|
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 |
$268.30 |
| Rate for Payer: Aetna Commercial |
$244.77
|
| Rate for Payer: Ambetter Exchange |
$115.49
|
| Rate for Payer: Anthem Medicaid |
$140.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.59
|
| 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 |
$206.41
|
| Rate for Payer: Humana Medicaid |
$140.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$115.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.49
|
| 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 |
$150.14
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.49
|
|
|
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 |
$119.65 |
| Rate for Payer: Aetna Commercial |
$119.65
|
| Rate for Payer: Ambetter Exchange |
$37.66
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$37.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.66
|
| 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 |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.66
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333T0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$699.84 |
| Rate for Payer: Aetna Commercial |
$561.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$568.62
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$605.07
|
| Rate for Payer: First Health Commercial |
$692.55
|
| Rate for Payer: Humana Commercial |
$619.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$597.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$538.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$641.52
|
| Rate for Payer: Ohio Health Group HMO |
$546.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$503.01
|
| Rate for Payer: PHCS Commercial |
$699.84
|
| Rate for Payer: United Healthcare All Payer |
$641.52
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
333T0014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.22
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333T0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$699.84 |
| Rate for Payer: Aetna Commercial |
$561.33
|
| Rate for Payer: Anthem Medicaid |
$250.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$568.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$605.07
|
| Rate for Payer: First Health Commercial |
$692.55
|
| Rate for Payer: Humana Commercial |
$619.65
|
| Rate for Payer: Humana KY Medicaid |
$250.70
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$253.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$597.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$538.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$255.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$641.52
|
| Rate for Payer: Ohio Health Group HMO |
$546.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$503.01
|
| Rate for Payer: PHCS Commercial |
$699.84
|
| Rate for Payer: United Healthcare All Payer |
$641.52
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
333T0014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem Medicaid |
$150.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Humana KY Medicaid |
$150.63
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$152.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.22
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
RADIATION TREAT AID(T
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
333T0016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,196.16 |
| Rate for Payer: Aetna Commercial |
$959.42
|
| Rate for Payer: Anthem Medicaid |
$428.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$623.00
|
| Rate for Payer: Cash Price |
$623.00
|
| Rate for Payer: Cigna Commercial |
$1,034.18
|
| Rate for Payer: First Health Commercial |
$1,183.70
|
| Rate for Payer: Humana Commercial |
$1,059.10
|
| Rate for Payer: Humana KY Medicaid |
$428.50
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$432.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,021.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$919.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$437.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,096.48
|
| Rate for Payer: Ohio Health Group HMO |
$934.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.74
|
| Rate for Payer: PHCS Commercial |
$1,196.16
|
| Rate for Payer: United Healthcare All Payer |
$1,096.48
|
|
|
RADIATION TREAT AID(T
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
333T0016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,196.16 |
| Rate for Payer: Aetna Commercial |
$959.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.88
|
| Rate for Payer: Cash Price |
$623.00
|
| Rate for Payer: Cigna Commercial |
$1,034.18
|
| Rate for Payer: First Health Commercial |
$1,183.70
|
| Rate for Payer: Humana Commercial |
$1,059.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,021.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$919.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,096.48
|
| Rate for Payer: Ohio Health Group HMO |
$934.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.74
|
| Rate for Payer: PHCS Commercial |
$1,196.16
|
| Rate for Payer: United Healthcare All Payer |
$1,096.48
|
|
|
RADICAL NIGHT REPAIR 60 ML GBL
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
22200148
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
RADICAL NIGHT REPAIR 60 ML GBL
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
22200148
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$58.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$58.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
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 |
$119.00 |
| 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
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.14 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| 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 |
$1,820.02 |
| Rate for Payer: Aetna Commercial |
$1,688.43
|
| Rate for Payer: Ambetter Exchange |
$1,121.98
|
| Rate for Payer: Anthem Medicaid |
$757.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,121.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,121.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,346.38
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,121.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.98
|
| 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 |
$1,458.57
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,121.98
|
|
|
RADICAL RESECTION OF ELBOW
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
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 |
$1,820.02 |
| Rate for Payer: Aetna Commercial |
$1,688.43
|
| Rate for Payer: Ambetter Exchange |
$1,121.98
|
| Rate for Payer: Anthem Medicaid |
$757.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,121.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,121.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,346.38
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,121.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.98
|
| 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 |
$1,458.57
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,121.98
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
76100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
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 |
$2,028.41 |
| Rate for Payer: Aetna Commercial |
$1,876.42
|
| Rate for Payer: Ambetter Exchange |
$1,241.25
|
| Rate for Payer: Anthem Medicaid |
$866.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,241.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,489.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,241.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.25
|
| 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 |
$1,613.62
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$875.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,241.25
|
|
|
RADICAL RESECTION OF STERNUM
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 21630
|
| Hospital Charge Code |
76100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| 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 |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
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 |
$2,028.41 |
| Rate for Payer: Aetna Commercial |
$1,876.42
|
| Rate for Payer: Ambetter Exchange |
$1,241.25
|
| Rate for Payer: Anthem Medicaid |
$866.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,241.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,489.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,241.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.25
|
| 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 |
$1,613.62
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$875.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,241.25
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
RADICAL RESECT OF TUMOR
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,690.40 |
| Max. Negotiated Rate |
$8,609.28 |
| Rate for Payer: Aetna Commercial |
$6,905.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.04
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$7,443.44
|
| Rate for Payer: First Health Commercial |
$8,519.60
|
| Rate for Payer: Humana Commercial |
$7,622.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,353.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,891.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,802.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,187.92
|
| Rate for Payer: PHCS Commercial |
$8,609.28
|
| Rate for Payer: United Healthcare All Payer |
$7,891.84
|
|
|
RADICAL RESECT OF TUMOR
|
Facility
|
OP
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$8,609.28 |
| Rate for Payer: Aetna Commercial |
$6,905.36
|
| Rate for Payer: Anthem Medicaid |
$3,084.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$7,443.44
|
| Rate for Payer: First Health Commercial |
$8,519.60
|
| Rate for Payer: Humana Commercial |
$7,622.80
|
| Rate for Payer: Humana KY Medicaid |
$3,084.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,353.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,145.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,891.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,802.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,187.92
|
| Rate for Payer: PHCS Commercial |
$8,609.28
|
| Rate for Payer: United Healthcare All Payer |
$7,891.84
|
|
|
RADICAL RESECT OF TUMOR
|
Professional
|
Both
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$5,380.80 |
| Rate for Payer: Aetna Commercial |
$616.59
|
| Rate for Payer: Ambetter Exchange |
$662.00
|
| Rate for Payer: Anthem Medicaid |
$341.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$662.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$662.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$794.40
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$682.89
|
| Rate for Payer: Healthspan PPO |
$558.50
|
| Rate for Payer: Humana Medicaid |
$341.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$662.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.77
|
| Rate for Payer: Molina Healthcare Passport |
$341.93
|
| Rate for Payer: Multiplan PHCS |
$5,380.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$860.60
|
| Rate for Payer: UHCCP Medicaid |
$3,138.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$662.00
|
|
|
RADICAL RESECT OF TUMOR(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761P0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$860.60 |
| Rate for Payer: Aetna Commercial |
$616.59
|
| Rate for Payer: Ambetter Exchange |
$662.00
|
| Rate for Payer: Anthem Medicaid |
$341.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$662.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$662.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$794.40
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$682.89
|
| Rate for Payer: Healthspan PPO |
$558.50
|
| Rate for Payer: Humana Medicaid |
$341.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$662.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.77
|
| Rate for Payer: Molina Healthcare Passport |
$341.93
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$860.60
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$662.00
|
|
|
RADICAL RESECT OF TUMOR(T
|
Facility
|
OP
|
$7,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761T0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,649.28 |
| Rate for Payer: Aetna Commercial |
$6,135.36
|
| Rate for Payer: Anthem Medicaid |
$2,740.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,215.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$6,613.44
|
| Rate for Payer: First Health Commercial |
$7,569.60
|
| Rate for Payer: Humana Commercial |
$6,772.80
|
| Rate for Payer: Humana KY Medicaid |
$2,740.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,768.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,533.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,880.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,795.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,011.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,932.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,497.92
|
| Rate for Payer: PHCS Commercial |
$7,649.28
|
| Rate for Payer: United Healthcare All Payer |
$7,011.84
|
|
