|
MARSUP BARTHOLIN CYST
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
MARSUP BARTHOLIN CYST(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
761P2156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$276.56
|
| Rate for Payer: Anthem Medicaid |
$165.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$270.50
|
| Rate for Payer: Healthspan PPO |
$267.78
|
| Rate for Payer: Humana Medicaid |
$165.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.35
|
| Rate for Payer: Molina Healthcare Passport |
$165.05
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.70
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$322.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$162.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.44
|
| Rate for Payer: Healthspan PPO |
$383.35
|
| Rate for Payer: Humana Medicaid |
$162.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.42
|
| Rate for Payer: Molina Healthcare Passport |
$162.18
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.80
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
761P1687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$322.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$162.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.44
|
| Rate for Payer: Healthspan PPO |
$383.35
|
| Rate for Payer: Humana Medicaid |
$162.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.42
|
| Rate for Payer: Molina Healthcare Passport |
$162.18
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.80
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
MASSAGE - 15 MIN 1
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
43000015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
MASSAGE - 15 MIN 1
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
43000015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
MASSAGE - 15 MINUTES
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
MASSAGE - 15 MINUTES
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
MASTECTOMY
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,659.39 |
| Rate for Payer: Aetna Commercial |
$1,659.39
|
| Rate for Payer: Anthem Medicaid |
$782.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,533.51
|
| Rate for Payer: Healthspan PPO |
$1,326.84
|
| Rate for Payer: Humana Medicaid |
$782.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,497.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.10
|
| Rate for Payer: Molina Healthcare Passport |
$782.45
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.27
|
|
|
MASTECTOMY
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
MASTECTOMY
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.22 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna Commercial |
$550.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.22
|
| Rate for Payer: Anthem Medicaid |
$256.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$508.41
|
| Rate for Payer: Healthspan PPO |
$553.63
|
| Rate for Payer: Humana Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.15
|
| Rate for Payer: Molina Healthcare Passport |
$256.03
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$240.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.59
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$585.60 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem Medicaid |
$209.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Humana KY Medicaid |
$209.78
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$211.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
MASTECTOMY FOR GYNECOMASTIA(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
761P0299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.22 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna Commercial |
$550.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.22
|
| Rate for Payer: Anthem Medicaid |
$256.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$508.41
|
| Rate for Payer: Healthspan PPO |
$553.63
|
| Rate for Payer: Humana Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.15
|
| Rate for Payer: Molina Healthcare Passport |
$256.03
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$240.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.59
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$20,370.08
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$13,822.56 |
| Max. Negotiated Rate |
$20,370.08 |
| Rate for Payer: Anthem Medicaid |
$13,822.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,550.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,370.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,642.58
|
| Rate for Payer: Humana KY Medicaid |
$13,822.56
|
| Rate for Payer: Humana Medicare Advantage |
$14,550.06
|
| Rate for Payer: Kentucky WC Medicaid |
$13,960.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,460.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,099.01
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$17,803.52
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$12,080.96 |
| Max. Negotiated Rate |
$17,803.52 |
| Rate for Payer: Anthem Medicaid |
$12,080.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,716.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,803.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,167.68
|
| Rate for Payer: Humana KY Medicaid |
$12,080.96
|
| Rate for Payer: Humana Medicare Advantage |
$12,716.80
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,260.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,322.58
|
|
|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$7,894.80
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,639.14 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
|
|
MASTECTOMY(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
761P0305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,659.39 |
| Rate for Payer: Aetna Commercial |
$1,659.39
|
| Rate for Payer: Anthem Medicaid |
$782.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,533.51
|
| Rate for Payer: Healthspan PPO |
$1,326.84
|
| Rate for Payer: Humana Medicaid |
$782.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,497.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.10
|
| Rate for Payer: Molina Healthcare Passport |
$782.45
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.27
|
|
|
MASTECTOMY; PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19302
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
