|
CHEMODENERV TRUNK MUSC 6/>(T
|
Facility
|
OP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 64647
|
| Hospital Charge Code |
761T2356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.95 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem Medicaid |
$388.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Humana KY Medicaid |
$388.95
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$392.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.39
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
|
CHEMO INJ IM SQ HORMONAL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
CHEMO INJ IM SQ HORMONAL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
CHEMO INJ IM SQ HORMONAL
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$55.56
|
| Rate for Payer: Ambetter Exchange |
$32.45
|
| Rate for Payer: Anthem Medicaid |
$35.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.94
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$64.07
|
| Rate for Payer: Healthspan PPO |
$52.06
|
| Rate for Payer: Humana Medicaid |
$35.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.53
|
| Rate for Payer: Molina Healthcare Passport |
$35.81
|
| Rate for Payer: Multiplan PHCS |
$70.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.19
|
| Rate for Payer: UHCCP Medicaid |
$41.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.45
|
|
|
CHEMO INJ IM SQ NONHORMONAL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$101.14 |
| Rate for Payer: Aetna Commercial |
$101.14
|
| Rate for Payer: Ambetter Exchange |
$61.17
|
| Rate for Payer: Anthem Medicaid |
$56.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.40
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$87.90
|
| Rate for Payer: Healthspan PPO |
$94.77
|
| Rate for Payer: Humana Medicaid |
$56.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.56
|
| Rate for Payer: Molina Healthcare Passport |
$56.43
|
| Rate for Payer: Multiplan PHCS |
$73.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.52
|
| Rate for Payer: UHCCP Medicaid |
$42.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.17
|
|
|
CHEMO INJ IM SQ NONHORMONAL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$41.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$41.96
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$42.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
CHEMO INJ IM SQ NONHORMONAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.16
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
CHEMO INTRALESIONAL OVER 7
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
33100016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$65.99
|
| Rate for Payer: Ambetter Exchange |
$41.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.49
|
| Rate for Payer: Anthem Medicaid |
$135.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.63
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$219.64
|
| Rate for Payer: Healthspan PPO |
$165.65
|
| Rate for Payer: Humana Medicaid |
$135.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.27
|
| Rate for Payer: Molina Healthcare Passport |
$135.56
|
| Rate for Payer: Multiplan PHCS |
$492.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.77
|
| Rate for Payer: UHCCP Medicaid |
$37.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.36
|
|
|
CHEMO INTRALESIONAL OVER 7
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
33100016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem Medicaid |
$282.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Humana KY Medicaid |
$282.00
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$284.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
CHEMO INTRALESIONAL OVER 7
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
33100016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
CHEMO INTRALESIONAL OVER 7 (P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
331P0016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: Aetna Commercial |
$65.99
|
| Rate for Payer: Ambetter Exchange |
$41.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.49
|
| Rate for Payer: Anthem Medicaid |
$135.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.63
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$219.64
|
| Rate for Payer: Healthspan PPO |
$165.65
|
| Rate for Payer: Humana Medicaid |
$135.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.27
|
| Rate for Payer: Molina Healthcare Passport |
$135.56
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.77
|
| Rate for Payer: UHCCP Medicaid |
$37.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.36
|
|
|
CHEMO INTRALESIONAL OVER 7 (T
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
331T0016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
CHEMO INTRALESIONAL OVER 7 (T
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 96406
|
| Hospital Charge Code |
331T0016
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
CHEMO INTRALESIONAL UP TO 7
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
33100015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem Medicaid |
$168.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Humana KY Medicaid |
$168.51
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$170.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
CHEMO INTRALESIONAL UP TO 7
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
33100015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Ambetter Exchange |
$26.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.50
|
| Rate for Payer: Anthem Medicaid |
$118.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$183.57
|
| Rate for Payer: Healthspan PPO |
$119.89
|
| Rate for Payer: Humana Medicaid |
$118.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.63
|
| Rate for Payer: Molina Healthcare Passport |
$118.26
|
| Rate for Payer: Multiplan PHCS |
$294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.05
|
| Rate for Payer: UHCCP Medicaid |
$24.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.96
|
|
|
CHEMO INTRALESIONAL UP TO 7
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
33100015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
CHEMO INTRALESIONAL UP TO 7 (P
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
331P0015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$183.57 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Ambetter Exchange |
$26.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.50
|
| Rate for Payer: Anthem Medicaid |
$118.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.35
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$183.57
|
| Rate for Payer: Healthspan PPO |
$119.89
|
| Rate for Payer: Humana Medicaid |
$118.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.63
|
| Rate for Payer: Molina Healthcare Passport |
$118.26
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.05
|
| Rate for Payer: UHCCP Medicaid |
$24.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.96
|
|
|
CHEMO INTRALESIONAL UP TO 7 (T
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
331T0015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CHEMO INTRALESIONAL UP TO 7 (T
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 96405
|
| Hospital Charge Code |
331T0015
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CHEMO INTRATHECAL INTO CNS
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
33100010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$288.60 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.78
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
CHEMO INTRATHECAL INTO CNS
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
33100010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$50.84 |
| Max. Negotiated Rate |
$577.20 |
| Rate for Payer: Aetna Commercial |
$138.63
|
| Rate for Payer: Ambetter Exchange |
$72.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.84
|
| Rate for Payer: Anthem Medicaid |
$248.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.98
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$155.60
|
| Rate for Payer: Healthspan PPO |
$296.89
|
| Rate for Payer: Humana Medicaid |
$248.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.85
|
| Rate for Payer: Molina Healthcare Passport |
$248.87
|
| Rate for Payer: Multiplan PHCS |
$577.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.22
|
| Rate for Payer: UHCCP Medicaid |
$53.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.48
|
|
|
CHEMO INTRATHECAL INTO CNS
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
33100010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$306.47 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem Medicaid |
$330.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Humana KY Medicaid |
$330.83
|
| Rate for Payer: Humana Medicare Advantage |
$306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$334.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.78
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
CHEMO INTRATHECAL INTO CNS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
331P0010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$50.84 |
| Max. Negotiated Rate |
$296.89 |
| Rate for Payer: Aetna Commercial |
$138.63
|
| Rate for Payer: Ambetter Exchange |
$72.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.84
|
| Rate for Payer: Anthem Medicaid |
$248.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.98
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$155.60
|
| Rate for Payer: Healthspan PPO |
$296.89
|
| Rate for Payer: Humana Medicaid |
$248.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.85
|
| Rate for Payer: Molina Healthcare Passport |
$248.87
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.22
|
| Rate for Payer: UHCCP Medicaid |
$53.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.48
|
|
|
CHEMO INTRATHECAL INTO CNS(T
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
331T0010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$176.08 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Anthem Medicaid |
$176.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cigna Commercial |
$424.96
|
| Rate for Payer: First Health Commercial |
$486.40
|
| Rate for Payer: Humana Commercial |
$435.20
|
| Rate for Payer: Humana KY Medicaid |
$176.08
|
| Rate for Payer: Humana Medicare Advantage |
$306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$177.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.56
|
| Rate for Payer: Ohio Health Group HMO |
$384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.28
|
| Rate for Payer: PHCS Commercial |
$491.52
|
| Rate for Payer: United Healthcare All Payer |
$450.56
|
|
|
CHEMO INTRATHECAL INTO CNS(T
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
331T0010
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.36
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cigna Commercial |
$424.96
|
| Rate for Payer: First Health Commercial |
$486.40
|
| Rate for Payer: Humana Commercial |
$435.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.56
|
| Rate for Payer: Ohio Health Group HMO |
$384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.28
|
| Rate for Payer: PHCS Commercial |
$491.52
|
| Rate for Payer: United Healthcare All Payer |
$450.56
|
|
