|
EXC MALIG LES 3.1-4.0 CM
|
Facility
|
OP
|
$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 Medicaid |
$1,023.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,487.50
|
| 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: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| 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 |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| 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(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761P0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$650.00 |
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| 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 |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$140.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.51
|
|
|
EXC MALIG LES 3.1-4.0 CM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761P0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$400.00 |
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$116.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.44
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
OP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761T0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| 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 |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.90
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761T0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
IP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
761T0085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.90
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
EXC MALIG LES 3.1-4.0 CM(T
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
761T0079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem Medicaid |
$885.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$894.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$903.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
OP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem Medicaid |
$847.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Humana KY Medicaid |
$847.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$864.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.84
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
IP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$739.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.84
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIG LES .6-1.0 CM
|
Professional
|
Both
|
$1,694.10
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,694.10 |
| Rate for Payer: Aetna Commercial |
$203.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$76.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,694.10
|
| Rate for Payer: Cash Price |
$847.05
|
| Rate for Payer: Cash Price |
$847.05
|
| Rate for Payer: Cigna Commercial |
$273.61
|
| Rate for Payer: Healthspan PPO |
$239.59
|
| Rate for Payer: Humana Medicaid |
$76.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.25
|
| Rate for Payer: Molina Healthcare Passport |
$76.72
|
| Rate for Payer: Multiplan PHCS |
$1,016.46
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,185.87
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.49
|
|
|
EXC MALIG LES .6-1.0 CM
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$2,464.00 |
| Rate for Payer: Aetna Commercial |
$206.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.03
|
| Rate for Payer: Anthem Medicaid |
$83.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,464.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$274.75
|
| Rate for Payer: Healthspan PPO |
$241.77
|
| Rate for Payer: Humana Medicaid |
$83.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.37
|
| Rate for Payer: Molina Healthcare Passport |
$83.70
|
| Rate for Payer: Multiplan PHCS |
$1,478.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,724.80
|
| Rate for Payer: UHCCP Medicaid |
$84.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.54
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
OP
|
$1,694.10
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.23 |
| Max. Negotiated Rate |
$1,626.34 |
| Rate for Payer: Aetna Commercial |
$1,304.46
|
| Rate for Payer: Anthem Medicaid |
$582.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$847.05
|
| Rate for Payer: Cash Price |
$847.05
|
| Rate for Payer: Cigna Commercial |
$1,406.10
|
| Rate for Payer: First Health Commercial |
$1,609.40
|
| Rate for Payer: Humana Commercial |
$1,439.98
|
| Rate for Payer: Humana KY Medicaid |
$582.60
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$588.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,490.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.17
|
| Rate for Payer: PHCS Commercial |
$1,626.34
|
| Rate for Payer: United Healthcare All Payer |
$1,490.81
|
|
|
EXC MALIG LES .6-1.0 CM
|
Facility
|
IP
|
$1,694.10
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
76100076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.23 |
| Max. Negotiated Rate |
$1,626.34 |
| Rate for Payer: Aetna Commercial |
$1,304.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.40
|
| Rate for Payer: Cash Price |
$847.05
|
| Rate for Payer: Cigna Commercial |
$1,406.10
|
| Rate for Payer: First Health Commercial |
$1,609.40
|
| Rate for Payer: Humana Commercial |
$1,439.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,490.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.17
|
| Rate for Payer: PHCS Commercial |
$1,626.34
|
| Rate for Payer: United Healthcare All Payer |
$1,490.81
|
|
|
EXC MALIG LES .6-1.0 CM(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761P0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$206.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.03
|
| Rate for Payer: Anthem Medicaid |
$83.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$274.75
|
| Rate for Payer: Healthspan PPO |
$241.77
|
| Rate for Payer: Humana Medicaid |
$83.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.37
|
| Rate for Payer: Molina Healthcare Passport |
$83.70
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$84.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.54
|
|
|
EXC MALIG LES .6-1.0 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761P0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$203.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$76.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$273.61
|
| Rate for Payer: Healthspan PPO |
$239.59
|
| Rate for Payer: Humana Medicaid |
$76.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.25
|
| Rate for Payer: Molina Healthcare Passport |
$76.72
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.49
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
IP
|
$2,089.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761T0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.57 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.59
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
OP
|
$1,394.10
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761T0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.23 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna Commercial |
$1,073.46
|
| Rate for Payer: Anthem Medicaid |
$479.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: First Health Commercial |
$1,324.40
|
| Rate for Payer: Humana Commercial |
$1,184.98
|
| Rate for Payer: Humana KY Medicaid |
$479.43
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$484.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$489.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.17
|
| Rate for Payer: PHCS Commercial |
$1,338.34
|
| Rate for Payer: United Healthcare All Payer |
$1,226.81
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
IP
|
$1,394.10
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
761T0076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.23 |
| Max. Negotiated Rate |
$1,338.34 |
| Rate for Payer: Aetna Commercial |
$1,073.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,087.40
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: First Health Commercial |
$1,324.40
|
| Rate for Payer: Humana Commercial |
$1,184.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,028.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,226.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,045.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.17
|
| Rate for Payer: PHCS Commercial |
$1,338.34
|
| Rate for Payer: United Healthcare All Payer |
$1,226.81
|
|
|
EXC MALIG LES .6-1.0 CM(T
|
Facility
|
OP
|
$2,089.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
761T0082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.57 |
| Max. Negotiated Rate |
$2,005.44 |
| Rate for Payer: Aetna Commercial |
$1,608.53
|
| Rate for Payer: Anthem Medicaid |
$718.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cash Price |
$1,044.50
|
| Rate for Payer: Cigna Commercial |
$1,733.87
|
| Rate for Payer: First Health Commercial |
$1,984.55
|
| Rate for Payer: Humana Commercial |
$1,775.65
|
| Rate for Payer: Humana KY Medicaid |
$718.41
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$725.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,838.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.59
|
| Rate for Payer: PHCS Commercial |
$2,005.44
|
| Rate for Payer: United Healthcare All Payer |
$1,838.32
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Professional
|
Both
|
$5,516.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$5,516.00 |
| Rate for Payer: Aetna Commercial |
$424.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.41
|
| Rate for Payer: Anthem Medicaid |
$227.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,516.00
|
| Rate for Payer: Cash Price |
$2,758.00
|
| Rate for Payer: Cash Price |
$2,758.00
|
| Rate for Payer: Cigna Commercial |
$527.28
|
| Rate for Payer: Healthspan PPO |
$446.23
|
| Rate for Payer: Humana Medicaid |
$227.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.64
|
| Rate for Payer: Molina Healthcare Passport |
$227.10
|
| Rate for Payer: Multiplan PHCS |
$3,309.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,861.20
|
| Rate for Payer: UHCCP Medicaid |
$169.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.37
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
OP
|
$4,635.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.55 |
| Max. Negotiated Rate |
$4,449.60 |
| Rate for Payer: Aetna Commercial |
$3,568.95
|
| Rate for Payer: Anthem Medicaid |
$1,593.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,615.30
|
| 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 |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna Commercial |
$3,847.05
|
| Rate for Payer: First Health Commercial |
$4,403.25
|
| Rate for Payer: Humana Commercial |
$3,939.75
|
| Rate for Payer: Humana KY Medicaid |
$1,593.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,610.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,800.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,420.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,078.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.85
|
| Rate for Payer: PHCS Commercial |
$4,449.60
|
| Rate for Payer: United Healthcare All Payer |
$4,078.80
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Professional
|
Both
|
$4,635.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Aetna Commercial |
$439.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.27
|
| Rate for Payer: Anthem Medicaid |
$194.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,635.00
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna Commercial |
$390.19
|
| Rate for Payer: Healthspan PPO |
$471.17
|
| Rate for Payer: Humana Medicaid |
$194.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$394.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.39
|
| Rate for Payer: Molina Healthcare Passport |
$194.50
|
| Rate for Payer: Multiplan PHCS |
$2,781.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,244.50
|
| Rate for Payer: UHCCP Medicaid |
$169.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.44
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
OP
|
$5,516.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.08 |
| Max. Negotiated Rate |
$5,295.36 |
| Rate for Payer: Aetna Commercial |
$4,247.32
|
| Rate for Payer: Anthem Medicaid |
$1,896.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,302.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,758.00
|
| Rate for Payer: Cash Price |
$2,758.00
|
| Rate for Payer: Cigna Commercial |
$4,578.28
|
| Rate for Payer: First Health Commercial |
$5,240.20
|
| Rate for Payer: Humana Commercial |
$4,688.60
|
| Rate for Payer: Humana KY Medicaid |
$1,896.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,916.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,523.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,070.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,935.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,854.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,709.96
|
| Rate for Payer: PHCS Commercial |
$5,295.36
|
| Rate for Payer: United Healthcare All Payer |
$4,854.08
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
IP
|
$4,635.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.55 |
| Max. Negotiated Rate |
$4,449.60 |
| Rate for Payer: Aetna Commercial |
$3,568.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,615.30
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna Commercial |
$3,847.05
|
| Rate for Payer: First Health Commercial |
$4,403.25
|
| Rate for Payer: Humana Commercial |
$3,939.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,800.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,420.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,078.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.85
|
| Rate for Payer: PHCS Commercial |
$4,449.60
|
| Rate for Payer: United Healthcare All Payer |
$4,078.80
|
|
|
EXC MALIG LES OVER 4.0 CM
|
Facility
|
IP
|
$5,516.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.08 |
| Max. Negotiated Rate |
$5,295.36 |
| Rate for Payer: Aetna Commercial |
$4,247.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,302.48
|
| Rate for Payer: Cash Price |
$2,758.00
|
| Rate for Payer: Cigna Commercial |
$4,578.28
|
| Rate for Payer: First Health Commercial |
$5,240.20
|
| Rate for Payer: Humana Commercial |
$4,688.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,523.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,070.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,654.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,854.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,709.96
|
| Rate for Payer: PHCS Commercial |
$5,295.36
|
| Rate for Payer: United Healthcare All Payer |
$4,854.08
|
|
