|
RADIATION TREAT AID
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Aetna Commercial |
$1,131.90
|
| Rate for Payer: Anthem Medicaid |
$505.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,146.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,220.10
|
| Rate for Payer: First Health Commercial |
$1,396.50
|
| Rate for Payer: Humana Commercial |
$1,249.50
|
| Rate for Payer: Humana KY Medicaid |
$505.53
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$510.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,205.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$515.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,293.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,102.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.70
|
| Rate for Payer: PHCS Commercial |
$1,411.20
|
| Rate for Payer: United Healthcare All Payer |
$1,293.60
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$244.77
|
| Rate for Payer: Anthem Medicaid |
$140.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,470.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$268.30
|
| Rate for Payer: Healthspan PPO |
$206.42
|
| Rate for Payer: Humana Medicaid |
$140.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.39
|
| Rate for Payer: Molina Healthcare Passport |
$140.58
|
| Rate for Payer: Multiplan PHCS |
$882.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,029.00
|
| Rate for Payer: UHCCP Medicaid |
$514.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.99
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$109.48
|
| Rate for Payer: Anthem Medicaid |
$87.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$858.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$92.33
|
| Rate for Payer: Humana Medicaid |
$87.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.52
|
| Rate for Payer: Molina Healthcare Passport |
$87.76
|
| Rate for Payer: Multiplan PHCS |
$514.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$600.60
|
| Rate for Payer: UHCCP Medicaid |
$300.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.64
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Aetna Commercial |
$1,131.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,146.60
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,220.10
|
| Rate for Payer: First Health Commercial |
$1,396.50
|
| Rate for Payer: Humana Commercial |
$1,249.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,205.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,293.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,102.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.70
|
| Rate for Payer: PHCS Commercial |
$1,411.20
|
| Rate for Payer: United Healthcare All Payer |
$1,293.60
|
|
|
RADIATION TREAT AID(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
333P0014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$119.65
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$118.98
|
| Rate for Payer: Healthspan PPO |
$100.90
|
| Rate for Payer: Humana Medicaid |
$59.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.00
|
| Rate for Payer: Molina Healthcare Passport |
$59.80
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
|
|
RADIATION TREAT AID(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
333P0016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$244.77
|
| Rate for Payer: Anthem Medicaid |
$140.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$268.30
|
| Rate for Payer: Healthspan PPO |
$206.42
|
| Rate for Payer: Humana Medicaid |
$140.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.39
|
| Rate for Payer: Molina Healthcare Passport |
$140.58
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.99
|
|
|
RADIATION TREAT AID(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333P0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$109.48
|
| Rate for Payer: Anthem Medicaid |
$87.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$92.33
|
| Rate for Payer: Humana Medicaid |
$87.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.52
|
| Rate for Payer: Molina Healthcare Passport |
$87.76
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.64
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
333T0016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333T0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$92.04 |
| Max. Negotiated Rate |
$679.68 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Anthem Medicaid |
$243.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$552.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$587.64
|
| Rate for Payer: First Health Commercial |
$672.60
|
| Rate for Payer: Humana Commercial |
$601.80
|
| Rate for Payer: Humana KY Medicaid |
$243.48
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$245.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$580.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$522.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$248.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$623.04
|
| Rate for Payer: Ohio Health Group HMO |
$531.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$219.48
|
| Rate for Payer: PHCS Commercial |
$679.68
|
| Rate for Payer: United Healthcare All Payer |
$623.04
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
333T0016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
333T0014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$317.24
|
| Rate for Payer: Anthem Medicaid |
$141.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$341.96
|
| Rate for Payer: First Health Commercial |
$391.40
|
| Rate for Payer: Humana Commercial |
$350.20
|
| Rate for Payer: Humana KY Medicaid |
$141.69
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$143.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
| Rate for Payer: Ohio Health Group HMO |
$309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.72
|
| Rate for Payer: PHCS Commercial |
$395.52
|
| Rate for Payer: United Healthcare All Payer |
$362.56
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333T0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$92.04 |
| Max. Negotiated Rate |
$679.68 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$552.24
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$587.64
|
| Rate for Payer: First Health Commercial |
$672.60
|
| Rate for Payer: Humana Commercial |
$601.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$580.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$522.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$623.04
|
| Rate for Payer: Ohio Health Group HMO |
$531.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$219.48
|
| Rate for Payer: PHCS Commercial |
$679.68
|
| Rate for Payer: United Healthcare All Payer |
$623.04
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
333T0014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$395.52 |
| Rate for Payer: Aetna Commercial |
$317.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.36
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$341.96
|
| Rate for Payer: First Health Commercial |
$391.40
|
| Rate for Payer: Humana Commercial |
$350.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$362.56
|
| Rate for Payer: Ohio Health Group HMO |
$309.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.72
|
| Rate for Payer: PHCS Commercial |
$395.52
|
| Rate for Payer: United Healthcare All Payer |
$362.56
|
|
|
RADICAL NIGHT REPAIR 60 ML GBL
|
Professional
|
Both
|
$170.00
|
|
| Hospital Charge Code |
22200148
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Multiplan PHCS |
$102.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.00
|
| Rate for Payer: UHCCP Medicaid |
$59.50
|
|
|
RADICAL RESECTION OF ELBOW
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
RADICAL RESECTION OF ELBOW
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
RADICAL RESECTION OF ELBOW
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.93 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,688.43
|
| Rate for Payer: Anthem Medicaid |
$757.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,820.02
|
| Rate for Payer: Healthspan PPO |
$1,529.36
|
| Rate for Payer: Humana Medicaid |
$757.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,447.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.09
|
| Rate for Payer: Molina Healthcare Passport |
$757.93
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.51
|
|
|
RADICAL RESECTION OF ELBOW(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
761P0512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.93 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,688.43
|
| Rate for Payer: Anthem Medicaid |
$757.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,820.02
|
| Rate for Payer: Healthspan PPO |
$1,529.36
|
| Rate for Payer: Humana Medicaid |
$757.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,447.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.09
|
| Rate for Payer: Molina Healthcare Passport |
$757.93
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.51
|
|
|
RADICAL RESECTION OF STERNUM
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 21632
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.16 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,861.56
|
| Rate for Payer: Anthem Medicaid |
$851.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$2,010.57
|
| Rate for Payer: Healthspan PPO |
$1,686.18
|
| Rate for Payer: Humana Medicaid |
$851.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,607.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.18
|
| Rate for Payer: Molina Healthcare Passport |
$851.16
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$859.67
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
76100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
76100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 21632
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
RADICAL RESECTION OF STERNUM
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
76100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.80 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,876.42
|
| Rate for Payer: Anthem Medicaid |
$866.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,028.41
|
| Rate for Payer: Healthspan PPO |
$1,699.63
|
| Rate for Payer: Humana Medicaid |
$866.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$884.14
|
| Rate for Payer: Molina Healthcare Passport |
$866.80
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$875.47
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 21632
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
RADICAL RESECTION OF STERNUM(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
761P0403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.80 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$1,876.42
|
| Rate for Payer: Anthem Medicaid |
$866.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,028.41
|
| Rate for Payer: Healthspan PPO |
$1,699.63
|
| Rate for Payer: Humana Medicaid |
$866.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$884.14
|
| Rate for Payer: Molina Healthcare Passport |
$866.80
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$875.47
|
|
