rate for Payer: United Healthcare All Payer |
$3,689.84
|
|
|
HDR RDNCL SKN SURF BRACHYTX(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333P0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$353.41 |
| Rate for Payer: Ambetter Exchange |
$224.94
|
| Rate for Payer: Anthem Medicaid |
$167.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$224.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$224.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$269.93
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$353.41
|
| Rate for Payer: Humana Medicaid |
$167.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$224.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.19
|
| Rate for Payer: Molina Healthcare Passport |
$167.83
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$292.42
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$224.94
|
|
|
HDR RDNCL SKN SURF BRACHYTX(T
|
Facility
|
OP
|
$3,933.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333T0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$3,775.68 |
| Rate for Payer: Aetna Commercial |
$3,028.41
|
| Rate for Payer: Anthem Medicaid |
$1,352.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$242.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$340.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.04
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cigna Commercial |
$3,264.39
|
| Rate for Payer: First Health Commercial |
$3,736.35
|
| Rate for Payer: Humana Commercial |
$3,343.05
|
| Rate for Payer: Humana KY Medicaid |
$1,352.56
|
| Rate for Payer: Humana Medicare Advantage |
$242.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,461.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,421.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.77
|
| Rate for Payer: PHCS Commercial |
$3,775.68
|
| Rate for Payer: United Healthcare All Payer |
$3,461.04
|
|
|
HDR RDNCL SKN SURF BRACHYTX(T
|
Facility
|
IP
|
$3,933.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333T0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,179.90 |
| Max. Negotiated Rate |
$3,775.68 |
| Rate for Payer: Aetna Commercial |
$3,028.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.74
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cigna Commercial |
$3,264.39
|
| Rate for Payer: First Health Commercial |
$3,736.35
|
| Rate for Payer: Humana Commercial |
$3,343.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,461.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,421.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.77
|
| Rate for Payer: PHCS Commercial |
$3,775.68
|
| Rate for Payer: United Healthcare All Payer |
$3,461.04
|
|
|
HEAD ALUMINA 28MM +0
|
Facility
|
OP
|
$7,175.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.68 |
| Max. Negotiated Rate |
$6,888.58 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Anthem Medicaid |
$2,467.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,596.97
|
| Rate for Payer: Cash Price |
$3,587.80
|
| Rate for Payer: Cigna Commercial |
$5,955.75
|
| Rate for Payer: First Health Commercial |
$6,816.82
|
| Rate for Payer: Humana Commercial |
$6,099.26
|
| Rate for Payer: Humana KY Medicaid |
$2,467.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,492.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,883.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,295.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,517.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,314.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,381.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,740.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,242.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.16
|
| Rate for Payer: PHCS Commercial |
$6,888.58
|
| Rate for Payer: United Healthcare All Payer |
$6,314.53
|
|
|
HEAD ALUMINA 28MM +0
|
Facility
|
IP
|
$7,175.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.68 |
| Max. Negotiated Rate |
$6,888.58 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,596.97
|
| Rate for Payer: Cash Price |
$3,587.80
|
| Rate for Payer: Cigna Commercial |
$5,955.75
|
| Rate for Payer: First Health Commercial |
$6,816.82
|
| Rate for Payer: Humana Commercial |
$6,099.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,883.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,295.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,314.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,381.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,740.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,242.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.16
|
| Rate for Payer: PHCS Commercial |
$6,888.58
|
| Rate for Payer: United Healthcare All Payer |
$6,314.53
|
|
|
HEAD ALUMINA 36MM +0
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
HEAD ALUMINA 36MM +0
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
HEAD ALUMINA 36MM +5
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
HEAD ALUMINA 36MM +5
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
HEAD ALUMINA 36MM -5
|
Facility
|
IP
|
$8,778.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.60 |
| Max. Negotiated Rate |
$8,427.53 |
| Rate for Payer: Aetna Commercial |
$6,759.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.37
|
| Rate for Payer: Cash Price |
$4,389.34
|
| Rate for Payer: Cigna Commercial |
$7,286.30
|
| Rate for Payer: First Health Commercial |
$8,339.75
|
| Rate for Payer: Humana Commercial |
$7,461.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,022.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,637.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,057.29
|
| Rate for Payer: PHCS Commercial |
$8,427.53
|
| Rate for Payer: United Healthcare All Payer |
$7,725.24
|
|
|
HEAD ALUMINA 36MM -5
|
Facility
|
OP
|
$8,778.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.60 |
| Max. Negotiated Rate |
$8,427.53 |
| Rate for Payer: Aetna Commercial |
$6,759.58
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.37
|
| Rate for Payer: Cash Price |
$4,389.34
|
| Rate for Payer: Cigna Commercial |
$7,286.30
|
| Rate for Payer: First Health Commercial |
$8,339.75
|
| Rate for Payer: Humana Commercial |
$7,461.88
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,022.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,637.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,057.29
|
| Rate for Payer: PHCS Commercial |
$8,427.53
|
| Rate for Payer: United Healthcare All Payer |
$7,725.24
|
|
