BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
IP
|
$1,972.90
|
|
Service Code
|
HCPCS J0585
|
Hospital Charge Code |
25001901
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$256.48 |
Max. Negotiated Rate |
$1,893.98 |
Rate for Payer: Aetna Commercial |
$1,519.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.86
|
Rate for Payer: Cash Price |
$986.45
|
Rate for Payer: Cigna Commercial |
$1,637.51
|
Rate for Payer: First Health Commercial |
$1,874.26
|
Rate for Payer: Humana Commercial |
$1,676.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.78
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$591.87
|
Rate for Payer: Ohio Health Choice Commercial |
$1,736.15
|
Rate for Payer: Ohio Health Group HMO |
$1,479.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$394.58
|
Rate for Payer: Ohio Health Group PPO No Differential |
$256.48
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.60
|
Rate for Payer: PHCS Commercial |
$1,893.98
|
Rate for Payer: United Healthcare All Payer |
$1,736.15
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Professional
|
Both
|
$12.68
|
|
Service Code
|
HCPCS J0585
|
Hospital Charge Code |
63600016
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$4.44 |
Max. Negotiated Rate |
$12.68 |
Rate for Payer: Aetna Commercial |
$8.33
|
Rate for Payer: Buckeye Medicare Advantage |
$12.68
|
Rate for Payer: Cash Price |
$6.34
|
Rate for Payer: Cash Price |
$6.34
|
Rate for Payer: Healthspan PPO |
$7.10
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.59
|
Rate for Payer: Multiplan PHCS |
$7.61
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.88
|
Rate for Payer: UHCCP Medicaid |
$4.44
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
OP
|
$12.68
|
|
Service Code
|
HCPCS J0585
|
Hospital Charge Code |
63600016
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.65 |
Max. Negotiated Rate |
$12.17 |
Rate for Payer: Aetna Commercial |
$9.76
|
Rate for Payer: Anthem Medicaid |
$4.36
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
Rate for Payer: Cash Price |
$6.34
|
Rate for Payer: Cash Price |
$6.34
|
Rate for Payer: Cigna Commercial |
$10.52
|
Rate for Payer: First Health Commercial |
$12.05
|
Rate for Payer: Humana Commercial |
$10.78
|
Rate for Payer: Humana KY Medicaid |
$4.36
|
Rate for Payer: Humana Medicare Advantage |
$6.33
|
Rate for Payer: Kentucky WC Medicaid |
$4.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
Rate for Payer: Ohio Health Group HMO |
$9.51
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
Rate for Payer: PHCS Commercial |
$12.17
|
Rate for Payer: United Healthcare All Payer |
$11.16
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
IP
|
$12.68
|
|
Service Code
|
HCPCS J0585
|
Hospital Charge Code |
636T0016
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.65 |
Max. Negotiated Rate |
$12.17 |
Rate for Payer: Aetna Commercial |
$9.76
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
Rate for Payer: Cash Price |
$6.34
|
Rate for Payer: Cigna Commercial |
$10.52
|
Rate for Payer: First Health Commercial |
$12.05
|
Rate for Payer: Humana Commercial |
$10.78
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
Rate for Payer: Ohio Health Group HMO |
$9.51
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
Rate for Payer: PHCS Commercial |
$12.17
|
Rate for Payer: United Healthcare All Payer |
$11.16
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
IP
|
$1,556.00
|
|
Service Code
|
HCPCS 44130
|
Hospital Charge Code |
76102610
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$202.28 |
Max. Negotiated Rate |
$1,493.76 |
Rate for Payer: Aetna Commercial |
$1,198.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cigna Commercial |
$1,291.48
|
Rate for Payer: First Health Commercial |
$1,478.20
|
Rate for Payer: Humana Commercial |
$1,322.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$466.80
|
Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$311.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$202.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.36
|
Rate for Payer: PHCS Commercial |
$1,493.76
|
Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
BOWEL TO BOWEL FUSION
|
Professional
|
Both
|
$1,556.00
|
|
Service Code
|
HCPCS 44130
|
Hospital Charge Code |
761P2610
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$544.60 |
Max. Negotiated Rate |
$1,820.23 |
Rate for Payer: Aetna Commercial |
$1,820.23
|
Rate for Payer: Anthem Medicaid |
$603.16
|
Rate for Payer: Buckeye Medicare Advantage |
$1,556.00
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cigna Commercial |
$1,641.02
|
Rate for Payer: Healthspan PPO |
$1,535.03
|
Rate for Payer: Humana Medicaid |
$603.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,663.70
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$615.22
|
Rate for Payer: Molina Healthcare Passport |
$603.16
|
Rate for Payer: Multiplan PHCS |
$933.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,089.20
|
Rate for Payer: UHCCP Medicaid |
$544.60
|
Rate for Payer: Wellcare CHIP/Medicaid |
$609.19
|
|
BOWEL TO BOWEL FUSION
|
Professional
|
Both
|
$1,556.00
|
|
Service Code
|
HCPCS 44130
|
Hospital Charge Code |
76102610
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$544.60 |
Max. Negotiated Rate |
$1,820.23 |
Rate for Payer: Aetna Commercial |
$1,820.23
|
Rate for Payer: Anthem Medicaid |
$603.16
|
Rate for Payer: Buckeye Medicare Advantage |
$1,556.00
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cigna Commercial |
$1,641.02
|
Rate for Payer: Healthspan PPO |
$1,535.03
|
Rate for Payer: Humana Medicaid |
$603.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,663.70
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$615.22
|
Rate for Payer: Molina Healthcare Passport |
$603.16
|
Rate for Payer: Multiplan PHCS |
$933.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,089.20
|
Rate for Payer: UHCCP Medicaid |
$544.60
|
Rate for Payer: Wellcare CHIP/Medicaid |
$609.19
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
OP
|
$1,556.00
|
|
Service Code
|
HCPCS 44130
|
Hospital Charge Code |
76102610
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$202.28 |
Max. Negotiated Rate |
$1,493.76 |
Rate for Payer: Aetna Commercial |
$1,198.12
|
Rate for Payer: Anthem Medicaid |
$535.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
Rate for Payer: Cash Price |
$778.00
|
Rate for Payer: Cigna Commercial |
$1,291.48
|
Rate for Payer: First Health Commercial |
$1,478.20
|
Rate for Payer: Humana Commercial |
$1,322.60
|
Rate for Payer: Humana KY Medicaid |
$535.11
|
Rate for Payer: Kentucky WC Medicaid |
$540.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$466.80
|
Rate for Payer: Molina Healthcare Medicaid |
$545.84
|
Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$311.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$202.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.36
|
Rate for Payer: PHCS Commercial |
$1,493.76
|
Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
BPH INITIAL TREATMENT
|
Professional
|
Both
|
$256.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
41000082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$15.97 |
Max. Negotiated Rate |
$256.00 |
Rate for Payer: Aetna Commercial |
$31.39
|
Rate for Payer: Anthem Medicaid |
$15.97
|
Rate for Payer: Buckeye Medicare Advantage |
$256.00
|
Rate for Payer: Cash Price |
$128.00
|
Rate for Payer: Cash Price |
$128.00
|
Rate for Payer: Cigna Commercial |
$32.05
|
Rate for Payer: Healthspan PPO |
$24.32
|
Rate for Payer: Humana Medicaid |
$15.97
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.00
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.29
|
Rate for Payer: Molina Healthcare Passport |
$15.97
|
Rate for Payer: Multiplan PHCS |
$153.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.20
|
Rate for Payer: UHCCP Medicaid |
$89.60
|
Rate for Payer: Wellcare CHIP/Medicaid |
$16.13
|
|
BPH INITIAL TREATMENT
|
Facility
|
OP
|
$256.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
41000082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$33.28 |
Max. Negotiated Rate |
$245.76 |
Rate for Payer: Aetna Commercial |
$197.12
|
Rate for Payer: Anthem Medicaid |
$88.04
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
Rate for Payer: Cash Price |
$128.00
|
Rate for Payer: Cash Price |
$128.00
|
Rate for Payer: Cigna Commercial |
$212.48
|
Rate for Payer: First Health Commercial |
$243.20
|
Rate for Payer: Humana Commercial |
$217.60
|
Rate for Payer: Humana KY Medicaid |
$88.04
|
Rate for Payer: Humana Medicare Advantage |
$110.46
|
Rate for Payer: Kentucky WC Medicaid |
$88.93
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
Rate for Payer: Molina Healthcare Medicaid |
$89.80
|
Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
Rate for Payer: Ohio Health Group HMO |
$192.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
Rate for Payer: PHCS Commercial |
$245.76
|
Rate for Payer: United Healthcare All Payer |
$225.28
|
|
BPH INITIAL TREATMENT
|
Facility
|
IP
|
$256.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
41000082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$33.28 |
Max. Negotiated Rate |
$245.76 |
Rate for Payer: Aetna Commercial |
$197.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
Rate for Payer: Cash Price |
$128.00
|
Rate for Payer: Cigna Commercial |
$212.48
|
Rate for Payer: First Health Commercial |
$243.20
|
Rate for Payer: Humana Commercial |
$217.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
Rate for Payer: Ohio Health Group HMO |
$192.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
Rate for Payer: PHCS Commercial |
$245.76
|
Rate for Payer: United Healthcare All Payer |
$225.28
|
|
BPH INITIAL TREATMENT(P
|
Professional
|
Both
|
$75.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
410P0082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$15.97 |
Max. Negotiated Rate |
$75.00 |
Rate for Payer: Aetna Commercial |
$31.39
|
Rate for Payer: Anthem Medicaid |
$15.97
|
Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cigna Commercial |
$32.05
|
Rate for Payer: Healthspan PPO |
$24.32
|
Rate for Payer: Humana Medicaid |
$15.97
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.00
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.29
|
Rate for Payer: Molina Healthcare Passport |
$15.97
|
Rate for Payer: Multiplan PHCS |
$45.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
Rate for Payer: UHCCP Medicaid |
$26.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$16.13
|
|
BPH INITIAL TREATMENT(T
|
Facility
|
OP
|
$181.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
410T0082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$23.53 |
Max. Negotiated Rate |
$173.76 |
Rate for Payer: Aetna Commercial |
$139.37
|
Rate for Payer: Anthem Medicaid |
$62.25
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
Rate for Payer: Cash Price |
$90.50
|
Rate for Payer: Cash Price |
$90.50
|
Rate for Payer: Cigna Commercial |
$150.23
|
Rate for Payer: First Health Commercial |
$171.95
|
Rate for Payer: Humana Commercial |
$153.85
|
Rate for Payer: Humana KY Medicaid |
$62.25
|
Rate for Payer: Humana Medicare Advantage |
$110.46
|
Rate for Payer: Kentucky WC Medicaid |
$62.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
Rate for Payer: Ohio Health Group HMO |
$135.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
Rate for Payer: PHCS Commercial |
$173.76
|
Rate for Payer: United Healthcare All Payer |
$159.28
|
|
BPH INITIAL TREATMENT(T
|
Facility
|
IP
|
$181.00
|
|
Service Code
|
HCPCS 94667
|
Hospital Charge Code |
410T0082
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$23.53 |
Max. Negotiated Rate |
$173.76 |
Rate for Payer: Aetna Commercial |
$139.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
Rate for Payer: Cash Price |
$90.50
|
Rate for Payer: Cigna Commercial |
$150.23
|
Rate for Payer: First Health Commercial |
$171.95
|
Rate for Payer: Humana Commercial |
$153.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
Rate for Payer: Ohio Health Group HMO |
$135.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
Rate for Payer: PHCS Commercial |
$173.76
|
Rate for Payer: United Healthcare All Payer |
$159.28
|
|
BPH SUBSEQUENT
|
Facility
|
OP
|
$176.00
|
|
Service Code
|
HCPCS 94668
|
Hospital Charge Code |
41000083
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem Medicaid |
$60.53
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Humana KY Medicaid |
$60.53
|
Rate for Payer: Humana Medicare Advantage |
$110.46
|
Rate for Payer: Kentucky WC Medicaid |
$61.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
BPH SUBSEQUENT
|
Facility
|
IP
|
$176.00
|
|
Service Code
|
HCPCS 94668
|
Hospital Charge Code |
41000083
|
Hospital Revenue Code
|
410
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
BRACHIOPLASTY
|
Professional
|
Both
|
$1,245.00
|
|
Hospital Charge Code |
22200037
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$435.75 |
Max. Negotiated Rate |
$1,245.00 |
Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
Rate for Payer: Cash Price |
$622.50
|
Rate for Payer: Multiplan PHCS |
$747.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
Rate for Payer: UHCCP Medicaid |
$435.75
|
|
BRACHIOPLASTY -80
|
Professional
|
Both
|
$622.50
|
|
Hospital Charge Code |
22200373
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$217.88 |
Max. Negotiated Rate |
$622.50 |
Rate for Payer: Buckeye Medicare Advantage |
$622.50
|
Rate for Payer: Cash Price |
$311.25
|
Rate for Payer: Multiplan PHCS |
$373.50
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.75
|
Rate for Payer: UHCCP Medicaid |
$217.88
|
|
BRACHY INTERMEDIATE
|
Professional
|
Both
|
$1,134.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
33300011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$118.59 |
Max. Negotiated Rate |
$1,134.00 |
Rate for Payer: Anthem Medicaid |
$183.36
|
Rate for Payer: Buckeye Medicare Advantage |
$1,134.00
|
Rate for Payer: Cash Price |
$567.00
|
Rate for Payer: Cash Price |
$567.00
|
Rate for Payer: Cigna Commercial |
$382.91
|
Rate for Payer: Humana Medicaid |
$183.36
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.59
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.03
|
Rate for Payer: Molina Healthcare Passport |
$183.36
|
Rate for Payer: Multiplan PHCS |
$680.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.80
|
Rate for Payer: UHCCP Medicaid |
$396.90
|
Rate for Payer: Wellcare CHIP/Medicaid |
$185.19
|
|
BRACHY INTERMEDIATE
|
Facility
|
OP
|
$1,134.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
33300011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$147.42 |
Max. Negotiated Rate |
$1,088.64 |
Rate for Payer: Aetna Commercial |
$873.18
|
Rate for Payer: Anthem Medicaid |
$389.98
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
Rate for Payer: Cash Price |
$567.00
|
Rate for Payer: Cash Price |
$567.00
|
Rate for Payer: Cigna Commercial |
$941.22
|
Rate for Payer: First Health Commercial |
$1,077.30
|
Rate for Payer: Humana Commercial |
$963.90
|
Rate for Payer: Humana KY Medicaid |
$389.98
|
Rate for Payer: Humana Medicare Advantage |
$319.52
|
Rate for Payer: Kentucky WC Medicaid |
$393.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
Rate for Payer: Ohio Health Group HMO |
$850.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$226.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
Rate for Payer: PHCS Commercial |
$1,088.64
|
Rate for Payer: United Healthcare All Payer |
$997.92
|
|
BRACHY INTERMEDIATE
|
Facility
|
IP
|
$1,134.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
33300011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$147.42 |
Max. Negotiated Rate |
$1,088.64 |
Rate for Payer: Aetna Commercial |
$873.18
|
Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
Rate for Payer: Cash Price |
$567.00
|
Rate for Payer: Cigna Commercial |
$941.22
|
Rate for Payer: First Health Commercial |
$1,077.30
|
Rate for Payer: Humana Commercial |
$963.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
Rate for Payer: Ohio Health Group HMO |
$850.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$226.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
Rate for Payer: PHCS Commercial |
$1,088.64
|
Rate for Payer: United Healthcare All Payer |
$997.92
|
|
BRACHY INTERMEDIATE(P
|
Professional
|
Both
|
$200.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
333P0011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$70.00 |
Max. Negotiated Rate |
$382.91 |
Rate for Payer: Anthem Medicaid |
$183.36
|
Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
Rate for Payer: Cash Price |
$100.00
|
Rate for Payer: Cash Price |
$100.00
|
Rate for Payer: Cigna Commercial |
$382.91
|
Rate for Payer: Humana Medicaid |
$183.36
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.59
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.03
|
Rate for Payer: Molina Healthcare Passport |
$183.36
|
Rate for Payer: Multiplan PHCS |
$120.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
Rate for Payer: UHCCP Medicaid |
$70.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$185.19
|
|
BRACHY INTERMEDIATE(T
|
Facility
|
IP
|
$934.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
333T0011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$121.42 |
Max. Negotiated Rate |
$896.64 |
Rate for Payer: Aetna Commercial |
$719.18
|
Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
Rate for Payer: Cash Price |
$467.00
|
Rate for Payer: Cigna Commercial |
$775.22
|
Rate for Payer: First Health Commercial |
$887.30
|
Rate for Payer: Humana Commercial |
$793.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
Rate for Payer: Ohio Health Group HMO |
$700.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
Rate for Payer: PHCS Commercial |
$896.64
|
Rate for Payer: United Healthcare All Payer |
$821.92
|
|
BRACHY INTERMEDIATE(T
|
Facility
|
OP
|
$934.00
|
|
Service Code
|
HCPCS 77317
|
Hospital Charge Code |
333T0011
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$121.42 |
Max. Negotiated Rate |
$896.64 |
Rate for Payer: Aetna Commercial |
$719.18
|
Rate for Payer: Anthem Medicaid |
$321.20
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
Rate for Payer: Cash Price |
$467.00
|
Rate for Payer: Cash Price |
$467.00
|
Rate for Payer: Cigna Commercial |
$775.22
|
Rate for Payer: First Health Commercial |
$887.30
|
Rate for Payer: Humana Commercial |
$793.90
|
Rate for Payer: Humana KY Medicaid |
$321.20
|
Rate for Payer: Humana Medicare Advantage |
$319.52
|
Rate for Payer: Kentucky WC Medicaid |
$324.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
Rate for Payer: Molina Healthcare Medicaid |
$327.65
|
Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
Rate for Payer: Ohio Health Group HMO |
$700.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
Rate for Payer: PHCS Commercial |
$896.64
|
Rate for Payer: United Healthcare All Payer |
$821.92
|
|
BRACHY SIMPLE
|
Facility
|
IP
|
$1,040.00
|
|
Service Code
|
HCPCS 77316
|
Hospital Charge Code |
33300010
|
Hospital Revenue Code
|
333
|
Min. Negotiated Rate |
$135.20 |
Max. Negotiated Rate |
$998.40 |
Rate for Payer: Aetna Commercial |
$800.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
Rate for Payer: Cash Price |
$520.00
|
Rate for Payer: Cigna Commercial |
$863.20
|
Rate for Payer: First Health Commercial |
$988.00
|
Rate for Payer: Humana Commercial |
$884.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
Rate for Payer: Ohio Health Group HMO |
$780.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$135.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.40
|
Rate for Payer: PHCS Commercial |
$998.40
|
Rate for Payer: United Healthcare All Payer |
$915.20
|
|