|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC
|
Facility
|
IP
|
$20,587.67
|
|
|
Service Code
|
MSDRG 435
|
| Min. Negotiated Rate |
$13,970.21 |
| Max. Negotiated Rate |
$20,587.67 |
| Rate for Payer: Anthem Medicaid |
$13,970.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,705.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,587.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,852.40
|
| Rate for Payer: Humana KY Medicaid |
$13,970.21
|
| Rate for Payer: Humana Medicare Advantage |
$14,705.48
|
| Rate for Payer: Kentucky WC Medicaid |
$14,109.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,646.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,249.61
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,722.40
|
|
|
Service Code
|
MSDRG 437
|
| Min. Negotiated Rate |
$6,597.34 |
| Max. Negotiated Rate |
$9,722.40 |
| Rate for Payer: Anthem Medicaid |
$6,597.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,944.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,722.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,375.17
|
| Rate for Payer: Humana KY Medicaid |
$6,597.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,944.57
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,333.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.29
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$14,023.81
|
|
|
Service Code
|
MSDRG 598
|
| Min. Negotiated Rate |
$9,516.16 |
| Max. Negotiated Rate |
$14,023.81 |
| Rate for Payer: Anthem Medicaid |
$9,516.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,017.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,023.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,522.96
|
| Rate for Payer: Humana KY Medicaid |
$9,516.16
|
| Rate for Payer: Humana Medicare Advantage |
$10,017.01
|
| Rate for Payer: Kentucky WC Medicaid |
$9,611.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,020.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,706.48
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$18,722.96
|
|
|
Service Code
|
MSDRG 597
|
| Min. Negotiated Rate |
$12,704.86 |
| Max. Negotiated Rate |
$18,722.96 |
| Rate for Payer: Anthem Medicaid |
$12,704.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,373.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,722.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,054.28
|
| Rate for Payer: Humana KY Medicaid |
$12,704.86
|
| Rate for Payer: Humana Medicare Advantage |
$13,373.54
|
| Rate for Payer: Kentucky WC Medicaid |
$12,831.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,048.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,958.96
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$7,870.55
|
|
|
Service Code
|
MSDRG 599
|
| Min. Negotiated Rate |
$5,340.73 |
| Max. Negotiated Rate |
$7,870.55 |
| Rate for Payer: Anthem Medicaid |
$5,340.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,621.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,870.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,589.46
|
| Rate for Payer: Humana KY Medicaid |
$5,340.73
|
| Rate for Payer: Humana Medicare Advantage |
$5,621.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5,394.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,746.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,447.54
|
|
|
MAMMO BREAST SPEC-1 VW (SURG)
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
32000184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$30.64
|
| Rate for Payer: Anthem Medicaid |
$18.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.00
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$33.67
|
| Rate for Payer: Healthspan PPO |
$28.71
|
| Rate for Payer: Humana Medicaid |
$18.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.64
|
| Rate for Payer: Molina Healthcare Passport |
$18.27
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.50
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.45
|
|
|
MAMMO BREAST SPEC-1 VW (SURG)
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
32000184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
MAMMO BREAST SPEC-1 VW (SURG)
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
32000184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
MAMMO BREAST SPEC-1 VW (SURG(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
320P0184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$30.64
|
| Rate for Payer: Anthem Medicaid |
$18.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.67
|
| Rate for Payer: Healthspan PPO |
$28.71
|
| Rate for Payer: Humana Medicaid |
$18.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.64
|
| Rate for Payer: Molina Healthcare Passport |
$18.27
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.45
|
|
|
MAMMO BREAST SPEC-1 VW (SURG(T
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
320T0184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$667.88 |
| Rate for Payer: Aetna Commercial |
$527.45
|
| Rate for Payer: Anthem Medicaid |
$235.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$568.55
|
| Rate for Payer: First Health Commercial |
$650.75
|
| Rate for Payer: Humana Commercial |
$582.25
|
| Rate for Payer: Humana KY Medicaid |
$235.57
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$237.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$561.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$505.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$602.80
|
| Rate for Payer: Ohio Health Group HMO |
$513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.35
|
| Rate for Payer: PHCS Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Payer |
$602.80
|
|
|
MAMMO BREAST SPEC-1 VW (SURG(T
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
320T0184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna Commercial |
$527.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.30
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$568.55
|
| Rate for Payer: First Health Commercial |
$650.75
|
| Rate for Payer: Humana Commercial |
$582.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$561.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$505.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$602.80
|
| Rate for Payer: Ohio Health Group HMO |
$513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.35
|
| Rate for Payer: PHCS Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Payer |
$602.80
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Professional
|
Both
|
$2,059.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$2,059.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.75
|
| Rate for Payer: Anthem Medicaid |
$82.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,059.00
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cigna Commercial |
$385.31
|
| Rate for Payer: Healthspan PPO |
$299.08
|
| Rate for Payer: Humana Medicaid |
$82.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.51
|
| Rate for Payer: Molina Healthcare Passport |
$82.85
|
| Rate for Payer: Multiplan PHCS |
$1,235.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,441.30
|
| Rate for Payer: UHCCP Medicaid |
$82.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.68
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
761P0292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$385.31 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.75
|
| Rate for Payer: Anthem Medicaid |
$82.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$385.31
|
| Rate for Payer: Healthspan PPO |
$299.08
|
| Rate for Payer: Humana Medicaid |
$82.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.51
|
| Rate for Payer: Molina Healthcare Passport |
$82.85
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$82.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.68
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
761T0292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,412.18
|
| Rate for Payer: Anthem Medicaid |
$630.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,430.52
|
| 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 |
$917.00
|
| Rate for Payer: Cash Price |
$917.00
|
| Rate for Payer: Cigna Commercial |
$1,522.22
|
| Rate for Payer: First Health Commercial |
$1,742.30
|
| Rate for Payer: Humana Commercial |
$1,558.90
|
| Rate for Payer: Humana KY Medicaid |
$630.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$637.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,353.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,375.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.54
|
| Rate for Payer: PHCS Commercial |
$1,760.64
|
| Rate for Payer: United Healthcare All Payer |
$1,613.92
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.67 |
| Max. Negotiated Rate |
$1,976.64 |
| Rate for Payer: Aetna Commercial |
$1,585.43
|
| Rate for Payer: Anthem Medicaid |
$708.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.02
|
| 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 |
$1,029.50
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cigna Commercial |
$1,708.97
|
| Rate for Payer: First Health Commercial |
$1,956.05
|
| Rate for Payer: Humana Commercial |
$1,750.15
|
| Rate for Payer: Humana KY Medicaid |
$708.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$715.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.29
|
| Rate for Payer: PHCS Commercial |
$1,976.64
|
| Rate for Payer: United Healthcare All Payer |
$1,811.92
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
761T0292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.42 |
| Max. Negotiated Rate |
$1,760.64 |
| Rate for Payer: Aetna Commercial |
$1,412.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,430.52
|
| Rate for Payer: Cash Price |
$917.00
|
| Rate for Payer: Cigna Commercial |
$1,522.22
|
| Rate for Payer: First Health Commercial |
$1,742.30
|
| Rate for Payer: Humana Commercial |
$1,558.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,353.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,375.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.54
|
| Rate for Payer: PHCS Commercial |
$1,760.64
|
| Rate for Payer: United Healthcare All Payer |
$1,613.92
|
|
|
MAMMO BRST LOC DEV PERC 1STLES
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
76100292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.67 |
| Max. Negotiated Rate |
$1,976.64 |
| Rate for Payer: Aetna Commercial |
$1,585.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.02
|
| Rate for Payer: Cash Price |
$1,029.50
|
| Rate for Payer: Cigna Commercial |
$1,708.97
|
| Rate for Payer: First Health Commercial |
$1,956.05
|
| Rate for Payer: Humana Commercial |
$1,750.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,688.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,519.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.29
|
| Rate for Payer: PHCS Commercial |
$1,976.64
|
| Rate for Payer: United Healthcare All Payer |
$1,811.92
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.31
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$39.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,301.00
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$265.70
|
| Rate for Payer: Healthspan PPO |
$205.25
|
| Rate for Payer: Humana Medicaid |
$39.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.73
|
| Rate for Payer: Molina Healthcare Passport |
$39.93
|
| Rate for Payer: Multiplan PHCS |
$780.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.70
|
| Rate for Payer: UHCCP Medicaid |
$41.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.33
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
761T0293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$1,152.96 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Anthem Medicaid |
$413.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.78
|
| Rate for Payer: Cash Price |
$600.50
|
| Rate for Payer: Cigna Commercial |
$996.83
|
| Rate for Payer: First Health Commercial |
$1,140.95
|
| Rate for Payer: Humana Commercial |
$1,020.85
|
| Rate for Payer: Humana KY Medicaid |
$413.02
|
| Rate for Payer: Kentucky WC Medicaid |
$417.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$886.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$421.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.88
|
| Rate for Payer: Ohio Health Group HMO |
$900.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.31
|
| Rate for Payer: PHCS Commercial |
$1,152.96
|
| Rate for Payer: United Healthcare All Payer |
$1,056.88
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
761P0293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$265.70 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$39.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$265.70
|
| Rate for Payer: Healthspan PPO |
$205.25
|
| Rate for Payer: Humana Medicaid |
$39.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.73
|
| Rate for Payer: Molina Healthcare Passport |
$39.93
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$41.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.33
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
761T0293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$1,152.96 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.78
|
| Rate for Payer: Cash Price |
$600.50
|
| Rate for Payer: Cigna Commercial |
$996.83
|
| Rate for Payer: First Health Commercial |
$1,140.95
|
| Rate for Payer: Humana Commercial |
$1,020.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$886.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.88
|
| Rate for Payer: Ohio Health Group HMO |
$900.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.31
|
| Rate for Payer: PHCS Commercial |
$1,152.96
|
| Rate for Payer: United Healthcare All Payer |
$1,056.88
|
|
|
MAMMO BRST LOCDEVPERC EAADDLES
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
76100293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem Medicaid |
$447.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Humana KY Medicaid |
$447.41
|
| Rate for Payer: Kentucky WC Medicaid |
$451.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.31
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
MAMMOSITE BALLOON
|
Facility
|
IP
|
$1,871.50
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$1,796.64 |
| Rate for Payer: Aetna Commercial |
$1,441.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.77
|
| Rate for Payer: Cash Price |
$935.75
|
| Rate for Payer: Cigna Commercial |
$1,553.34
|
| Rate for Payer: First Health Commercial |
$1,777.92
|
| Rate for Payer: Humana Commercial |
$1,590.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.16
|
| Rate for Payer: PHCS Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare All Payer |
$1,646.92
|
|
|
MAMMOSITE BALLOON
|
Facility
|
OP
|
$1,871.50
|
|
|
Service Code
|
HCPCS C1728
|
| Hospital Charge Code |
27000012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$1,796.64 |
| Rate for Payer: Aetna Commercial |
$1,441.06
|
| Rate for Payer: Anthem Medicaid |
$643.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.77
|
| Rate for Payer: Cash Price |
$935.75
|
| Rate for Payer: Cigna Commercial |
$1,553.34
|
| Rate for Payer: First Health Commercial |
$1,777.92
|
| Rate for Payer: Humana Commercial |
$1,590.78
|
| Rate for Payer: Humana KY Medicaid |
$643.61
|
| Rate for Payer: Kentucky WC Medicaid |
$650.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.16
|
| Rate for Payer: PHCS Commercial |
$1,796.64
|
| Rate for Payer: United Healthcare All Payer |
$1,646.92
|
|
