|
NEBUPENT (PENTAMIDINE)300 MG
|
Facility
|
OP
|
$336.89
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
25003253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.07 |
| Max. Negotiated Rate |
$323.41 |
| Rate for Payer: Aetna Commercial |
$259.41
|
| Rate for Payer: Anthem Medicaid |
$115.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.77
|
| Rate for Payer: Cash Price |
$168.44
|
| Rate for Payer: Cigna Commercial |
$279.62
|
| Rate for Payer: First Health Commercial |
$320.05
|
| Rate for Payer: Humana Commercial |
$286.36
|
| Rate for Payer: Humana KY Medicaid |
$115.86
|
| Rate for Payer: Kentucky WC Medicaid |
$117.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.46
|
| Rate for Payer: Ohio Health Group HMO |
$252.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.45
|
| Rate for Payer: PHCS Commercial |
$323.41
|
| Rate for Payer: United Healthcare All Payer |
$296.46
|
|
|
NEBUPENT (PENTAMIDINE)300 MG
|
Facility
|
IP
|
$336.89
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
25003253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.07 |
| Max. Negotiated Rate |
$323.41 |
| Rate for Payer: Aetna Commercial |
$259.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.77
|
| Rate for Payer: Cash Price |
$168.44
|
| Rate for Payer: Cigna Commercial |
$279.62
|
| Rate for Payer: First Health Commercial |
$320.05
|
| Rate for Payer: Humana Commercial |
$286.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.46
|
| Rate for Payer: Ohio Health Group HMO |
$252.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.45
|
| Rate for Payer: PHCS Commercial |
$323.41
|
| Rate for Payer: United Healthcare All Payer |
$296.46
|
|
|
NECK ANGLE HIP STEM 127 DEG
|
Facility
|
OP
|
$9,578.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.63 |
| Max. Negotiated Rate |
$9,195.61 |
| Rate for Payer: Aetna Commercial |
$7,375.65
|
| Rate for Payer: Anthem Medicaid |
$3,294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,471.43
|
| Rate for Payer: Cash Price |
$4,789.38
|
| Rate for Payer: Cigna Commercial |
$7,950.37
|
| Rate for Payer: First Health Commercial |
$9,099.82
|
| Rate for Payer: Humana Commercial |
$8,141.95
|
| Rate for Payer: Humana KY Medicaid |
$3,294.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,327.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,854.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,069.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,873.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,360.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,429.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,184.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,663.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,333.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,609.34
|
| Rate for Payer: PHCS Commercial |
$9,195.61
|
| Rate for Payer: United Healthcare All Payer |
$8,429.31
|
|
|
NECK ANGLE HIP STEM 127 DEG
|
Facility
|
IP
|
$9,578.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.63 |
| Max. Negotiated Rate |
$9,195.61 |
| Rate for Payer: Aetna Commercial |
$7,375.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,471.43
|
| Rate for Payer: Cash Price |
$4,789.38
|
| Rate for Payer: Cigna Commercial |
$7,950.37
|
| Rate for Payer: First Health Commercial |
$9,099.82
|
| Rate for Payer: Humana Commercial |
$8,141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,854.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,069.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,873.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,429.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,184.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,663.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,333.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,609.34
|
| Rate for Payer: PHCS Commercial |
$9,195.61
|
| Rate for Payer: United Healthcare All Payer |
$8,429.31
|
|
|
NECK-CESSITY
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
22200128
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
NECK-CESSITY
|
Professional
|
Both
|
$125.00
|
|
| Hospital Charge Code |
22200128
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
|
|
NECK-CESSITY
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
22200128
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
Neck FrntLsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200471
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
Neck Front Laser Hair Removal
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200210
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Neck Front LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200211
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
NECK REJUV MOD 30MM 16^ 130^ P
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 30MM 16^ 130^ P
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 34MM 16^ 130^ P
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 34MM 16^ 130^ P
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 38MM 16^ 130^ P
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 38MM 16^ 130^ P
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 42MM 16^ 130^ P
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK REJUV MOD 42MM 16^ 130^ P
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NECK STD MOD HEAD 36MM
|
Facility
|
IP
|
$8,058.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.67 |
| Max. Negotiated Rate |
$7,736.54 |
| Rate for Payer: Aetna Commercial |
$6,205.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.94
|
| Rate for Payer: Cash Price |
$4,029.45
|
| Rate for Payer: Cigna Commercial |
$6,688.89
|
| Rate for Payer: First Health Commercial |
$7,655.95
|
| Rate for Payer: Humana Commercial |
$6,850.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,608.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,044.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,447.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,011.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.64
|
| Rate for Payer: PHCS Commercial |
$7,736.54
|
| Rate for Payer: United Healthcare All Payer |
$7,091.83
|
|
|
NECK STD MOD HEAD 36MM
|
Facility
|
OP
|
$8,058.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.67 |
| Max. Negotiated Rate |
$7,736.54 |
| Rate for Payer: Aetna Commercial |
$6,205.35
|
| Rate for Payer: Anthem Medicaid |
$2,771.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.94
|
| Rate for Payer: Cash Price |
$4,029.45
|
| Rate for Payer: Cigna Commercial |
$6,688.89
|
| Rate for Payer: First Health Commercial |
$7,655.95
|
| Rate for Payer: Humana Commercial |
$6,850.06
|
| Rate for Payer: Humana KY Medicaid |
$2,771.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,608.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,827.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,044.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,447.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,011.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.64
|
| Rate for Payer: PHCS Commercial |
$7,736.54
|
| Rate for Payer: United Healthcare All Payer |
$7,091.83
|
|
|
NEEDLE BIOPSY AXILLA US
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem Medicaid |
$492.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Humana KY Medicaid |
$492.46
|
| Rate for Payer: Kentucky WC Medicaid |
$497.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$502.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
NEEDLE BIOPSY AXILLA US
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$859.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$501.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY AXILLA US
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
NEEDLE BIOPSY AXILLA US(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY AXILLA US(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem Medicaid |
$423.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Humana KY Medicaid |
$423.68
|
| Rate for Payer: Kentucky WC Medicaid |
$428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$432.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
