|
BRACHY SIMPLE
|
Facility
|
OP
|
$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 Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$520.00
|
| 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: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| 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 |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| 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
|
|
|
BRACHY SIMPLE
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
33300010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem Medicaid |
$140.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$292.65
|
| Rate for Payer: Humana Medicaid |
$140.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.96
|
| Rate for Payer: Molina Healthcare Passport |
$140.16
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.56
|
|
|
BRACHY SIMPLE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
333P0010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$292.65 |
| Rate for Payer: Anthem Medicaid |
$140.16
|
| 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 |
$292.65
|
| Rate for Payer: Humana Medicaid |
$140.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.96
|
| Rate for Payer: Molina Healthcare Passport |
$140.16
|
| 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 |
$141.56
|
|
|
BRACHY SIMPLE(T
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
333T0010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
BRACHY SIMPLE(T
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
333T0010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
BRACHYTHERAPY TRANS RAD PLACE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
48000065
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
BRACHYTHERAPY TRANS RAD PLACE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
48000065
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Professional
|
Both
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$1,942.58 |
| Rate for Payer: Aetna Commercial |
$130.99
|
| Rate for Payer: Anthem Medicaid |
$33.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,942.58
|
| Rate for Payer: Cash Price |
$971.29
|
| Rate for Payer: Cash Price |
$971.29
|
| Rate for Payer: Cigna Commercial |
$119.75
|
| Rate for Payer: Healthspan PPO |
$102.28
|
| Rate for Payer: Humana Medicaid |
$33.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.09
|
| Rate for Payer: Molina Healthcare Passport |
$33.42
|
| Rate for Payer: Multiplan PHCS |
$1,165.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,359.81
|
| Rate for Payer: UHCCP Medicaid |
$679.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.75
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Facility
|
IP
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.54 |
| Max. Negotiated Rate |
$1,864.88 |
| Rate for Payer: Aetna Commercial |
$1,495.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.21
|
| Rate for Payer: Cash Price |
$971.29
|
| Rate for Payer: Cigna Commercial |
$1,612.34
|
| Rate for Payer: First Health Commercial |
$1,845.45
|
| Rate for Payer: Humana Commercial |
$1,651.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.20
|
| Rate for Payer: PHCS Commercial |
$1,864.88
|
| Rate for Payer: United Healthcare All Payer |
$1,709.47
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Facility
|
OP
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.54 |
| Max. Negotiated Rate |
$1,864.88 |
| Rate for Payer: Aetna Commercial |
$1,495.79
|
| Rate for Payer: Anthem Medicaid |
$668.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$971.29
|
| Rate for Payer: Cash Price |
$971.29
|
| Rate for Payer: Cigna Commercial |
$1,612.34
|
| Rate for Payer: First Health Commercial |
$1,845.45
|
| Rate for Payer: Humana Commercial |
$1,651.19
|
| Rate for Payer: Humana KY Medicaid |
$668.05
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$674.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.20
|
| Rate for Payer: PHCS Commercial |
$1,864.88
|
| Rate for Payer: United Healthcare All Payer |
$1,709.47
|
|
|
BRAIN CANAL SHUNT PROCEDURE(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
761P2283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$130.99
|
| Rate for Payer: Anthem Medicaid |
$33.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$119.75
|
| Rate for Payer: Healthspan PPO |
$102.28
|
| Rate for Payer: Humana Medicaid |
$33.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.09
|
| Rate for Payer: Molina Healthcare Passport |
$33.42
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.75
|
|
|
BRAIN CANAL SHUNT PROCEDURE(T
|
Facility
|
IP
|
$1,392.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
761T2283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.04 |
| Max. Negotiated Rate |
$1,336.88 |
| Rate for Payer: Aetna Commercial |
$1,072.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,086.21
|
| Rate for Payer: Cash Price |
$696.29
|
| Rate for Payer: Cigna Commercial |
$1,155.84
|
| Rate for Payer: First Health Commercial |
$1,322.95
|
| Rate for Payer: Humana Commercial |
$1,183.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,225.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.70
|
| Rate for Payer: PHCS Commercial |
$1,336.88
|
| Rate for Payer: United Healthcare All Payer |
$1,225.47
|
|
|
BRAIN CANAL SHUNT PROCEDURE(T
|
Facility
|
OP
|
$1,392.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
761T2283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.04 |
| Max. Negotiated Rate |
$1,336.88 |
| Rate for Payer: Aetna Commercial |
$1,072.29
|
| Rate for Payer: Anthem Medicaid |
$478.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,086.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$696.29
|
| Rate for Payer: Cash Price |
$696.29
|
| Rate for Payer: Cigna Commercial |
$1,155.84
|
| Rate for Payer: First Health Commercial |
$1,322.95
|
| Rate for Payer: Humana Commercial |
$1,183.69
|
| Rate for Payer: Humana KY Medicaid |
$478.91
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$483.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$488.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,225.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.70
|
| Rate for Payer: PHCS Commercial |
$1,336.88
|
| Rate for Payer: United Healthcare All Payer |
$1,225.47
|
|
|
BRAIN IMAGING (PET)
|
Facility
|
IP
|
$6,565.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
34000028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$853.45 |
| Max. Negotiated Rate |
$6,302.40 |
| Rate for Payer: Aetna Commercial |
$5,055.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,120.70
|
| Rate for Payer: Cash Price |
$3,282.50
|
| Rate for Payer: Cigna Commercial |
$5,448.95
|
| Rate for Payer: First Health Commercial |
$6,236.75
|
| Rate for Payer: Humana Commercial |
$5,580.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,383.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,844.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,969.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,777.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.15
|
| Rate for Payer: PHCS Commercial |
$6,302.40
|
| Rate for Payer: United Healthcare All Payer |
$5,777.20
|
|
|
BRAIN IMAGING (PET)
|
Professional
|
Both
|
$6,565.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
34000028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$6,565.00 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Anthem Medicaid |
$840.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,565.00
|
| Rate for Payer: Cash Price |
$3,282.50
|
| Rate for Payer: Cash Price |
$3,282.50
|
| Rate for Payer: Cigna Commercial |
$449.72
|
| Rate for Payer: Healthspan PPO |
$973.64
|
| Rate for Payer: Humana Medicaid |
$840.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.16
|
| Rate for Payer: Molina Healthcare Passport |
$840.35
|
| Rate for Payer: Multiplan PHCS |
$3,939.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,595.50
|
| Rate for Payer: UHCCP Medicaid |
$2,297.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$848.75
|
|
|
BRAIN IMAGING (PET)
|
Facility
|
OP
|
$6,565.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
34000028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$853.45 |
| Max. Negotiated Rate |
$6,302.40 |
| Rate for Payer: Aetna Commercial |
$5,055.05
|
| Rate for Payer: Anthem Medicaid |
$2,257.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,352.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,120.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,894.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,826.37
|
| Rate for Payer: Cash Price |
$3,282.50
|
| Rate for Payer: Cash Price |
$3,282.50
|
| Rate for Payer: Cigna Commercial |
$5,448.95
|
| Rate for Payer: First Health Commercial |
$6,236.75
|
| Rate for Payer: Humana Commercial |
$5,580.25
|
| Rate for Payer: Humana KY Medicaid |
$2,257.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,352.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,280.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,383.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,844.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,623.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,303.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,777.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.15
|
| Rate for Payer: PHCS Commercial |
$6,302.40
|
| Rate for Payer: United Healthcare All Payer |
$5,777.20
|
|
|
BRAIN IMAGING (PET)(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
340P0028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$2,081.06 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Anthem Medicaid |
$840.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$449.72
|
| Rate for Payer: Healthspan PPO |
$973.64
|
| Rate for Payer: Humana Medicaid |
$840.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.16
|
| Rate for Payer: Molina Healthcare Passport |
$840.35
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$848.75
|
|
|
BRAIN IMAGING (PET)(T
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
340T0028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.95 |
| Max. Negotiated Rate |
$6,158.40 |
| Rate for Payer: Aetna Commercial |
$4,939.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cigna Commercial |
$5,324.45
|
| Rate for Payer: First Health Commercial |
$6,094.25
|
| Rate for Payer: Humana Commercial |
$5,452.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,260.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,734.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,924.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,645.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,988.65
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
BRAIN IMAGING (PET)(T
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
340T0028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.95 |
| Max. Negotiated Rate |
$6,158.40 |
| Rate for Payer: Aetna Commercial |
$4,939.55
|
| Rate for Payer: Anthem Medicaid |
$2,206.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,352.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,894.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,826.37
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cigna Commercial |
$5,324.45
|
| Rate for Payer: First Health Commercial |
$6,094.25
|
| Rate for Payer: Humana Commercial |
$5,452.75
|
| Rate for Payer: Humana KY Medicaid |
$2,206.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,352.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,228.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,260.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,734.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,623.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,250.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,645.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,988.65
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
BREAK FREE
|
Professional
|
Both
|
$60.00
|
|
| Hospital Charge Code |
22200130
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
|
|
BREAKUP FAT NECROS/AERATE (P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
761P2699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,580.74
|
| Rate for Payer: Anthem Medicaid |
$631.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,466.69
|
| Rate for Payer: Healthspan PPO |
$1,333.07
|
| Rate for Payer: Humana Medicaid |
$631.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.63
|
| Rate for Payer: Molina Healthcare Passport |
$631.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.31
|
|
|
BREAKUP FAT NECROS/AERATE (T
|
Facility
|
IP
|
$3,797.33
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
761T2699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.65 |
| Max. Negotiated Rate |
$3,645.44 |
| Rate for Payer: Aetna Commercial |
$2,923.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.92
|
| Rate for Payer: Cash Price |
$1,898.66
|
| Rate for Payer: Cigna Commercial |
$3,151.78
|
| Rate for Payer: First Health Commercial |
$3,607.46
|
| Rate for Payer: Humana Commercial |
$3,227.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.17
|
| Rate for Payer: PHCS Commercial |
$3,645.44
|
| Rate for Payer: United Healthcare All Payer |
$3,341.65
|
|
|
BREAKUP FAT NECROS/AERATE (T
|
Facility
|
OP
|
$3,797.33
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
761T2699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.65 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Aetna Commercial |
$2,923.94
|
| Rate for Payer: Anthem Medicaid |
$1,305.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$1,898.66
|
| Rate for Payer: Cash Price |
$1,898.66
|
| Rate for Payer: Cigna Commercial |
$3,151.78
|
| Rate for Payer: First Health Commercial |
$3,607.46
|
| Rate for Payer: Humana Commercial |
$3,227.73
|
| Rate for Payer: Humana KY Medicaid |
$1,305.90
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,332.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.17
|
| Rate for Payer: PHCS Commercial |
$3,645.44
|
| Rate for Payer: United Healthcare All Payer |
$3,341.65
|
|
|
BREAKUP FAT NECROS/AERATE TISS
|
Professional
|
Both
|
$5,497.33
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5,497.33 |
| Rate for Payer: Anthem Medicaid |
$250.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,497.33
|
| Rate for Payer: Cash Price |
$2,748.66
|
| Rate for Payer: Cash Price |
$2,748.66
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$250.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.00
|
| Rate for Payer: Molina Healthcare Passport |
$250.00
|
| Rate for Payer: Multiplan PHCS |
$3,298.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,848.13
|
| Rate for Payer: UHCCP Medicaid |
$1,924.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.50
|
|
|
BREAST AUGMENTATION W/IMPLAN(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 19325
|
| Hospital Charge Code |
761P0308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.12 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$935.47
|
| Rate for Payer: Anthem Medicaid |
$421.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$888.81
|
| Rate for Payer: Healthspan PPO |
$747.99
|
| Rate for Payer: Humana Medicaid |
$421.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$827.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.54
|
| Rate for Payer: Molina Healthcare Passport |
$421.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.33
|
|
