|
EXC MALIG LES OVER 4.0 CM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
761P0080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$600.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| 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 |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$169.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.44
|
|
|
EXC MALIG LES OVER 4.0 CM(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
761P0086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$700.00 |
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| 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 |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$169.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.37
|
|
|
EXC MALIG LES OVER 4.0 CM(T
|
Facility
|
IP
|
$4,035.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
761T0080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.55 |
| Max. Negotiated Rate |
$3,873.60 |
| Rate for Payer: Aetna Commercial |
$3,106.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.30
|
| Rate for Payer: Cash Price |
$2,017.50
|
| Rate for Payer: Cigna Commercial |
$3,349.05
|
| Rate for Payer: First Health Commercial |
$3,833.25
|
| Rate for Payer: Humana Commercial |
$3,429.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.85
|
| Rate for Payer: PHCS Commercial |
$3,873.60
|
| Rate for Payer: United Healthcare All Payer |
$3,550.80
|
|
|
EXC MALIG LES OVER 4.0 CM(T
|
Facility
|
IP
|
$4,816.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
761T0086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.08 |
| Max. Negotiated Rate |
$4,623.36 |
| Rate for Payer: Aetna Commercial |
$3,708.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,756.48
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Cigna Commercial |
$3,997.28
|
| Rate for Payer: First Health Commercial |
$4,575.20
|
| Rate for Payer: Humana Commercial |
$4,093.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,949.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,554.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,444.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,238.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.96
|
| Rate for Payer: PHCS Commercial |
$4,623.36
|
| Rate for Payer: United Healthcare All Payer |
$4,238.08
|
|
|
EXC MALIG LES OVER 4.0 CM(T
|
Facility
|
OP
|
$4,816.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
761T0086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.08 |
| Max. Negotiated Rate |
$4,623.36 |
| Rate for Payer: Aetna Commercial |
$3,708.32
|
| Rate for Payer: Anthem Medicaid |
$1,656.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,756.48
|
| 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 |
$2,408.00
|
| Rate for Payer: Cash Price |
$2,408.00
|
| Rate for Payer: Cigna Commercial |
$3,997.28
|
| Rate for Payer: First Health Commercial |
$4,575.20
|
| Rate for Payer: Humana Commercial |
$4,093.60
|
| Rate for Payer: Humana KY Medicaid |
$1,656.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,673.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,949.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,554.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,689.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,238.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.96
|
| Rate for Payer: PHCS Commercial |
$4,623.36
|
| Rate for Payer: United Healthcare All Payer |
$4,238.08
|
|
|
EXC MALIG LES OVER 4.0 CM(T
|
Facility
|
OP
|
$4,035.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
761T0080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.55 |
| Max. Negotiated Rate |
$3,873.60 |
| Rate for Payer: Aetna Commercial |
$3,106.95
|
| Rate for Payer: Anthem Medicaid |
$1,387.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.30
|
| 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 |
$2,017.50
|
| Rate for Payer: Cash Price |
$2,017.50
|
| Rate for Payer: Cigna Commercial |
$3,349.05
|
| Rate for Payer: First Health Commercial |
$3,833.25
|
| Rate for Payer: Humana Commercial |
$3,429.75
|
| Rate for Payer: Humana KY Medicaid |
$1,387.64
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.85
|
| Rate for Payer: PHCS Commercial |
$3,873.60
|
| Rate for Payer: United Healthcare All Payer |
$3,550.80
|
|
|
EXC MALIG LES UP TO 0.5CM
|
Facility
|
IP
|
$2,829.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
76100087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$2,715.84 |
| Rate for Payer: Aetna Commercial |
$2,178.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$2,348.07
|
| Rate for Payer: First Health Commercial |
$2,687.55
|
| Rate for Payer: Humana Commercial |
$2,404.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,319.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,087.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$848.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,489.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,121.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$565.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$367.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$876.99
|
| Rate for Payer: PHCS Commercial |
$2,715.84
|
| Rate for Payer: United Healthcare All Payer |
$2,489.52
|
|
|
EXC MALIG LES UP TO 0.5CM
|
Facility
|
OP
|
$2,829.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
76100087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$2,715.84 |
| Rate for Payer: Aetna Commercial |
$2,178.33
|
| Rate for Payer: Anthem Medicaid |
$972.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,206.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$2,348.07
|
| Rate for Payer: First Health Commercial |
$2,687.55
|
| Rate for Payer: Humana Commercial |
$2,404.65
|
| Rate for Payer: Humana KY Medicaid |
$972.89
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$982.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,319.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,087.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$992.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,489.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,121.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$565.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$367.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$876.99
|
| Rate for Payer: PHCS Commercial |
$2,715.84
|
| Rate for Payer: United Healthcare All Payer |
$2,489.52
|
|
|
EXC MALIG LES UP TO 0.5CM
|
Professional
|
Both
|
$2,829.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
76100087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$2,829.00 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.29
|
| Rate for Payer: Anthem Medicaid |
$69.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,829.00
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$244.06
|
| Rate for Payer: Healthspan PPO |
$206.86
|
| Rate for Payer: Humana Medicaid |
$69.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.58
|
| Rate for Payer: Molina Healthcare Passport |
$69.20
|
| Rate for Payer: Multiplan PHCS |
$1,697.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,980.30
|
| Rate for Payer: UHCCP Medicaid |
$75.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.89
|
|
|
EXC MALIG LES UP TO 0.5CM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
761P0087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.29
|
| Rate for Payer: Anthem Medicaid |
$69.20
|
| 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 |
$244.06
|
| Rate for Payer: Healthspan PPO |
$206.86
|
| Rate for Payer: Humana Medicaid |
$69.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.58
|
| Rate for Payer: Molina Healthcare Passport |
$69.20
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$75.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.89
|
|
|
EXC MALIG LES UP TO 0.5CM(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
761T0087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
EXC MALIG LES UP TO 0.5CM(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
761T0087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
EXC MALIG LES UP TO .5 CM
|
Professional
|
Both
|
$3,519.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Aetna Commercial |
$159.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.80
|
| Rate for Payer: Anthem Medicaid |
$58.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,519.00
|
| Rate for Payer: Cash Price |
$1,759.50
|
| Rate for Payer: Cash Price |
$1,759.50
|
| Rate for Payer: Cigna Commercial |
$236.20
|
| Rate for Payer: Healthspan PPO |
$197.49
|
| Rate for Payer: Humana Medicaid |
$58.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.91
|
| Rate for Payer: Molina Healthcare Passport |
$58.74
|
| Rate for Payer: Multiplan PHCS |
$2,111.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,463.30
|
| Rate for Payer: UHCCP Medicaid |
$72.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.33
|
|
|
EXC MALIG LES UP TO .5 CM
|
Facility
|
IP
|
$2,635.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$2,529.60 |
| Rate for Payer: Aetna Commercial |
$2,028.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,055.30
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$2,187.05
|
| Rate for Payer: First Health Commercial |
$2,503.25
|
| Rate for Payer: Humana Commercial |
$2,239.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,160.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,944.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$790.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,318.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,976.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$527.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.85
|
| Rate for Payer: PHCS Commercial |
$2,529.60
|
| Rate for Payer: United Healthcare All Payer |
$2,318.80
|
|
|
EXC MALIG LES UP TO .5 CM
|
Facility
|
OP
|
$2,635.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$2,529.60 |
| Rate for Payer: Aetna Commercial |
$2,028.95
|
| Rate for Payer: Anthem Medicaid |
$906.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,055.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$2,187.05
|
| Rate for Payer: First Health Commercial |
$2,503.25
|
| Rate for Payer: Humana Commercial |
$2,239.75
|
| Rate for Payer: Humana KY Medicaid |
$906.18
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$915.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,160.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,944.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$924.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,318.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,976.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$527.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.85
|
| Rate for Payer: PHCS Commercial |
$2,529.60
|
| Rate for Payer: United Healthcare All Payer |
$2,318.80
|
|
|
EXC MALIG LES UP TO .5 CM
|
Professional
|
Both
|
$2,635.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$2,635.00 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.70
|
| Rate for Payer: Anthem Medicaid |
$57.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,635.00
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cash Price |
$1,317.50
|
| Rate for Payer: Cigna Commercial |
$236.18
|
| Rate for Payer: Healthspan PPO |
$193.75
|
| Rate for Payer: Humana Medicaid |
$57.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.64
|
| Rate for Payer: Molina Healthcare Passport |
$57.49
|
| Rate for Payer: Multiplan PHCS |
$1,581.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,844.50
|
| Rate for Payer: UHCCP Medicaid |
$71.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.06
|
|
|
EXC MALIG LES UP TO .5 CM
|
Facility
|
IP
|
$3,519.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.47 |
| Max. Negotiated Rate |
$3,378.24 |
| Rate for Payer: Aetna Commercial |
$2,709.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.82
|
| Rate for Payer: Cash Price |
$1,759.50
|
| Rate for Payer: Cigna Commercial |
$2,920.77
|
| Rate for Payer: First Health Commercial |
$3,343.05
|
| Rate for Payer: Humana Commercial |
$2,991.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.89
|
| Rate for Payer: PHCS Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare All Payer |
$3,096.72
|
|
|
EXC MALIG LES UP TO .5 CM
|
Facility
|
OP
|
$3,519.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.47 |
| Max. Negotiated Rate |
$3,378.24 |
| Rate for Payer: Aetna Commercial |
$2,709.63
|
| Rate for Payer: Anthem Medicaid |
$1,210.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.82
|
| 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 |
$1,759.50
|
| Rate for Payer: Cash Price |
$1,759.50
|
| Rate for Payer: Cigna Commercial |
$2,920.77
|
| Rate for Payer: First Health Commercial |
$3,343.05
|
| Rate for Payer: Humana Commercial |
$2,991.15
|
| Rate for Payer: Humana KY Medicaid |
$1,210.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.89
|
| Rate for Payer: PHCS Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare All Payer |
$3,096.72
|
|
|
EXC MALIG LES UP TO .5 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
761P0081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$159.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.80
|
| Rate for Payer: Anthem Medicaid |
$58.74
|
| 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 |
$236.20
|
| Rate for Payer: Healthspan PPO |
$197.49
|
| Rate for Payer: Humana Medicaid |
$58.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.91
|
| Rate for Payer: Molina Healthcare Passport |
$58.74
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$72.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.33
|
|
|
EXC MALIG LES UP TO .5 CM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
761P0075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$157.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.70
|
| Rate for Payer: Anthem Medicaid |
$57.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$236.18
|
| Rate for Payer: Healthspan PPO |
$193.75
|
| Rate for Payer: Humana Medicaid |
$57.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.64
|
| Rate for Payer: Molina Healthcare Passport |
$57.49
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$71.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.06
|
|
|
EXC MALIG LES UP TO .5 CM(T
|
Facility
|
OP
|
$3,219.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
761T0081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.47 |
| Max. Negotiated Rate |
$3,090.24 |
| Rate for Payer: Aetna Commercial |
$2,478.63
|
| Rate for Payer: Anthem Medicaid |
$1,107.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.82
|
| 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 |
$1,609.50
|
| Rate for Payer: Cash Price |
$1,609.50
|
| Rate for Payer: Cigna Commercial |
$2,671.77
|
| Rate for Payer: First Health Commercial |
$3,058.05
|
| Rate for Payer: Humana Commercial |
$2,736.15
|
| Rate for Payer: Humana KY Medicaid |
$1,107.01
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.89
|
| Rate for Payer: PHCS Commercial |
$3,090.24
|
| Rate for Payer: United Healthcare All Payer |
$2,832.72
|
|
|
EXC MALIG LES UP TO .5 CM(T
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
761T0075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$2,289.60 |
| Rate for Payer: Aetna Commercial |
$1,836.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cigna Commercial |
$1,979.55
|
| Rate for Payer: First Health Commercial |
$2,265.75
|
| Rate for Payer: Humana Commercial |
$2,027.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,955.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,760.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$715.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,098.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,788.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$477.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$739.35
|
| Rate for Payer: PHCS Commercial |
$2,289.60
|
| Rate for Payer: United Healthcare All Payer |
$2,098.80
|
|
|
EXC MALIG LES UP TO .5 CM(T
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
761T0075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$2,289.60 |
| Rate for Payer: Aetna Commercial |
$1,836.45
|
| Rate for Payer: Anthem Medicaid |
$820.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,860.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cigna Commercial |
$1,979.55
|
| Rate for Payer: First Health Commercial |
$2,265.75
|
| Rate for Payer: Humana Commercial |
$2,027.25
|
| Rate for Payer: Humana KY Medicaid |
$820.20
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$828.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,955.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,760.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$836.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,098.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,788.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$477.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$739.35
|
| Rate for Payer: PHCS Commercial |
$2,289.60
|
| Rate for Payer: United Healthcare All Payer |
$2,098.80
|
|
|
EXC MALIG LES UP TO .5 CM(T
|
Facility
|
IP
|
$3,219.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
761T0081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.47 |
| Max. Negotiated Rate |
$3,090.24 |
| Rate for Payer: Aetna Commercial |
$2,478.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.82
|
| Rate for Payer: Cash Price |
$1,609.50
|
| Rate for Payer: Cigna Commercial |
$2,671.77
|
| Rate for Payer: First Health Commercial |
$3,058.05
|
| Rate for Payer: Humana Commercial |
$2,736.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.89
|
| Rate for Payer: PHCS Commercial |
$3,090.24
|
| Rate for Payer: United Healthcare All Payer |
$2,832.72
|
|
|
EXC MALIGN INCL MARGINS
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$2,797.44 |
| Rate for Payer: Aetna Commercial |
$2,243.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,272.92
|
| Rate for Payer: Cash Price |
$1,457.00
|
| Rate for Payer: Cigna Commercial |
$2,418.62
|
| Rate for Payer: First Health Commercial |
$2,768.30
|
| Rate for Payer: Humana Commercial |
$2,476.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,389.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,150.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,564.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,185.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.34
|
| Rate for Payer: PHCS Commercial |
$2,797.44
|
| Rate for Payer: United Healthcare All Payer |
$2,564.32
|
|
