|
BRACHY INTERMEDIATE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77317
|
| Hospital Charge Code |
33300011
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$340.20 |
| 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 |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| 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: Ambetter Exchange |
$294.23
|
| Rate for Payer: Anthem Medicaid |
$183.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$294.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.23
|
| 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 |
$382.50
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$185.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.23
|
|
|
BRACHY INTERMEDIATE(T
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 77317
|
| Hospital Charge Code |
333T0011
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$280.20 |
| 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 |
$747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$812.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.46
|
| 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 |
$321.20 |
| 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 |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| 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 |
$338.24
|
| 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 |
$405.89
|
| 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 |
$747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$812.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.46
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
BRACHY SIMPLE
|
Professional
|
Both
|
$1,069.92
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
33300010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$641.95 |
| Rate for Payer: Ambetter Exchange |
$223.62
|
| Rate for Payer: Anthem Medicaid |
$140.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.34
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cash Price |
$534.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$223.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.96
|
| Rate for Payer: Molina Healthcare Passport |
$140.16
|
| Rate for Payer: Multiplan PHCS |
$641.95
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.71
|
| Rate for Payer: UHCCP Medicaid |
$374.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.62
|
|
|
BRACHY SIMPLE
|
Facility
|
OP
|
$1,069.92
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
33300010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,027.12 |
| Rate for Payer: Aetna Commercial |
$823.84
|
| Rate for Payer: Anthem Medicaid |
$367.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cigna Commercial |
$888.03
|
| Rate for Payer: First Health Commercial |
$1,016.42
|
| Rate for Payer: Humana Commercial |
$909.43
|
| Rate for Payer: Humana KY Medicaid |
$367.95
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$371.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.53
|
| Rate for Payer: Ohio Health Group HMO |
$802.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.24
|
| Rate for Payer: PHCS Commercial |
$1,027.12
|
| Rate for Payer: United Healthcare All Payer |
$941.53
|
|
|
BRACHY SIMPLE
|
Facility
|
IP
|
$1,069.92
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
33300010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$320.98 |
| Max. Negotiated Rate |
$1,027.12 |
| Rate for Payer: Aetna Commercial |
$823.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.54
|
| Rate for Payer: Cash Price |
$534.96
|
| Rate for Payer: Cigna Commercial |
$888.03
|
| Rate for Payer: First Health Commercial |
$1,016.42
|
| Rate for Payer: Humana Commercial |
$909.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.53
|
| Rate for Payer: Ohio Health Group HMO |
$802.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.24
|
| Rate for Payer: PHCS Commercial |
$1,027.12
|
| Rate for Payer: United Healthcare All Payer |
$941.53
|
|
|
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: Ambetter Exchange |
$223.62
|
| Rate for Payer: Anthem Medicaid |
$140.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$223.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.62
|
| 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 |
$290.71
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.62
|
|
|
BRACHY SIMPLE(T
|
Facility
|
IP
|
$869.92
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
333T0010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.98 |
| Max. Negotiated Rate |
$835.12 |
| Rate for Payer: Aetna Commercial |
$669.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.54
|
| Rate for Payer: Cash Price |
$434.96
|
| Rate for Payer: Cigna Commercial |
$722.03
|
| Rate for Payer: First Health Commercial |
$826.42
|
| Rate for Payer: Humana Commercial |
$739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.53
|
| Rate for Payer: Ohio Health Group HMO |
$652.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.24
|
| Rate for Payer: PHCS Commercial |
$835.12
|
| Rate for Payer: United Healthcare All Payer |
$765.53
|
|
|
BRACHY SIMPLE(T
|
Facility
|
OP
|
$869.92
|
|
|
Service Code
|
HCPCS 77316
|
| Hospital Charge Code |
333T0010
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$299.17 |
| Max. Negotiated Rate |
$835.12 |
| Rate for Payer: Aetna Commercial |
$669.84
|
| Rate for Payer: Anthem Medicaid |
$299.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$434.96
|
| Rate for Payer: Cash Price |
$434.96
|
| Rate for Payer: Cigna Commercial |
$722.03
|
| Rate for Payer: First Health Commercial |
$826.42
|
| Rate for Payer: Humana Commercial |
$739.43
|
| Rate for Payer: Humana KY Medicaid |
$299.17
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$302.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.53
|
| Rate for Payer: Ohio Health Group HMO |
$652.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.24
|
| Rate for Payer: PHCS Commercial |
$835.12
|
| Rate for Payer: United Healthcare All Payer |
$765.53
|
|
|
BRACHYTHERAPY TRANS RAD PLACE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 92974
|
| Hospital Charge Code |
48000065
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.30 |
| 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 |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| 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 |
$78.30 |
| 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 |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Facility
|
OP
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.87 |
| 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 |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| 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 |
$639.87
|
| 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 |
$767.84
|
| 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 |
$1,456.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.38
|
| Rate for Payer: PHCS Commercial |
$1,864.88
|
| Rate for Payer: United Healthcare All Payer |
$1,709.47
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Facility
|
IP
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.77 |
| 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 |
$1,456.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.38
|
| Rate for Payer: PHCS Commercial |
$1,864.88
|
| Rate for Payer: United Healthcare All Payer |
$1,709.47
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Professional
|
Both
|
$1,942.58
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
76102283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.99 |
| Max. Negotiated Rate |
$1,165.55 |
| Rate for Payer: Aetna Commercial |
$130.99
|
| Rate for Payer: Ambetter Exchange |
$52.99
|
| Rate for Payer: Anthem Medicaid |
$39.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.59
|
| 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 |
$39.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.99
|
| Rate for Payer: Multiplan PHCS |
$1,165.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.89
|
| Rate for Payer: UHCCP Medicaid |
$679.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.99
|
|
|
BRAIN CANAL SHUNT PROCEDURE(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
761P2283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.99 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$130.99
|
| Rate for Payer: Ambetter Exchange |
$52.99
|
| Rate for Payer: Anthem Medicaid |
$39.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.59
|
| 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 |
$39.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$105.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.99
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.89
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.99
|
|
|
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 |
$417.77 |
| 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 |
$1,044.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$960.88
|
| 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 |
$478.91 |
| 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 |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,086.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| 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 |
$639.87
|
| 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 |
$767.84
|
| 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 |
$1,044.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$960.88
|
| Rate for Payer: PHCS Commercial |
$1,336.88
|
| Rate for Payer: United Healthcare All Payer |
$1,225.47
|
|
|
BRAIN IMAGING (PET)
|
Facility
|
OP
|
$6,565.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
34000028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,347.71 |
| 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 |
$1,347.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,120.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,886.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,819.41
|
| 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 |
$1,347.71
|
| 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 |
$1,617.25
|
| 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 |
$5,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,711.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,529.85
|
| Rate for Payer: PHCS Commercial |
$6,302.40
|
| Rate for Payer: United Healthcare All Payer |
$5,777.20
|
|
|
BRAIN IMAGING (PET)
|
Facility
|
IP
|
$6,565.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
34000028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,969.50 |
| 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 |
$5,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,711.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,529.85
|
| 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 |
$4,595.50 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Anthem Medicaid |
$840.35
|
| 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)(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: 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
|
OP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
340T0028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,347.71 |
| 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 |
$1,347.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,886.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,819.41
|
| 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 |
$1,347.71
|
| 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 |
$1,617.25
|
| 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 |
$5,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,581.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,426.35
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
BRAIN IMAGING (PET)(T
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78608
|
| Hospital Charge Code |
340T0028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,924.50 |
| 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 |
$5,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,581.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,426.35
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
BREAK FREE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
22200130
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
