|
REQUIP (ROPINIROLE) 0.25MG TAB
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
25001307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
REQUIP (ROPINIROLE) 0.25MG TAB
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
25001307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
REQUIP (ROPINIROLE) 0.5MG TAB
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 50268074215
|
| Hospital Charge Code |
25001308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
REQUIP (ROPINIROLE) 0.5MG TAB
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 50268074215
|
| Hospital Charge Code |
25001308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
REQUIP(ROPINIROLE)1MG TAB
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
25001315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
REQUIP(ROPINIROLE)1MG TAB
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
25001315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
REQUIP(ROPINIROLE)2MG TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68462025601
|
| Hospital Charge Code |
25001316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
REQUIP(ROPINIROLE)2MG TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68462025601
|
| Hospital Charge Code |
25001316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
REREMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
REREMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.63 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
REREMOVE WRIST TENDON LESION
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$636.47 |
| Rate for Payer: Aetna Commercial |
$548.65
|
| Rate for Payer: Ambetter Exchange |
$375.54
|
| Rate for Payer: Anthem Medicaid |
$244.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$450.65
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$636.47
|
| Rate for Payer: Healthspan PPO |
$496.96
|
| Rate for Payer: Humana Medicaid |
$244.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$471.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$375.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.23
|
| Rate for Payer: Molina Healthcare Passport |
$244.34
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.20
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.54
|
|
|
REREMOVE WRIST TENDON LESIO(P
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
761P0583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$636.47 |
| Rate for Payer: Aetna Commercial |
$548.65
|
| Rate for Payer: Ambetter Exchange |
$375.54
|
| Rate for Payer: Anthem Medicaid |
$244.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$450.65
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$636.47
|
| Rate for Payer: Healthspan PPO |
$496.96
|
| Rate for Payer: Humana Medicaid |
$244.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$471.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$375.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.23
|
| Rate for Payer: Molina Healthcare Passport |
$244.34
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.20
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.54
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
OP
|
$8,319.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,986.24 |
| Rate for Payer: Aetna Commercial |
$6,405.63
|
| Rate for Payer: Anthem Medicaid |
$2,860.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.82
|
| 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 |
$4,159.50
|
| Rate for Payer: Cash Price |
$4,159.50
|
| Rate for Payer: Cigna Commercial |
$6,904.77
|
| Rate for Payer: First Health Commercial |
$7,903.05
|
| Rate for Payer: Humana Commercial |
$7,071.15
|
| Rate for Payer: Humana KY Medicaid |
$2,860.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,821.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,139.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,918.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,320.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,237.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,740.11
|
| Rate for Payer: PHCS Commercial |
$7,986.24
|
| Rate for Payer: United Healthcare All Payer |
$7,320.72
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Professional
|
Both
|
$8,319.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.09 |
| Max. Negotiated Rate |
$4,991.40 |
| Rate for Payer: Aetna Commercial |
$1,196.76
|
| Rate for Payer: Ambetter Exchange |
$976.26
|
| Rate for Payer: Anthem Medicaid |
$636.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$976.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$976.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,171.51
|
| Rate for Payer: Cash Price |
$4,159.50
|
| Rate for Payer: Cash Price |
$4,159.50
|
| Rate for Payer: Cigna Commercial |
$1,299.55
|
| Rate for Payer: Healthspan PPO |
$1,084.01
|
| Rate for Payer: Humana Medicaid |
$636.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,258.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$976.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$648.81
|
| Rate for Payer: Molina Healthcare Passport |
$636.09
|
| Rate for Payer: Multiplan PHCS |
$4,991.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,269.14
|
| Rate for Payer: UHCCP Medicaid |
$2,911.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$976.26
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
IP
|
$8,319.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,495.70 |
| Max. Negotiated Rate |
$7,986.24 |
| Rate for Payer: Aetna Commercial |
$6,405.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.82
|
| Rate for Payer: Cash Price |
$4,159.50
|
| Rate for Payer: Cigna Commercial |
$6,904.77
|
| Rate for Payer: First Health Commercial |
$7,903.05
|
| Rate for Payer: Humana Commercial |
$7,071.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,821.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,139.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,320.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,237.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,740.11
|
| Rate for Payer: PHCS Commercial |
$7,986.24
|
| Rate for Payer: United Healthcare All Payer |
$7,320.72
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,277.30 |
| Rate for Payer: Aetna Commercial |
$2,007.19
|
| Rate for Payer: Ambetter Exchange |
$1,262.81
|
| Rate for Payer: Anthem Medicaid |
$940.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,262.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,262.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,515.37
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$2,277.30
|
| Rate for Payer: Healthspan PPO |
$1,431.90
|
| Rate for Payer: Humana Medicaid |
$940.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,640.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,262.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,262.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$959.01
|
| Rate for Payer: Molina Healthcare Passport |
$940.21
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,641.65
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$949.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,262.81
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(P
|
Professional
|
Both
|
$2,785.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761P0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.09 |
| Max. Negotiated Rate |
$1,671.00 |
| Rate for Payer: Aetna Commercial |
$1,196.76
|
| Rate for Payer: Ambetter Exchange |
$976.26
|
| Rate for Payer: Anthem Medicaid |
$636.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$976.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$976.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,171.51
|
| Rate for Payer: Cash Price |
$1,392.50
|
| Rate for Payer: Cash Price |
$1,392.50
|
| Rate for Payer: Cigna Commercial |
$1,299.55
|
| Rate for Payer: Healthspan PPO |
$1,084.01
|
| Rate for Payer: Humana Medicaid |
$636.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,258.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$976.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$648.81
|
| Rate for Payer: Molina Healthcare Passport |
$636.09
|
| Rate for Payer: Multiplan PHCS |
$1,671.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,269.14
|
| Rate for Payer: UHCCP Medicaid |
$974.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$976.26
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
761P0505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,277.30 |
| Rate for Payer: Aetna Commercial |
$2,007.19
|
| Rate for Payer: Ambetter Exchange |
$1,262.81
|
| Rate for Payer: Anthem Medicaid |
$940.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,262.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,262.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,515.37
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$2,277.30
|
| Rate for Payer: Healthspan PPO |
$1,431.90
|
| Rate for Payer: Humana Medicaid |
$940.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,640.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,262.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,262.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$959.01
|
| Rate for Payer: Molina Healthcare Passport |
$940.21
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,641.65
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$949.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,262.81
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(T
|
Facility
|
OP
|
$5,534.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761T0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,903.14 |
| Max. Negotiated Rate |
$5,312.64 |
| Rate for Payer: Aetna Commercial |
$4,261.18
|
| Rate for Payer: Anthem Medicaid |
$1,903.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,316.52
|
| 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 |
$2,767.00
|
| Rate for Payer: Cash Price |
$2,767.00
|
| Rate for Payer: Cigna Commercial |
$4,593.22
|
| Rate for Payer: First Health Commercial |
$5,257.30
|
| Rate for Payer: Humana Commercial |
$4,703.90
|
| Rate for Payer: Humana KY Medicaid |
$1,903.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,922.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,537.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,869.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,150.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,814.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,818.46
|
| Rate for Payer: PHCS Commercial |
$5,312.64
|
| Rate for Payer: United Healthcare All Payer |
$4,869.92
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(T
|
Facility
|
IP
|
$5,534.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761T0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,660.20 |
| Max. Negotiated Rate |
$5,312.64 |
| Rate for Payer: Aetna Commercial |
$4,261.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,316.52
|
| Rate for Payer: Cash Price |
$2,767.00
|
| Rate for Payer: Cigna Commercial |
$4,593.22
|
| Rate for Payer: First Health Commercial |
$5,257.30
|
| Rate for Payer: Humana Commercial |
$4,703.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,537.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,869.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,150.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,814.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,818.46
|
| Rate for Payer: PHCS Commercial |
$5,312.64
|
| Rate for Payer: United Healthcare All Payer |
$4,869.92
|
|
|
RESECT BACK TUM < 5 CM
|
Professional
|
Both
|
$8,056.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.71 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$1,720.35
|
| Rate for Payer: Ambetter Exchange |
$968.15
|
| Rate for Payer: Anthem Medicaid |
$710.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$968.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$968.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,161.78
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$1,846.19
|
| Rate for Payer: Healthspan PPO |
$1,558.27
|
| Rate for Payer: Humana Medicaid |
$710.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,296.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$968.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$724.92
|
| Rate for Payer: Molina Healthcare Passport |
$710.71
|
| Rate for Payer: Multiplan PHCS |
$4,833.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,258.60
|
| Rate for Payer: UHCCP Medicaid |
$2,819.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$717.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$968.15
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,416.80 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,008.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,558.64
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| 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 |
$4,028.00
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,008.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,558.64
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
