|
IMPLNT OS SEG DIST-FEM 8.5CM L
|
Facility
|
OP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem Medicaid |
$24,316.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Humana KY Medicaid |
$24,316.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,564.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM R
|
Facility
|
OP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem Medicaid |
$26,846.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Humana KY Medicaid |
$26,846.21
|
| Rate for Payer: Kentucky WC Medicaid |
$27,119.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,384.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM R
|
Facility
|
IP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
IMPLNT OSS RESURF ANT FLNG 3CM
|
Facility
|
IP
|
$8,155.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,446.58 |
| Max. Negotiated Rate |
$7,829.05 |
| Rate for Payer: Aetna Commercial |
$6,279.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,361.10
|
| Rate for Payer: Cash Price |
$4,077.63
|
| Rate for Payer: Cigna Commercial |
$6,768.87
|
| Rate for Payer: First Health Commercial |
$7,747.50
|
| Rate for Payer: Humana Commercial |
$6,931.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,687.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,116.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,524.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,095.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,627.13
|
| Rate for Payer: PHCS Commercial |
$7,829.05
|
| Rate for Payer: United Healthcare All Payer |
$7,176.63
|
|
|
IMPLNT OSS RESURF ANT FLNG 3CM
|
Facility
|
OP
|
$8,155.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,446.58 |
| Max. Negotiated Rate |
$7,829.05 |
| Rate for Payer: Aetna Commercial |
$6,279.55
|
| Rate for Payer: Anthem Medicaid |
$2,804.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,361.10
|
| Rate for Payer: Cash Price |
$4,077.63
|
| Rate for Payer: Cigna Commercial |
$6,768.87
|
| Rate for Payer: First Health Commercial |
$7,747.50
|
| Rate for Payer: Humana Commercial |
$6,931.97
|
| Rate for Payer: Humana KY Medicaid |
$2,804.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,833.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,687.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,116.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,524.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,095.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,627.13
|
| Rate for Payer: PHCS Commercial |
$7,829.05
|
| Rate for Payer: United Healthcare All Payer |
$7,176.63
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 L
|
Facility
|
IP
|
$78,985.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,695.54 |
| Max. Negotiated Rate |
$75,825.72 |
| Rate for Payer: Aetna Commercial |
$60,818.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,608.39
|
| Rate for Payer: Cash Price |
$39,492.56
|
| Rate for Payer: Cigna Commercial |
$65,557.65
|
| Rate for Payer: First Health Commercial |
$75,035.86
|
| Rate for Payer: Humana Commercial |
$67,137.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,767.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,291.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,695.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,506.91
|
| Rate for Payer: Ohio Health Group HMO |
$59,238.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,188.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,717.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,499.73
|
| Rate for Payer: PHCS Commercial |
$75,825.72
|
| Rate for Payer: United Healthcare All Payer |
$69,506.91
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 L
|
Facility
|
OP
|
$78,985.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,695.54 |
| Max. Negotiated Rate |
$75,825.72 |
| Rate for Payer: Aetna Commercial |
$60,818.54
|
| Rate for Payer: Anthem Medicaid |
$27,162.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,608.39
|
| Rate for Payer: Cash Price |
$39,492.56
|
| Rate for Payer: Cigna Commercial |
$65,557.65
|
| Rate for Payer: First Health Commercial |
$75,035.86
|
| Rate for Payer: Humana Commercial |
$67,137.35
|
| Rate for Payer: Humana KY Medicaid |
$27,162.98
|
| Rate for Payer: Kentucky WC Medicaid |
$27,439.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,767.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,291.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,695.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,707.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,506.91
|
| Rate for Payer: Ohio Health Group HMO |
$59,238.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,188.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,717.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,499.73
|
| Rate for Payer: PHCS Commercial |
$75,825.72
|
| Rate for Payer: United Healthcare All Payer |
$69,506.91
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 R
|
Facility
|
OP
|
$78,985.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,695.54 |
| Max. Negotiated Rate |
$75,825.72 |
| Rate for Payer: Aetna Commercial |
$60,818.54
|
| Rate for Payer: Anthem Medicaid |
$27,162.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,608.39
|
| Rate for Payer: Cash Price |
$39,492.56
|
| Rate for Payer: Cigna Commercial |
$65,557.65
|
| Rate for Payer: First Health Commercial |
$75,035.86
|
| Rate for Payer: Humana Commercial |
$67,137.35
|
| Rate for Payer: Humana KY Medicaid |
$27,162.98
|
| Rate for Payer: Kentucky WC Medicaid |
$27,439.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,767.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,291.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,695.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,707.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,506.91
|
| Rate for Payer: Ohio Health Group HMO |
$59,238.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,188.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,717.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,499.73
|
| Rate for Payer: PHCS Commercial |
$75,825.72
|
| Rate for Payer: United Healthcare All Payer |
$69,506.91
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 R
|
Facility
|
IP
|
$78,985.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,695.54 |
| Max. Negotiated Rate |
$75,825.72 |
| Rate for Payer: Aetna Commercial |
$60,818.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,608.39
|
| Rate for Payer: Cash Price |
$39,492.56
|
| Rate for Payer: Cigna Commercial |
$65,557.65
|
| Rate for Payer: First Health Commercial |
$75,035.86
|
| Rate for Payer: Humana Commercial |
$67,137.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,767.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,291.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,695.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,506.91
|
| Rate for Payer: Ohio Health Group HMO |
$59,238.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,188.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,717.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,499.73
|
| Rate for Payer: PHCS Commercial |
$75,825.72
|
| Rate for Payer: United Healthcare All Payer |
$69,506.91
|
|
|
IMPLSYS 2NDRY FIXATN BIOSWVLK
|
Facility
|
IP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
IMPLSYS 2NDRY FIXATN BIOSWVLK
|
Facility
|
OP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem Medicaid |
$1,669.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Humana KY Medicaid |
$1,669.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
IMRT COMPLEX DELIVERY
|
Facility
|
OP
|
$1,746.00
|
|
|
Service Code
|
HCPCS 77386
|
| Hospital Charge Code |
33300022
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$1,676.16 |
| Rate for Payer: Aetna Commercial |
$1,344.42
|
| Rate for Payer: Anthem Medicaid |
$600.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna Commercial |
$1,449.18
|
| Rate for Payer: First Health Commercial |
$1,658.70
|
| Rate for Payer: Humana Commercial |
$1,484.10
|
| Rate for Payer: Humana KY Medicaid |
$600.45
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$606.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,519.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.74
|
| Rate for Payer: PHCS Commercial |
$1,676.16
|
| Rate for Payer: United Healthcare All Payer |
$1,536.48
|
|
|
IMRT COMPLEX DELIVERY
|
Facility
|
IP
|
$1,746.00
|
|
|
Service Code
|
HCPCS 77386
|
| Hospital Charge Code |
33300022
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$523.80 |
| Max. Negotiated Rate |
$1,676.16 |
| Rate for Payer: Aetna Commercial |
$1,344.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.88
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna Commercial |
$1,449.18
|
| Rate for Payer: First Health Commercial |
$1,658.70
|
| Rate for Payer: Humana Commercial |
$1,484.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,519.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.74
|
| Rate for Payer: PHCS Commercial |
$1,676.16
|
| Rate for Payer: United Healthcare All Payer |
$1,536.48
|
|
|
IMRT PLAN
|
Facility
|
OP
|
$6,966.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,264.24 |
| Max. Negotiated Rate |
$6,687.36 |
| Rate for Payer: Aetna Commercial |
$5,363.82
|
| Rate for Payer: Anthem Medicaid |
$2,395.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,264.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,433.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,769.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,706.72
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cigna Commercial |
$5,781.78
|
| Rate for Payer: First Health Commercial |
$6,617.70
|
| Rate for Payer: Humana Commercial |
$5,921.10
|
| Rate for Payer: Humana KY Medicaid |
$2,395.61
|
| Rate for Payer: Humana Medicare Advantage |
$1,264.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,419.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,712.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,140.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,443.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,130.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,224.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,060.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,806.54
|
| Rate for Payer: PHCS Commercial |
$6,687.36
|
| Rate for Payer: United Healthcare All Payer |
$6,130.08
|
|
|
IMRT PLAN
|
Facility
|
IP
|
$6,966.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,089.80 |
| Max. Negotiated Rate |
$6,687.36 |
| Rate for Payer: Aetna Commercial |
$5,363.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,433.48
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cigna Commercial |
$5,781.78
|
| Rate for Payer: First Health Commercial |
$6,617.70
|
| Rate for Payer: Humana Commercial |
$5,921.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,712.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,140.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,089.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,130.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,224.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,060.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,806.54
|
| Rate for Payer: PHCS Commercial |
$6,687.36
|
| Rate for Payer: United Healthcare All Payer |
$6,130.08
|
|
|
IMRT PLAN
|
Professional
|
Both
|
$6,966.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$4,179.60 |
| Rate for Payer: Aetna Commercial |
$3,267.35
|
| Rate for Payer: Ambetter Exchange |
$1,663.58
|
| Rate for Payer: Anthem Medicaid |
$1,032.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,663.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,663.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.30
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cash Price |
$3,483.00
|
| Rate for Payer: Cigna Commercial |
$2,585.13
|
| Rate for Payer: Healthspan PPO |
$2,755.42
|
| Rate for Payer: Humana Medicaid |
$1,032.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,032.62
|
| Rate for Payer: Multiplan PHCS |
$4,179.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,162.65
|
| Rate for Payer: UHCCP Medicaid |
$2,438.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,042.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,663.58
|
|
|
IMRT PLAN(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
333P0007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$3,267.35 |
| Rate for Payer: Aetna Commercial |
$3,267.35
|
| Rate for Payer: Ambetter Exchange |
$1,663.58
|
| Rate for Payer: Anthem Medicaid |
$1,032.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,663.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,663.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$2,585.13
|
| Rate for Payer: Healthspan PPO |
$2,755.42
|
| Rate for Payer: Humana Medicaid |
$1,032.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,032.62
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,162.65
|
| Rate for Payer: UHCCP Medicaid |
$257.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,042.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,663.58
|
|
|
IMRT PLAN(T
|
Facility
|
IP
|
$6,231.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
333T0007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,869.30 |
| Max. Negotiated Rate |
$5,981.76 |
| Rate for Payer: Aetna Commercial |
$4,797.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,860.18
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$5,171.73
|
| Rate for Payer: First Health Commercial |
$5,919.45
|
| Rate for Payer: Humana Commercial |
$5,296.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,109.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,598.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,869.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,483.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,420.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,299.39
|
| Rate for Payer: PHCS Commercial |
$5,981.76
|
| Rate for Payer: United Healthcare All Payer |
$5,483.28
|
|
|
IMRT PLAN(T
|
Facility
|
OP
|
$6,231.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
333T0007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,264.24 |
| Max. Negotiated Rate |
$5,981.76 |
| Rate for Payer: Aetna Commercial |
$4,797.87
|
| Rate for Payer: Anthem Medicaid |
$2,142.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,264.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,860.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,769.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,706.72
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$5,171.73
|
| Rate for Payer: First Health Commercial |
$5,919.45
|
| Rate for Payer: Humana Commercial |
$5,296.35
|
| Rate for Payer: Humana KY Medicaid |
$2,142.84
|
| Rate for Payer: Humana Medicare Advantage |
$1,264.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,164.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,109.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,598.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,185.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,483.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,420.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,299.39
|
| Rate for Payer: PHCS Commercial |
$5,981.76
|
| Rate for Payer: United Healthcare All Payer |
$5,483.28
|
|
|
IMRT SIMPLE DELIVERY
|
Facility
|
OP
|
$1,653.00
|
|
|
Service Code
|
HCPCS 77385
|
| Hospital Charge Code |
33300021
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$1,586.88 |
| Rate for Payer: Aetna Commercial |
$1,272.81
|
| Rate for Payer: Anthem Medicaid |
$568.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,289.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$826.50
|
| Rate for Payer: Cash Price |
$826.50
|
| Rate for Payer: Cigna Commercial |
$1,371.99
|
| Rate for Payer: First Health Commercial |
$1,570.35
|
| Rate for Payer: Humana Commercial |
$1,405.05
|
| Rate for Payer: Humana KY Medicaid |
$568.47
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,355.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,219.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$579.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,454.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,438.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.57
|
| Rate for Payer: PHCS Commercial |
$1,586.88
|
| Rate for Payer: United Healthcare All Payer |
$1,454.64
|
|
|
IMRT SIMPLE DELIVERY
|
Facility
|
IP
|
$1,653.00
|
|
|
Service Code
|
HCPCS 77385
|
| Hospital Charge Code |
33300021
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$495.90 |
| Max. Negotiated Rate |
$1,586.88 |
| Rate for Payer: Aetna Commercial |
$1,272.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,289.34
|
| Rate for Payer: Cash Price |
$826.50
|
| Rate for Payer: Cigna Commercial |
$1,371.99
|
| Rate for Payer: First Health Commercial |
$1,570.35
|
| Rate for Payer: Humana Commercial |
$1,405.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,355.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,219.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,454.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,438.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.57
|
| Rate for Payer: PHCS Commercial |
$1,586.88
|
| Rate for Payer: United Healthcare All Payer |
$1,454.64
|
|
|
IM/SQ INJECTION
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
26000008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
IM/SQ INJECTION
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
26000008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna Commercial |
$31.94
|
| Rate for Payer: Ambetter Exchange |
$13.20
|
| Rate for Payer: Anthem Medicaid |
$18.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.84
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$28.79
|
| Rate for Payer: Healthspan PPO |
$29.93
|
| Rate for Payer: Humana Medicaid |
$18.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.46
|
| Rate for Payer: Molina Healthcare Passport |
$18.10
|
| Rate for Payer: Multiplan PHCS |
$52.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.16
|
| Rate for Payer: UHCCP Medicaid |
$30.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.20
|
|
|
IM/SQ INJECTION
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
26000008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
IM/SQ INJECTION(T
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
260T0008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
