|
MASSAGE - 15 MINUTES
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
MASTECTOMY
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| 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 |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
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: Ambetter Exchange |
$1,121.84
|
| Rate for Payer: Anthem Medicaid |
$782.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,121.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,121.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,346.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,121.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.84
|
| 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 |
$1,458.39
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,121.84
|
|
|
MASTECTOMY
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| 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 |
$6,025.70
|
| 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 |
$7,230.84
|
| 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 |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.78 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem Medicaid |
$209.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| 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 |
$3,538.18
|
| 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 |
$4,245.82
|
| 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 |
$488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.90
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
76100299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.00 |
| 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 |
$488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.90
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
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 |
$553.63 |
| Rate for Payer: Aetna Commercial |
$550.01
|
| Rate for Payer: Ambetter Exchange |
$409.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.22
|
| Rate for Payer: Anthem Medicaid |
$353.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.64
|
| 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 |
$353.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.51
|
| Rate for Payer: Molina Healthcare Passport |
$353.44
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.61
|
| Rate for Payer: UHCCP Medicaid |
$240.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.70
|
|
|
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 |
$553.63 |
| Rate for Payer: Aetna Commercial |
$550.01
|
| Rate for Payer: Ambetter Exchange |
$409.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.22
|
| Rate for Payer: Anthem Medicaid |
$353.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.64
|
| 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 |
$353.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.51
|
| Rate for Payer: Molina Healthcare Passport |
$353.44
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.61
|
| Rate for Payer: UHCCP Medicaid |
$240.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.70
|
|
|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$8,435.98
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,025.70 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
|
|
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: Ambetter Exchange |
$1,121.84
|
| Rate for Payer: Anthem Medicaid |
$782.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,121.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,121.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,346.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,121.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.84
|
| 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 |
$1,458.39
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,121.84
|
|
|
MASTECTOMY; PARTIAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19302
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,269.27 |
| Rate for Payer: Aetna Commercial |
$1,269.27
|
| Rate for Payer: Ambetter Exchange |
$864.15
|
| Rate for Payer: Anthem Medicaid |
$604.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$864.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$864.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,036.98
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,185.67
|
| Rate for Payer: Healthspan PPO |
$1,014.90
|
| Rate for Payer: Humana Medicaid |
$604.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$864.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.00
|
| Rate for Payer: Molina Healthcare Passport |
$604.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,123.39
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$610.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$864.15
|
|
|
MASTECTOMY; PARTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19302
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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: 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 |
$360.00
|
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
MASTECTOMY; PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19302
|
| Hospital Charge Code |
76100301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| 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 |
$6,025.70
|
| 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 |
$7,230.84
|
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
MASTECTOMY; PARTIAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19302
|
| Hospital Charge Code |
761P0301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,269.27 |
| Rate for Payer: Aetna Commercial |
$1,269.27
|
| Rate for Payer: Ambetter Exchange |
$864.15
|
| Rate for Payer: Anthem Medicaid |
$604.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$864.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$864.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,036.98
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,185.67
|
| Rate for Payer: Healthspan PPO |
$1,014.90
|
| Rate for Payer: Humana Medicaid |
$604.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$864.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.00
|
| Rate for Payer: Molina Healthcare Passport |
$604.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,123.39
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$610.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$864.15
|
|
|
MASTECTOMY: RADICAL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,571.49 |
| Rate for Payer: Aetna Commercial |
$1,571.49
|
| Rate for Payer: Ambetter Exchange |
$1,089.78
|
| Rate for Payer: Anthem Medicaid |
$748.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,089.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,089.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,307.74
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,466.18
|
| Rate for Payer: Healthspan PPO |
$1,256.55
|
| Rate for Payer: Humana Medicaid |
$748.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,422.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,089.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$763.23
|
| Rate for Payer: Molina Healthcare Passport |
$748.26
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,416.71
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$755.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,089.78
|
|
|
MASTECTOMY: RADICAL
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
MASTECTOMY: RADICAL
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
MASTECTOMY: RADICAL(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
761P0304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,571.49 |
| Rate for Payer: Aetna Commercial |
$1,571.49
|
| Rate for Payer: Ambetter Exchange |
$1,089.78
|
| Rate for Payer: Anthem Medicaid |
$748.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,089.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,089.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,307.74
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,466.18
|
| Rate for Payer: Healthspan PPO |
$1,256.55
|
| Rate for Payer: Humana Medicaid |
$748.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,422.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,089.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$763.23
|
| Rate for Payer: Molina Healthcare Passport |
$748.26
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,416.71
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$755.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,089.78
|
|
|
MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$1,345.65 |
| Rate for Payer: Aetna Commercial |
$1,345.65
|
| Rate for Payer: Ambetter Exchange |
$914.57
|
| Rate for Payer: Anthem Medicaid |
$621.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$914.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$914.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,097.48
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,262.24
|
| Rate for Payer: Healthspan PPO |
$1,075.97
|
| Rate for Payer: Humana Medicaid |
$621.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,260.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$914.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$633.51
|
| Rate for Payer: Molina Healthcare Passport |
$621.09
|
| Rate for Payer: Multiplan PHCS |
$756.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,188.94
|
| Rate for Payer: UHCCP Medicaid |
$441.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$627.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$914.57
|
|
|
MASTECTOMY SIMPLE COMPLETE
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem Medicaid |
$433.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Humana KY Medicaid |
$433.31
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Kentucky WC Medicaid |
$437.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
MASTECTOMY SIMPLE COMPLETE
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 19303
|
| Hospital Charge Code |
76100302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
MASTECTOMY, SIMPLE, COMPLETE
|
Facility
|
OP
|
$8,435.98
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,025.70 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
|
