|
EXC LYMPH NODE(T
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
761T1594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
EXC LYMPH NODE(T
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
761T1594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.39 |
| Max. Negotiated Rate |
$2,114.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Aetna Commercial |
$1,696.31
|
| Rate for Payer: Anthem Medicaid |
$757.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$1,101.50
|
| Rate for Payer: Cash Price |
$1,101.50
|
| Rate for Payer: Cigna Commercial |
$1,828.49
|
| Rate for Payer: First Health Commercial |
$2,092.85
|
| Rate for Payer: Humana Commercial |
$1,872.55
|
| Rate for Payer: Humana KY Medicaid |
$757.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$765.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,806.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,625.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$772.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,938.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.93
|
| Rate for Payer: PHCS Commercial |
$2,114.88
|
| Rate for Payer: United Healthcare All Payer |
$1,938.64
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.39 |
| Max. Negotiated Rate |
$2,114.88 |
| Rate for Payer: Aetna Commercial |
$1,696.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.34
|
| Rate for Payer: Cash Price |
$1,101.50
|
| Rate for Payer: Cigna Commercial |
$1,828.49
|
| Rate for Payer: First Health Commercial |
$2,092.85
|
| Rate for Payer: Humana Commercial |
$1,872.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,806.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,625.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,938.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.93
|
| Rate for Payer: PHCS Commercial |
$2,114.88
|
| Rate for Payer: United Healthcare All Payer |
$1,938.64
|
|
|
EXC MALIG LES 1.1-2.0 CM
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
76100077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$2,203.00 |
| Rate for Payer: Aetna Commercial |
$223.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.67
|
| Rate for Payer: Anthem Medicaid |
$88.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,203.00
|
| Rate for Payer: Cash Price |
$1,101.50
|
| Rate for Payer: Cash Price |
$1,101.50
|
| Rate for Payer: Cigna Commercial |
$305.34
|
| Rate for Payer: Healthspan PPO |
$262.95
|
| Rate for Payer: Humana Medicaid |
$88.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.92
|
| Rate for Payer: Molina Healthcare Passport |
$88.16
|
| Rate for Payer: Multiplan PHCS |
$1,321.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,542.10
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.04
|
|
|
EXC MALIG LES 1.1-2.0 CM(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761P0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$223.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.67
|
| Rate for Payer: Anthem Medicaid |
$88.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$305.34
|
| Rate for Payer: Healthspan PPO |
$262.95
|
| Rate for Payer: Humana Medicaid |
$88.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.92
|
| Rate for Payer: Molina Healthcare Passport |
$88.16
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.04
|
|
|
EXC MALIG LES 1.1-2.0 CM(T
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761T0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$1,802.88 |
| Rate for Payer: Aetna Commercial |
$1,446.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.84
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,558.74
|
| Rate for Payer: First Health Commercial |
$1,784.10
|
| Rate for Payer: Humana Commercial |
$1,596.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.18
|
| Rate for Payer: PHCS Commercial |
$1,802.88
|
| Rate for Payer: United Healthcare All Payer |
$1,652.64
|
|
|
EXC MALIG LES 1.1-2.0 CM(T
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
761T0077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$1,802.88 |
| Rate for Payer: Aetna Commercial |
$1,446.06
|
| Rate for Payer: Anthem Medicaid |
$645.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,558.74
|
| Rate for Payer: First Health Commercial |
$1,784.10
|
| Rate for Payer: Humana Commercial |
$1,596.30
|
| Rate for Payer: Humana KY Medicaid |
$645.84
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$652.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.18
|
| Rate for Payer: PHCS Commercial |
$1,802.88
|
| Rate for Payer: United Healthcare All Payer |
$1,652.64
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.77 |
| Max. Negotiated Rate |
$2,793.00 |
| Rate for Payer: Aetna Commercial |
$267.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$106.14
|
| Rate for Payer: Anthem Medicaid |
$102.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,793.00
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cigna Commercial |
$347.67
|
| Rate for Payer: Healthspan PPO |
$300.03
|
| Rate for Payer: Humana Medicaid |
$102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.83
|
| Rate for Payer: Molina Healthcare Passport |
$102.77
|
| Rate for Payer: Multiplan PHCS |
$1,675.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,955.10
|
| Rate for Payer: UHCCP Medicaid |
$111.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.80
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.09 |
| Max. Negotiated Rate |
$2,681.28 |
| Rate for Payer: Aetna Commercial |
$2,150.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,178.54
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cigna Commercial |
$2,318.19
|
| Rate for Payer: First Health Commercial |
$2,653.35
|
| Rate for Payer: Humana Commercial |
$2,374.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,290.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,061.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$837.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,457.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,094.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$865.83
|
| Rate for Payer: PHCS Commercial |
$2,681.28
|
| Rate for Payer: United Healthcare All Payer |
$2,457.84
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Professional
|
Both
|
$3,898.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$3,898.00 |
| Rate for Payer: Aetna Commercial |
$294.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$120.36
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,898.00
|
| Rate for Payer: Cash Price |
$1,949.00
|
| Rate for Payer: Cash Price |
$1,949.00
|
| Rate for Payer: Cigna Commercial |
$368.35
|
| Rate for Payer: Healthspan PPO |
$321.68
|
| Rate for Payer: Humana Medicaid |
$125.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$263.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.68
|
| Rate for Payer: Molina Healthcare Passport |
$125.18
|
| Rate for Payer: Multiplan PHCS |
$2,338.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,728.60
|
| Rate for Payer: UHCCP Medicaid |
$126.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.43
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.09 |
| Max. Negotiated Rate |
$2,681.28 |
| Rate for Payer: Aetna Commercial |
$2,150.61
|
| Rate for Payer: Anthem Medicaid |
$960.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,178.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cash Price |
$1,396.50
|
| Rate for Payer: Cigna Commercial |
$2,318.19
|
| Rate for Payer: First Health Commercial |
$2,653.35
|
| Rate for Payer: Humana Commercial |
$2,374.05
|
| Rate for Payer: Humana KY Medicaid |
$960.51
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$970.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,290.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,061.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$979.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,457.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,094.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$865.83
|
| Rate for Payer: PHCS Commercial |
$2,681.28
|
| Rate for Payer: United Healthcare All Payer |
$2,457.84
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.74 |
| Max. Negotiated Rate |
$3,742.08 |
| Rate for Payer: Aetna Commercial |
$3,001.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.44
|
| Rate for Payer: Cash Price |
$1,949.00
|
| Rate for Payer: Cigna Commercial |
$3,235.34
|
| Rate for Payer: First Health Commercial |
$3,703.10
|
| Rate for Payer: Humana Commercial |
$3,313.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,196.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$779.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.38
|
| Rate for Payer: PHCS Commercial |
$3,742.08
|
| Rate for Payer: United Healthcare All Payer |
$3,430.24
|
|
|
EXC MALIG LES 2.1-3.0 CM
|
Facility
|
OP
|
$3,898.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.74 |
| Max. Negotiated Rate |
$3,742.08 |
| Rate for Payer: Aetna Commercial |
$3,001.46
|
| Rate for Payer: Anthem Medicaid |
$1,340.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,949.00
|
| Rate for Payer: Cash Price |
$1,949.00
|
| Rate for Payer: Cigna Commercial |
$3,235.34
|
| Rate for Payer: First Health Commercial |
$3,703.10
|
| Rate for Payer: Humana Commercial |
$3,313.30
|
| Rate for Payer: Humana KY Medicaid |
$1,340.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,196.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$779.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.38
|
| Rate for Payer: PHCS Commercial |
$3,742.08
|
| Rate for Payer: United Healthcare All Payer |
$3,430.24
|
|
|
EXC MALIG LES 2.1-3.0 CM(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761P0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.77 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$267.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$106.14
|
| Rate for Payer: Anthem Medicaid |
$102.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$347.67
|
| Rate for Payer: Healthspan PPO |
$300.03
|
| Rate for Payer: Humana Medicaid |
$102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.83
|
| Rate for Payer: Molina Healthcare Passport |
$102.77
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$111.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.80
|
|
|
EXC MALIG LES 2.1-3.0 CM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761P0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$294.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$120.36
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$368.35
|
| Rate for Payer: Healthspan PPO |
$321.68
|
| Rate for Payer: Humana Medicaid |
$125.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$263.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.68
|
| Rate for Payer: Molina Healthcare Passport |
$125.18
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$126.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.43
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
OP
|
$3,298.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761T0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.74 |
| Max. Negotiated Rate |
$3,166.08 |
| Rate for Payer: Aetna Commercial |
$2,539.46
|
| Rate for Payer: Anthem Medicaid |
$1,134.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,572.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,649.00
|
| Rate for Payer: Cash Price |
$1,649.00
|
| Rate for Payer: Cigna Commercial |
$2,737.34
|
| Rate for Payer: First Health Commercial |
$3,133.10
|
| Rate for Payer: Humana Commercial |
$2,803.30
|
| Rate for Payer: Humana KY Medicaid |
$1,134.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,145.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,704.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,156.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,902.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,473.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.38
|
| Rate for Payer: PHCS Commercial |
$3,166.08
|
| Rate for Payer: United Healthcare All Payer |
$2,902.24
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
IP
|
$3,298.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
761T0084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.74 |
| Max. Negotiated Rate |
$3,166.08 |
| Rate for Payer: Aetna Commercial |
$2,539.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,572.44
|
| Rate for Payer: Cash Price |
$1,649.00
|
| Rate for Payer: Cigna Commercial |
$2,737.34
|
| Rate for Payer: First Health Commercial |
$3,133.10
|
| Rate for Payer: Humana Commercial |
$2,803.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,704.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,902.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,473.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.38
|
| Rate for Payer: PHCS Commercial |
$3,166.08
|
| Rate for Payer: United Healthcare All Payer |
$2,902.24
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761T0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.59 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.33
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
EXC MALIG LES 2.1-3.0 CM(T
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
761T0078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.59 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem Medicaid |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Humana KY Medicaid |
$840.15
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.33
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$922.25
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Aetna Commercial |
$294.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.75
|
| Rate for Payer: Anthem Medicaid |
$115.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,975.00
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$376.86
|
| Rate for Payer: Healthspan PPO |
$332.16
|
| Rate for Payer: Humana Medicaid |
$115.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$265.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.60
|
| Rate for Payer: Molina Healthcare Passport |
$115.29
|
| Rate for Payer: Multiplan PHCS |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,082.50
|
| Rate for Payer: UHCCP Medicaid |
$116.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.44
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Professional
|
Both
|
$4,340.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$4,340.00 |
| Rate for Payer: Aetna Commercial |
$336.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.88
|
| Rate for Payer: Anthem Medicaid |
$150.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,340.00
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$307.39
|
| Rate for Payer: Healthspan PPO |
$363.33
|
| Rate for Payer: Humana Medicaid |
$150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$299.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.01
|
| Rate for Payer: Molina Healthcare Passport |
$150.01
|
| Rate for Payer: Multiplan PHCS |
$2,604.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,038.00
|
| Rate for Payer: UHCCP Medicaid |
$140.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.51
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
IP
|
$4,340.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.20 |
| Max. Negotiated Rate |
$4,166.40 |
| Rate for Payer: Aetna Commercial |
$3,341.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.20
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$3,602.20
|
| Rate for Payer: First Health Commercial |
$4,123.00
|
| Rate for Payer: Humana Commercial |
$3,689.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,558.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.40
|
| Rate for Payer: PHCS Commercial |
$4,166.40
|
| Rate for Payer: United Healthcare All Payer |
$3,819.20
|
|
|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
OP
|
$4,340.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.20 |
| Max. Negotiated Rate |
$4,166.40 |
| Rate for Payer: Aetna Commercial |
$3,341.80
|
| Rate for Payer: Anthem Medicaid |
$1,492.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$3,602.20
|
| Rate for Payer: First Health Commercial |
$4,123.00
|
| Rate for Payer: Humana Commercial |
$3,689.00
|
| Rate for Payer: Humana KY Medicaid |
$1,492.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,558.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,522.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.40
|
| Rate for Payer: PHCS Commercial |
$4,166.40
|
| Rate for Payer: United Healthcare All Payer |
$3,819.20
|
|
