|
NEEDLE BIOPSY RT AXILLA
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200079
|
|
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 RT AXILLA
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200079
|
|
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 RT AXILLA
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200079
|
|
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 RT AXILLA(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0079
|
|
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 RT AXILLA(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0079
|
|
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 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: 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: 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
|
|
|
NEEDLE BIOPSY RT AXILLA(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0079
|
|
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
|
|
|
NEEDLE BIOPSY RT BREAST US
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200071
|
|
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 RT BREAST US
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200071
|
|
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 RT BREAST US
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200071
|
|
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 RT BREAST US(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0071
|
|
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 RT BREAST US(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0071
|
|
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
|
|
|
NEEDLE BIOPSY RT BREAST US(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0071
|
|
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 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: 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: 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
|
|
|
NEEDLE LOC RT BREAST
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200072
|
|
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 LOC RT BREAST
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200072
|
|
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 LOC RT BREAST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200072
|
|
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 LOC RT BREAST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0072
|
|
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 LOC RT BREAST(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0072
|
|
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
|
|
|
NEEDLE LOC RT BREAST(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0072
|
|
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 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: 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: 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
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
740T0013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$435.90 |
| Max. Negotiated Rate |
$1,394.88 |
| Rate for Payer: Aetna Commercial |
$1,118.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,133.34
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cigna Commercial |
$1,205.99
|
| Rate for Payer: First Health Commercial |
$1,380.35
|
| Rate for Payer: Humana Commercial |
$1,235.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,191.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,072.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,278.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.57
|
| Rate for Payer: PHCS Commercial |
$1,394.88
|
| Rate for Payer: United Healthcare All Payer |
$1,278.64
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
740T0013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,394.88 |
| Rate for Payer: Aetna Commercial |
$1,118.81
|
| Rate for Payer: Anthem Medicaid |
$499.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,133.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cigna Commercial |
$1,205.99
|
| Rate for Payer: First Health Commercial |
$1,380.35
|
| Rate for Payer: Humana Commercial |
$1,235.05
|
| Rate for Payer: Humana KY Medicaid |
$499.69
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$504.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,191.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,072.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$509.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,278.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.57
|
| Rate for Payer: PHCS Commercial |
$1,394.88
|
| Rate for Payer: United Healthcare All Payer |
$1,278.64
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
74000013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$683.55 |
| Max. Negotiated Rate |
$1,367.10 |
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Multiplan PHCS |
$1,171.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,367.10
|
| Rate for Payer: UHCCP Medicaid |
$683.55
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
740P0013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
74000013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna Commercial |
$1,503.81
|
| Rate for Payer: Anthem Medicaid |
$671.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna Commercial |
$1,620.99
|
| Rate for Payer: First Health Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial |
$1,660.05
|
| Rate for Payer: Humana KY Medicaid |
$671.64
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$678.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,718.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.57
|
| Rate for Payer: PHCS Commercial |
$1,874.88
|
| Rate for Payer: United Healthcare All Payer |
$1,718.64
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
74000013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$585.90 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna Commercial |
$1,503.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.34
|
| Rate for Payer: Cash Price |
$976.50
|
| Rate for Payer: Cigna Commercial |
$1,620.99
|
| Rate for Payer: First Health Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial |
$1,660.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,718.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.57
|
| Rate for Payer: PHCS Commercial |
$1,874.88
|
| Rate for Payer: United Healthcare All Payer |
$1,718.64
|
|
|
NEGATIVE PRESS GREATER 50 SQCM
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42000075
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
