|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401T0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$47.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.86
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$47.11
|
| Rate for Payer: Kentucky WC Medicaid |
$47.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.86
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Anthem Medicaid |
$42.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: Humana Medicaid |
$42.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.67
|
| Rate for Payer: Molina Healthcare Passport |
$42.81
|
| Rate for Payer: Multiplan PHCS |
$82.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.90
|
| Rate for Payer: UHCCP Medicaid |
$47.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.24
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401P0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$88.73 |
| Rate for Payer: Anthem Medicaid |
$42.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: Humana Medicaid |
$42.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.67
|
| Rate for Payer: Molina Healthcare Passport |
$42.81
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.24
|
|
|
SCREEN COLON HIGH RISK
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Anthem Medicaid |
$270.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Humana Medicaid |
$270.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.28
|
| Rate for Payer: Molina Healthcare Passport |
$270.86
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.57
|
|
|
SCREEN COLON HIGH RISK
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
SCREEN COLON HIGH RISK
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
SCREEN COLONOSCOPY NOT HIGH RI
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$554.00 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Humana Medicaid |
$150.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.29
|
| Rate for Payer: Molina Healthcare Passport |
$150.28
|
| Rate for Payer: Multiplan PHCS |
$332.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$387.80
|
| Rate for Payer: UHCCP Medicaid |
$193.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.78
|
|
|
SCREEN COLONOSCOPY NOT HIGH RI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.74
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
SCREEN COLONOSCOPY NOT HIGH RI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.74
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$42.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.40
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCREENING PAP SMEAR BY PHYS
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS P3001
|
| Hospital Charge Code |
30001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$82.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$82.54
|
| Rate for Payer: Kentucky WC Medicaid |
$83.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
SCREENING PAP SMEAR BY PHYS
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS P3001
|
| Hospital Charge Code |
30001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
SCREENING PAP SMEAR PROCEDURE
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001421
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$18.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.76
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$18.23
|
| Rate for Payer: Humana Medicare Advantage |
$17.31
|
| Rate for Payer: Kentucky WC Medicaid |
$18.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
SCREENING PAP SMEAR PROCEDURE
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001421
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$35.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$35.77
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$36.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.97
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
|
|
SCREENING PAP-SPECIMEN COLL (P
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
300P1588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.97
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
|
|
SCREW 1.9MM*5
|
Facility
|
OP
|
$1,741.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.37 |
| Max. Negotiated Rate |
$1,671.65 |
| Rate for Payer: Aetna Commercial |
$1,340.80
|
| Rate for Payer: Anthem Medicaid |
$598.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.21
|
| Rate for Payer: Cash Price |
$870.65
|
| Rate for Payer: Cigna Commercial |
$1,445.28
|
| Rate for Payer: First Health Commercial |
$1,654.24
|
| Rate for Payer: Humana Commercial |
$1,480.10
|
| Rate for Payer: Humana KY Medicaid |
$598.83
|
| Rate for Payer: Kentucky WC Medicaid |
$604.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.80
|
| Rate for Payer: PHCS Commercial |
$1,671.65
|
| Rate for Payer: United Healthcare All Payer |
$1,532.34
|
|
|
SCREW 1.9MM*5
|
Facility
|
IP
|
$1,741.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.37 |
| Max. Negotiated Rate |
$1,671.65 |
| Rate for Payer: Aetna Commercial |
$1,340.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.21
|
| Rate for Payer: Cash Price |
$870.65
|
| Rate for Payer: Cigna Commercial |
$1,445.28
|
| Rate for Payer: First Health Commercial |
$1,654.24
|
| Rate for Payer: Humana Commercial |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.80
|
| Rate for Payer: PHCS Commercial |
$1,671.65
|
| Rate for Payer: United Healthcare All Payer |
$1,532.34
|
|
|
SCREW 2.0*12 SNAP OFF
|
Facility
|
OP
|
$2,076.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.91 |
| Max. Negotiated Rate |
$1,993.20 |
| Rate for Payer: Aetna Commercial |
$1,598.71
|
| Rate for Payer: Anthem Medicaid |
$714.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,619.48
|
| Rate for Payer: Cash Price |
$1,038.12
|
| Rate for Payer: Cigna Commercial |
$1,723.29
|
| Rate for Payer: First Health Commercial |
$1,972.44
|
| Rate for Payer: Humana Commercial |
$1,764.81
|
| Rate for Payer: Humana KY Medicaid |
$714.02
|
| Rate for Payer: Kentucky WC Medicaid |
$721.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,702.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,532.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$728.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,827.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,557.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.64
|
| Rate for Payer: PHCS Commercial |
$1,993.20
|
| Rate for Payer: United Healthcare All Payer |
$1,827.10
|
|
