|
EXC TUMOR - FOREARM - WRIST
|
Facility
|
OP
|
$4,051.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
76100575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,393.14 |
| Max. Negotiated Rate |
$3,888.96 |
| Rate for Payer: Aetna Commercial |
$3,119.27
|
| Rate for Payer: Anthem Medicaid |
$1,393.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,159.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cigna Commercial |
$3,362.33
|
| Rate for Payer: First Health Commercial |
$3,848.45
|
| Rate for Payer: Humana Commercial |
$3,443.35
|
| Rate for Payer: Humana KY Medicaid |
$1,393.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,321.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,989.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,564.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,038.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,240.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,524.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.19
|
| Rate for Payer: PHCS Commercial |
$3,888.96
|
| Rate for Payer: United Healthcare All Payer |
$3,564.88
|
|
|
EXC TUMOR - FOREARM - WRIST
|
Professional
|
Both
|
$4,051.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
76100575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.65 |
| Max. Negotiated Rate |
$2,430.60 |
| Rate for Payer: Aetna Commercial |
$470.38
|
| Rate for Payer: Ambetter Exchange |
$301.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.65
|
| Rate for Payer: Anthem Medicaid |
$173.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.24
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cigna Commercial |
$613.73
|
| Rate for Payer: Healthspan PPO |
$426.07
|
| Rate for Payer: Humana Medicaid |
$173.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.13
|
| Rate for Payer: Molina Healthcare Passport |
$173.66
|
| Rate for Payer: Multiplan PHCS |
$2,430.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.43
|
| Rate for Payer: UHCCP Medicaid |
$170.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.87
|
|
|
EXC TUMOR - FOREARM - WRIST(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
761P0575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.65 |
| Max. Negotiated Rate |
$613.73 |
| Rate for Payer: Aetna Commercial |
$470.38
|
| Rate for Payer: Ambetter Exchange |
$301.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.65
|
| Rate for Payer: Anthem Medicaid |
$173.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.24
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$613.73
|
| Rate for Payer: Healthspan PPO |
$426.07
|
| Rate for Payer: Humana Medicaid |
$173.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.13
|
| Rate for Payer: Molina Healthcare Passport |
$173.66
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.43
|
| Rate for Payer: UHCCP Medicaid |
$170.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.87
|
|
|
EXC TUMOR - FOREARM - WRIST(T
|
Facility
|
OP
|
$3,401.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
761T0575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,169.60 |
| Max. Negotiated Rate |
$3,264.96 |
| Rate for Payer: Aetna Commercial |
$2,618.77
|
| Rate for Payer: Anthem Medicaid |
$1,169.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cigna Commercial |
$2,822.83
|
| Rate for Payer: First Health Commercial |
$3,230.95
|
| Rate for Payer: Humana Commercial |
$2,890.85
|
| Rate for Payer: Humana KY Medicaid |
$1,169.60
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,193.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.69
|
| Rate for Payer: PHCS Commercial |
$3,264.96
|
| Rate for Payer: United Healthcare All Payer |
$2,992.88
|
|
|
EXC TUMOR - FOREARM - WRIST(T
|
Facility
|
IP
|
$3,401.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
761T0575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.30 |
| Max. Negotiated Rate |
$3,264.96 |
| Rate for Payer: Aetna Commercial |
$2,618.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.78
|
| Rate for Payer: Cash Price |
$1,700.50
|
| Rate for Payer: Cigna Commercial |
$2,822.83
|
| Rate for Payer: First Health Commercial |
$3,230.95
|
| Rate for Payer: Humana Commercial |
$2,890.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,720.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.69
|
| Rate for Payer: PHCS Commercial |
$3,264.96
|
| Rate for Payer: United Healthcare All Payer |
$2,992.88
|
|
|
EXC TUMOR HAND OR FINGER
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
76100668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$755.44 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Ambetter Exchange |
$318.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.44
|
| Rate for Payer: Anthem Medicaid |
$170.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.46
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$562.63
|
| Rate for Payer: Healthspan PPO |
$755.44
|
| Rate for Payer: Humana Medicaid |
$170.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$419.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.56
|
| Rate for Payer: Molina Healthcare Passport |
$170.16
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$414.34
|
| Rate for Payer: UHCCP Medicaid |
$178.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.72
|
|
|
EXC TUMOR HAND OR FINGER
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
76100668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
EXC TUMOR HAND OR FINGER
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
76100668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
EXC TUMOR HAND OR FINGER(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
761P0668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$755.44 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Ambetter Exchange |
$318.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.44
|
| Rate for Payer: Anthem Medicaid |
$170.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.46
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$562.63
|
| Rate for Payer: Healthspan PPO |
$755.44
|
| Rate for Payer: Humana Medicaid |
$170.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$419.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.56
|
| Rate for Payer: Molina Healthcare Passport |
$170.16
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$414.34
|
| Rate for Payer: UHCCP Medicaid |
$178.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.72
|
|
|
EXC TUMOR PELVIS & HIP AREA
|
Facility
|
OP
|
$8,099.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
76100768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,775.04 |
| Rate for Payer: Aetna Commercial |
$6,236.23
|
| Rate for Payer: Anthem Medicaid |
$2,785.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$4,049.50
|
| Rate for Payer: Cash Price |
$4,049.50
|
| Rate for Payer: Cigna Commercial |
$6,722.17
|
| Rate for Payer: First Health Commercial |
$7,694.05
|
| Rate for Payer: Humana Commercial |
$6,884.15
|
| Rate for Payer: Humana KY Medicaid |
$2,785.25
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,813.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,046.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,588.31
|
| Rate for Payer: PHCS Commercial |
$7,775.04
|
| Rate for Payer: United Healthcare All Payer |
$7,127.12
|
|
|
EXC TUMOR PELVIS & HIP AREA
|
Facility
|
IP
|
$8,099.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
76100768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,429.70 |
| Max. Negotiated Rate |
$7,775.04 |
| Rate for Payer: Aetna Commercial |
$6,236.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.22
|
| Rate for Payer: Cash Price |
$4,049.50
|
| Rate for Payer: Cigna Commercial |
$6,722.17
|
| Rate for Payer: First Health Commercial |
$7,694.05
|
| Rate for Payer: Humana Commercial |
$6,884.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,046.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,588.31
|
| Rate for Payer: PHCS Commercial |
$7,775.04
|
| Rate for Payer: United Healthcare All Payer |
$7,127.12
|
|
|
EXC TUMOR PELVIS & HIP AREA
|
Professional
|
Both
|
$8,099.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
76100768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.44 |
| Max. Negotiated Rate |
$4,859.40 |
| Rate for Payer: Aetna Commercial |
$754.13
|
| Rate for Payer: Ambetter Exchange |
$344.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.44
|
| Rate for Payer: Anthem Medicaid |
$268.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.36
|
| Rate for Payer: Cash Price |
$4,049.50
|
| Rate for Payer: Cash Price |
$4,049.50
|
| Rate for Payer: Cigna Commercial |
$810.71
|
| Rate for Payer: Healthspan PPO |
$800.89
|
| Rate for Payer: Humana Medicaid |
$268.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.94
|
| Rate for Payer: Molina Healthcare Passport |
$268.57
|
| Rate for Payer: Multiplan PHCS |
$4,859.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$447.81
|
| Rate for Payer: UHCCP Medicaid |
$225.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.47
|
|
|
EXC TUMOR PELVIS & HIP AREA(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
761P0768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.44 |
| Max. Negotiated Rate |
$810.71 |
| Rate for Payer: Aetna Commercial |
$754.13
|
| Rate for Payer: Ambetter Exchange |
$344.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.44
|
| Rate for Payer: Anthem Medicaid |
$268.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.36
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$810.71
|
| Rate for Payer: Healthspan PPO |
$800.89
|
| Rate for Payer: Humana Medicaid |
$268.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.94
|
| Rate for Payer: Molina Healthcare Passport |
$268.57
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$447.81
|
| Rate for Payer: UHCCP Medicaid |
$225.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.47
|
|
|
EXC TUMOR PELVIS & HIP AREA(T
|
Facility
|
OP
|
$7,224.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
761T0768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,484.33 |
| Max. Negotiated Rate |
$6,935.04 |
| Rate for Payer: Aetna Commercial |
$5,562.48
|
| Rate for Payer: Anthem Medicaid |
$2,484.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,634.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,612.00
|
| Rate for Payer: Cash Price |
$3,612.00
|
| Rate for Payer: Cigna Commercial |
$5,995.92
|
| Rate for Payer: First Health Commercial |
$6,862.80
|
| Rate for Payer: Humana Commercial |
$6,140.40
|
| Rate for Payer: Humana KY Medicaid |
$2,484.33
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,509.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,923.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,331.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,534.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,357.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,418.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,779.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,284.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.56
|
| Rate for Payer: PHCS Commercial |
$6,935.04
|
| Rate for Payer: United Healthcare All Payer |
$6,357.12
|
|
|
EXC TUMOR PELVIS & HIP AREA(T
|
Facility
|
IP
|
$7,224.00
|
|
|
Service Code
|
HCPCS 27047
|
| Hospital Charge Code |
761T0768
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,167.20 |
| Max. Negotiated Rate |
$6,935.04 |
| Rate for Payer: Aetna Commercial |
$5,562.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,634.72
|
| Rate for Payer: Cash Price |
$3,612.00
|
| Rate for Payer: Cigna Commercial |
$5,995.92
|
| Rate for Payer: First Health Commercial |
$6,862.80
|
| Rate for Payer: Humana Commercial |
$6,140.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,923.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,331.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,167.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,357.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,418.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,779.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,284.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.56
|
| Rate for Payer: PHCS Commercial |
$6,935.04
|
| Rate for Payer: United Healthcare All Payer |
$6,357.12
|
|
|
EXC. TUMOR - THIGH - DEEP
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
76100814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.72 |
| Max. Negotiated Rate |
$772.99 |
| Rate for Payer: Aetna Commercial |
$609.54
|
| Rate for Payer: Ambetter Exchange |
$594.61
|
| Rate for Payer: Anthem Medicaid |
$282.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$594.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$594.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$713.53
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$658.28
|
| Rate for Payer: Healthspan PPO |
$552.12
|
| Rate for Payer: Humana Medicaid |
$282.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$594.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.37
|
| Rate for Payer: Molina Healthcare Passport |
$282.72
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.99
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$594.61
|
|
|
EXC. TUMOR - THIGH - DEEP
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
76100814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXC. TUMOR - THIGH - DEEP
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
76100814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXC. TUMOR - THIGH - DEEP(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
761P0814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.72 |
| Max. Negotiated Rate |
$772.99 |
| Rate for Payer: Aetna Commercial |
$609.54
|
| Rate for Payer: Ambetter Exchange |
$594.61
|
| Rate for Payer: Anthem Medicaid |
$282.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$594.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$594.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$713.53
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$658.28
|
| Rate for Payer: Healthspan PPO |
$552.12
|
| Rate for Payer: Humana Medicaid |
$282.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$594.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.37
|
| Rate for Payer: Molina Healthcare Passport |
$282.72
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.99
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$594.61
|
|
|
EXECDRIN X/S CAP
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 46122038278
|
| Hospital Charge Code |
25000647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
EXECDRIN X/S CAP
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 46122038278
|
| Hospital Charge Code |
25000647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
EXELON 13.3 MG 24HR PATCH
|
Facility
|
IP
|
$39.87
|
|
|
Service Code
|
NDC 78050315
|
| Hospital Charge Code |
25000650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$38.28 |
| Rate for Payer: Aetna Commercial |
$30.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.10
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: First Health Commercial |
$37.88
|
| Rate for Payer: Humana Commercial |
$33.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.09
|
| Rate for Payer: Ohio Health Group HMO |
$29.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.51
|
| Rate for Payer: PHCS Commercial |
$38.28
|
| Rate for Payer: United Healthcare All Payer |
$35.09
|
|
|
EXELON 13.3 MG 24HR PATCH
|
Facility
|
OP
|
$39.87
|
|
|
Service Code
|
NDC 78050315
|
| Hospital Charge Code |
25000650
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$38.28 |
| Rate for Payer: Aetna Commercial |
$30.70
|
| Rate for Payer: Anthem Medicaid |
$13.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.10
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: First Health Commercial |
$37.88
|
| Rate for Payer: Humana Commercial |
$33.89
|
| Rate for Payer: Humana KY Medicaid |
$13.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.09
|
| Rate for Payer: Ohio Health Group HMO |
$29.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.51
|
| Rate for Payer: PHCS Commercial |
$38.28
|
| Rate for Payer: United Healthcare All Payer |
$35.09
|
|
|
EXELON 4.6MG/24HR PATCH
|
Facility
|
OP
|
$30.52
|
|
|
Service Code
|
NDC 781730431
|
| Hospital Charge Code |
25000651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: Anthem Medicaid |
$10.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.81
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cigna Commercial |
$25.33
|
| Rate for Payer: First Health Commercial |
$28.99
|
| Rate for Payer: Humana Commercial |
$25.94
|
| Rate for Payer: Humana KY Medicaid |
$10.50
|
| Rate for Payer: Kentucky WC Medicaid |
$10.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.86
|
| Rate for Payer: Ohio Health Group HMO |
$22.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.06
|
| Rate for Payer: PHCS Commercial |
$29.30
|
| Rate for Payer: United Healthcare All Payer |
$26.86
|
|
|
EXELON 4.6MG/24HR PATCH
|
Facility
|
IP
|
$30.52
|
|
|
Service Code
|
NDC 781730431
|
| Hospital Charge Code |
25000651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.81
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cigna Commercial |
$25.33
|
| Rate for Payer: First Health Commercial |
$28.99
|
| Rate for Payer: Humana Commercial |
$25.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.86
|
| Rate for Payer: Ohio Health Group HMO |
$22.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.06
|
| Rate for Payer: PHCS Commercial |
$29.30
|
| Rate for Payer: United Healthcare All Payer |
$26.86
|
|
