|
RSV ANTIGEN SCREEN
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Ambetter Exchange |
$13.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.72
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.10
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.10
|
|
|
RSV ANTIGEN SCREEN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
RSV ANTIGEN SCREEN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$13.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.10
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$13.10
|
| Rate for Payer: Humana Medicare Advantage |
$13.10
|
| Rate for Payer: Kentucky WC Medicaid |
$13.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
RSV A RT PCR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$70.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$70.20
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$70.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
RSV A RT PCR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
RSV B RT PCR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RSV B RT PCR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$70.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$70.20
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$70.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.18
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RT AXILLA US
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
RT AXILLA US
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
RT AXILLA US
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
RT AXILLA US(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
RT AXILLA US(T
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
RT AXILLA US(T
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
RT BREAST ASPIRATION US
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200069
|
|
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
|
|
|
RT BREAST ASPIRATION US
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200069
|
|
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
|
|
|
RT BREAST ASPIRATION US
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200069
|
|
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
|
|
|
RT BREAST ASPIRATION US(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0069
|
|
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
|
|
|
RT BREAST ASPIRATION US(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0069
|
|
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
|
|
|
RT BREAST ASPIRATION US(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0069
|
|
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
|
|
|
RT BREAST LUMP US
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Ambetter Exchange |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.40
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$141.32
|
| Rate for Payer: Humana Medicaid |
$67.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
RT BREAST LUMP US
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.60 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.78
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
RT BREAST LUMP US
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$517.20 |
| Rate for Payer: Ambetter Exchange |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.40
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$141.32
|
| Rate for Payer: Humana Medicaid |
$67.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
RT BREAST LUMP US
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
RT BREAST LUMP US
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.78
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
RT BREAST LUMP US
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
