|
PERQ DEV BREAST 1ST STRTCTC
|
Facility
|
OP
|
$2,319.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,226.24 |
| Rate for Payer: Aetna Commercial |
$1,785.63
|
| Rate for Payer: Anthem Medicaid |
$797.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,808.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,159.50
|
| Rate for Payer: Cash Price |
$1,159.50
|
| Rate for Payer: Cigna Commercial |
$1,924.77
|
| Rate for Payer: First Health Commercial |
$2,203.05
|
| Rate for Payer: Humana Commercial |
$1,971.15
|
| Rate for Payer: Humana KY Medicaid |
$797.50
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$805.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,901.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,711.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$813.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,040.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,739.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,017.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,600.11
|
| Rate for Payer: PHCS Commercial |
$2,226.24
|
| Rate for Payer: United Healthcare All Payer |
$2,040.72
|
|
|
PERQ DEV BREAST 1ST STRTCTC
|
Facility
|
IP
|
$2,319.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.70 |
| Max. Negotiated Rate |
$2,226.24 |
| Rate for Payer: Aetna Commercial |
$1,785.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,808.82
|
| Rate for Payer: Cash Price |
$1,159.50
|
| Rate for Payer: Cigna Commercial |
$1,924.77
|
| Rate for Payer: First Health Commercial |
$2,203.05
|
| Rate for Payer: Humana Commercial |
$1,971.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,901.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,711.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$695.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,040.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,739.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,017.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,600.11
|
| Rate for Payer: PHCS Commercial |
$2,226.24
|
| Rate for Payer: United Healthcare All Payer |
$2,040.72
|
|
|
PERQ DEV BREAST 1ST STRTCTC(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761P0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$436.46 |
| Rate for Payer: Ambetter Exchange |
$92.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$208.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.47
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$436.46
|
| Rate for Payer: Healthspan PPO |
$338.44
|
| Rate for Payer: Humana Medicaid |
$208.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.76
|
| Rate for Payer: Molina Healthcare Passport |
$208.59
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.76
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.89
|
|
|
PERQ DEV BREAST 1ST STRTCTC(T
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761T0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,019.84 |
| Rate for Payer: Aetna Commercial |
$1,620.08
|
| Rate for Payer: Anthem Medicaid |
$723.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cigna Commercial |
$1,746.32
|
| Rate for Payer: First Health Commercial |
$1,998.80
|
| Rate for Payer: Humana Commercial |
$1,788.40
|
| Rate for Payer: Humana KY Medicaid |
$723.57
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$730.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,725.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,552.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,851.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,830.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,451.76
|
| Rate for Payer: PHCS Commercial |
$2,019.84
|
| Rate for Payer: United Healthcare All Payer |
$1,851.52
|
|
|
PERQ DEV BREAST 1ST STRTCTC(T
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761T0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.20 |
| Max. Negotiated Rate |
$2,019.84 |
| Rate for Payer: Aetna Commercial |
$1,620.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.12
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cigna Commercial |
$1,746.32
|
| Rate for Payer: First Health Commercial |
$1,998.80
|
| Rate for Payer: Humana Commercial |
$1,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,725.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,552.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,851.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,830.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,451.76
|
| Rate for Payer: PHCS Commercial |
$2,019.84
|
| Rate for Payer: United Healthcare All Payer |
$1,851.52
|
|
|
PERQ DEV BREAST 1ST US IMAG
|
Facility
|
IP
|
$2,939.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$881.70 |
| Max. Negotiated Rate |
$2,821.44 |
| Rate for Payer: Aetna Commercial |
$2,263.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,292.42
|
| Rate for Payer: Cash Price |
$1,469.50
|
| Rate for Payer: Cigna Commercial |
$2,439.37
|
| Rate for Payer: First Health Commercial |
$2,792.05
|
| Rate for Payer: Humana Commercial |
$2,498.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,409.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,168.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,586.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,204.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,556.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.91
|
| Rate for Payer: PHCS Commercial |
$2,821.44
|
| Rate for Payer: United Healthcare All Payer |
$2,586.32
|
|
|
PERQ DEV BREAST 1ST US IMAG
|
Facility
|
OP
|
$2,939.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,821.44 |
| Rate for Payer: Aetna Commercial |
$2,263.03
|
| Rate for Payer: Anthem Medicaid |
$1,010.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,292.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,469.50
|
| Rate for Payer: Cash Price |
$1,469.50
|
| Rate for Payer: Cigna Commercial |
$2,439.37
|
| Rate for Payer: First Health Commercial |
$2,792.05
|
| Rate for Payer: Humana Commercial |
$2,498.15
|
| Rate for Payer: Humana KY Medicaid |
$1,010.72
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,409.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,168.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,586.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,204.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,556.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.91
|
| Rate for Payer: PHCS Commercial |
$2,821.44
|
| Rate for Payer: United Healthcare All Payer |
$2,586.32
|
|
|
PERQ DEV BREAST 1ST US IMAG
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$1,763.40 |
| Rate for Payer: Ambetter Exchange |
$78.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.42
|
| Rate for Payer: Anthem Medicaid |
$346.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.33
|
| Rate for Payer: Cash Price |
$1,469.50
|
| Rate for Payer: Cash Price |
$1,469.50
|
| Rate for Payer: Cigna Commercial |
$731.66
|
| Rate for Payer: Healthspan PPO |
$565.24
|
| Rate for Payer: Humana Medicaid |
$346.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.93
|
| Rate for Payer: Molina Healthcare Passport |
$346.99
|
| Rate for Payer: Multiplan PHCS |
$1,763.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.19
|
| Rate for Payer: UHCCP Medicaid |
$70.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.61
|
|
|
PERQ DEV BREAST 1ST US IMAG(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
761P0295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$731.66 |
| Rate for Payer: Ambetter Exchange |
$78.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.42
|
| Rate for Payer: Anthem Medicaid |
$346.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.33
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$731.66
|
| Rate for Payer: Healthspan PPO |
$565.24
|
| Rate for Payer: Humana Medicaid |
$346.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.93
|
| Rate for Payer: Molina Healthcare Passport |
$346.99
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.19
|
| Rate for Payer: UHCCP Medicaid |
$70.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.61
|
|
|
PERQ DEV BREAST 1ST US IMAG(T
|
Facility
|
IP
|
$2,039.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
761T0295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.70 |
| Max. Negotiated Rate |
$1,957.44 |
| Rate for Payer: Aetna Commercial |
$1,570.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.42
|
| Rate for Payer: Cash Price |
$1,019.50
|
| Rate for Payer: Cigna Commercial |
$1,692.37
|
| Rate for Payer: First Health Commercial |
$1,937.05
|
| Rate for Payer: Humana Commercial |
$1,733.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,406.91
|
| Rate for Payer: PHCS Commercial |
$1,957.44
|
| Rate for Payer: United Healthcare All Payer |
$1,794.32
|
|
|
PERQ DEV BREAST 1ST US IMAG(T
|
Facility
|
OP
|
$2,039.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
761T0295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$1,957.44 |
| Rate for Payer: Aetna Commercial |
$1,570.03
|
| Rate for Payer: Anthem Medicaid |
$701.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,019.50
|
| Rate for Payer: Cash Price |
$1,019.50
|
| Rate for Payer: Cigna Commercial |
$1,692.37
|
| Rate for Payer: First Health Commercial |
$1,937.05
|
| Rate for Payer: Humana Commercial |
$1,733.15
|
| Rate for Payer: Humana KY Medicaid |
$701.21
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$708.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,406.91
|
| Rate for Payer: PHCS Commercial |
$1,957.44
|
| Rate for Payer: United Healthcare All Payer |
$1,794.32
|
|
|
PERQ DEV BREAST ADD US IMAG
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$1,263.00 |
| Rate for Payer: Ambetter Exchange |
$39.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.94
|
| Rate for Payer: Anthem Medicaid |
$289.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.16
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$611.03
|
| Rate for Payer: Healthspan PPO |
$470.94
|
| Rate for Payer: Humana Medicaid |
$289.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.81
|
| Rate for Payer: Molina Healthcare Passport |
$289.03
|
| Rate for Payer: Multiplan PHCS |
$1,263.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.09
|
| Rate for Payer: UHCCP Medicaid |
$35.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.30
|
|
|
PERQ DEV BREAST ADD US IMAG
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$2,020.80 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem Medicaid |
$723.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Humana KY Medicaid |
$723.91
|
| Rate for Payer: Kentucky WC Medicaid |
$731.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
PERQ DEV BREAST ADD US IMAG
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$2,020.80 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
PERQ DEV BREAST ADD US IMAG(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
761P0296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$611.03 |
| Rate for Payer: Ambetter Exchange |
$39.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.94
|
| Rate for Payer: Anthem Medicaid |
$289.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.16
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$611.03
|
| Rate for Payer: Healthspan PPO |
$470.94
|
| Rate for Payer: Humana Medicaid |
$289.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.81
|
| Rate for Payer: Molina Healthcare Passport |
$289.03
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.09
|
| Rate for Payer: UHCCP Medicaid |
$35.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.30
|
|
|
PERQ DEV BREAST ADD US IMAG(T
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
761T0296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,252.80 |
| Rate for Payer: Aetna Commercial |
$1,004.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.90
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,083.15
|
| Rate for Payer: First Health Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial |
$1,109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,070.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$963.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.45
|
| Rate for Payer: PHCS Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare All Payer |
$1,148.40
|
|
|
PERQ DEV BREAST ADD US IMAG(T
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
761T0296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,252.80 |
| Rate for Payer: Aetna Commercial |
$1,004.85
|
| Rate for Payer: Anthem Medicaid |
$448.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.90
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,083.15
|
| Rate for Payer: First Health Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial |
$1,109.25
|
| Rate for Payer: Humana KY Medicaid |
$448.79
|
| Rate for Payer: Kentucky WC Medicaid |
$453.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,070.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$963.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$457.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.45
|
| Rate for Payer: PHCS Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare All Payer |
$1,148.40
|
|
|
PERQ DEV SOFT TISS 1ST IMAG
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$621.00 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Aetna Commercial |
$1,593.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,614.60
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna Commercial |
$1,718.10
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: Humana Commercial |
$1,759.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,697.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,527.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,821.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.30
|
| Rate for Payer: PHCS Commercial |
$1,987.20
|
| Rate for Payer: United Healthcare All Payer |
$1,821.60
|
|
|
PERQ DEV SOFT TISS 1ST IMAG
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Aetna Commercial |
$1,593.90
|
| Rate for Payer: Anthem Medicaid |
$711.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,614.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna Commercial |
$1,718.10
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: Humana Commercial |
$1,759.50
|
| Rate for Payer: Humana KY Medicaid |
$711.87
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$719.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,697.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,527.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,821.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.30
|
| Rate for Payer: PHCS Commercial |
$1,987.20
|
| Rate for Payer: United Healthcare All Payer |
$1,821.60
|
|
|
PERQ DEV SOFT TISS 1ST IMAG
|
Professional
|
Both
|
$2,070.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Ambetter Exchange |
$78.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.14
|
| Rate for Payer: Anthem Medicaid |
$398.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.33
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna Commercial |
$144.35
|
| Rate for Payer: Humana Medicaid |
$398.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.79
|
| Rate for Payer: Molina Healthcare Passport |
$398.81
|
| Rate for Payer: Multiplan PHCS |
$1,242.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.19
|
| Rate for Payer: UHCCP Medicaid |
$73.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.61
|
|
|
PERQ DEV SOFT TISS 1ST IMAG(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
761P0006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$406.79 |
| Rate for Payer: Ambetter Exchange |
$78.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.14
|
| Rate for Payer: Anthem Medicaid |
$398.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.33
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$144.35
|
| Rate for Payer: Humana Medicaid |
$398.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.79
|
| Rate for Payer: Molina Healthcare Passport |
$398.81
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.19
|
| Rate for Payer: UHCCP Medicaid |
$73.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.61
|
|
|
PERQ DEV SOFT TISS 1ST IMAG(T
|
Facility
|
IP
|
$1,820.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
761T0006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,747.20 |
| Rate for Payer: Aetna Commercial |
$1,401.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.60
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,510.60
|
| Rate for Payer: First Health Commercial |
$1,729.00
|
| Rate for Payer: Humana Commercial |
$1,547.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.80
|
| Rate for Payer: PHCS Commercial |
$1,747.20
|
| Rate for Payer: United Healthcare All Payer |
$1,601.60
|
|
|
PERQ DEV SOFT TISS 1ST IMAG(T
|
Facility
|
OP
|
$1,820.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
761T0006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.90 |
| Max. Negotiated Rate |
$1,747.20 |
| Rate for Payer: Aetna Commercial |
$1,401.40
|
| Rate for Payer: Anthem Medicaid |
$625.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,510.60
|
| Rate for Payer: First Health Commercial |
$1,729.00
|
| Rate for Payer: Humana Commercial |
$1,547.00
|
| Rate for Payer: Humana KY Medicaid |
$625.90
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$632.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.80
|
| Rate for Payer: PHCS Commercial |
$1,747.20
|
| Rate for Payer: United Healthcare All Payer |
$1,601.60
|
|
|
PERQ&IC ALLG TEST DRUGS/BIOL
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 95018
|
| Hospital Charge Code |
41000105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$128.64 |
| Rate for Payer: Aetna Commercial |
$103.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.52
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$111.22
|
| Rate for Payer: First Health Commercial |
$127.30
|
| Rate for Payer: Humana Commercial |
$113.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.92
|
| Rate for Payer: Ohio Health Group HMO |
$100.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.46
|
| Rate for Payer: PHCS Commercial |
$128.64
|
| Rate for Payer: United Healthcare All Payer |
$117.92
|
|
|
PERQ&IC ALLG TEST DRUGS/BIOL
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 95018
|
| Hospital Charge Code |
41000105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$80.40 |
| Rate for Payer: Ambetter Exchange |
$6.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.66
|
| Rate for Payer: Anthem Medicaid |
$22.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.96
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$35.75
|
| Rate for Payer: Healthspan PPO |
$37.08
|
| Rate for Payer: Humana Medicaid |
$22.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.05
|
| Rate for Payer: Molina Healthcare Passport |
$22.60
|
| Rate for Payer: Multiplan PHCS |
$80.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.62
|
| Rate for Payer: UHCCP Medicaid |
$5.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
|
