|
SAVION FLEX WIRE 300CM
|
Facility
|
OP
|
$2,102.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.71 |
| Max. Negotiated Rate |
$2,018.28 |
| Rate for Payer: Aetna Commercial |
$1,618.82
|
| Rate for Payer: Anthem Medicaid |
$723.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.85
|
| Rate for Payer: Cash Price |
$1,051.18
|
| Rate for Payer: Cigna Commercial |
$1,744.97
|
| Rate for Payer: First Health Commercial |
$1,997.25
|
| Rate for Payer: Humana Commercial |
$1,787.01
|
| Rate for Payer: Humana KY Medicaid |
$723.01
|
| Rate for Payer: Kentucky WC Medicaid |
$730.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.64
|
| Rate for Payer: PHCS Commercial |
$2,018.28
|
| Rate for Payer: United Healthcare All Payer |
$1,850.09
|
|
|
SBRT MANAGEMENT
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 77435
|
| Hospital Charge Code |
33300040
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$508.67 |
| Max. Negotiated Rate |
$2,595.87 |
| Rate for Payer: Aetna Commercial |
$1,052.99
|
| Rate for Payer: Ambetter Exchange |
$611.24
|
| Rate for Payer: Anthem Medicaid |
$508.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.49
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: Healthspan PPO |
$888.00
|
| Rate for Payer: Humana Medicaid |
$508.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,595.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$611.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.84
|
| Rate for Payer: Molina Healthcare Passport |
$508.67
|
| Rate for Payer: Multiplan PHCS |
$945.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.61
|
| Rate for Payer: UHCCP Medicaid |
$551.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.24
|
|
|
SBRT MANAGEMENT
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 77435
|
| Hospital Charge Code |
33300040
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem Medicaid |
$541.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Humana KY Medicaid |
$541.64
|
| Rate for Payer: Kentucky WC Medicaid |
$547.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.75
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
SBRT MANAGEMENT
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 77435
|
| Hospital Charge Code |
33300040
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.75
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
SBRT MANAGEMENT(P
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 77435
|
| Hospital Charge Code |
333P0040
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$508.67 |
| Max. Negotiated Rate |
$2,595.87 |
| Rate for Payer: Aetna Commercial |
$1,052.99
|
| Rate for Payer: Ambetter Exchange |
$611.24
|
| Rate for Payer: Anthem Medicaid |
$508.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.49
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: Healthspan PPO |
$888.00
|
| Rate for Payer: Humana Medicaid |
$508.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,595.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$611.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.84
|
| Rate for Payer: Molina Healthcare Passport |
$508.67
|
| Rate for Payer: Multiplan PHCS |
$945.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.61
|
| Rate for Payer: UHCCP Medicaid |
$551.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.24
|
|
|
SBSQ NB EM PER DAY HOSP
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$47.38
|
| Rate for Payer: Ambetter Exchange |
$37.68
|
| Rate for Payer: Anthem Medicaid |
$24.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.22
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$48.22
|
| Rate for Payer: Healthspan PPO |
$35.22
|
| Rate for Payer: Humana Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare Passport |
$24.63
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.98
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.68
|
|
|
SBSQ NB EM PER DAY HOSP
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
SBSQ NB EM PER DAY HOSP
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
SBSQ NB EM PER DAY HOSP(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
510P0118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$47.38
|
| Rate for Payer: Ambetter Exchange |
$37.68
|
| Rate for Payer: Anthem Medicaid |
$24.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.22
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$48.22
|
| Rate for Payer: Healthspan PPO |
$35.22
|
| Rate for Payer: Humana Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare Passport |
$24.63
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.98
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.68
|
|
|
SCALLOPS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000909
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SCALLOPS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000909
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SCALP COOL 1ST MEAS&CALBRJ
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
HCPCS 0662T
|
| Hospital Charge Code |
76102918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.10 |
| Max. Negotiated Rate |
$2,617.92 |
| Rate for Payer: Aetna Commercial |
$2,099.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,127.06
|
| Rate for Payer: Cash Price |
$1,363.50
|
| Rate for Payer: Cigna Commercial |
$2,263.41
|
| Rate for Payer: First Health Commercial |
$2,590.65
|
| Rate for Payer: Humana Commercial |
$2,317.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,236.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,012.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$818.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,399.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,045.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,372.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,881.63
|
| Rate for Payer: PHCS Commercial |
$2,617.92
|
| Rate for Payer: United Healthcare All Payer |
$2,399.76
|
|
|
SCALP COOL 1ST MEAS&CALBRJ
|
Facility
|
OP
|
$2,727.00
|
|
|
Service Code
|
HCPCS 0662T
|
| Hospital Charge Code |
76102918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$937.82 |
| Max. Negotiated Rate |
$2,617.92 |
| Rate for Payer: Aetna Commercial |
$2,099.79
|
| Rate for Payer: Anthem Medicaid |
$937.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,617.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,127.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,264.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,183.53
|
| Rate for Payer: Cash Price |
$1,363.50
|
| Rate for Payer: Cash Price |
$1,363.50
|
| Rate for Payer: Cigna Commercial |
$2,263.41
|
| Rate for Payer: First Health Commercial |
$2,590.65
|
| Rate for Payer: Humana Commercial |
$2,317.95
|
| Rate for Payer: Humana KY Medicaid |
$937.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,617.43
|
| Rate for Payer: Kentucky WC Medicaid |
$947.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,236.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,012.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$956.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,399.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,045.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,372.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,881.63
|
| Rate for Payer: PHCS Commercial |
$2,617.92
|
| Rate for Payer: United Healthcare All Payer |
$2,399.76
|
|
|
SCALP COOL 1ST MEAS&CALBRJ
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 0662T
|
| Hospital Charge Code |
76102918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$954.45 |
| Max. Negotiated Rate |
$1,908.90 |
| Rate for Payer: Cash Price |
$1,363.50
|
| Rate for Payer: Multiplan PHCS |
$1,636.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,908.90
|
| Rate for Payer: UHCCP Medicaid |
$954.45
|
|
|
SCALP COOL PLMT MNTR RMVL
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.95 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Multiplan PHCS |
$154.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.90
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
|
|
SCALP COOL PLMT MNTR RMVL
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SCALP COOL PLMT MNTR RMVL
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem Medicaid |
$88.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Humana KY Medicaid |
$88.38
|
| Rate for Payer: Kentucky WC Medicaid |
$89.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$1,944.96 |
| Rate for Payer: Aetna Commercial |
$1,560.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.28
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,681.58
|
| Rate for Payer: First Health Commercial |
$1,924.70
|
| Rate for Payer: Humana Commercial |
$1,722.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.94
|
| Rate for Payer: PHCS Commercial |
$1,944.96
|
| Rate for Payer: United Healthcare All Payer |
$1,782.88
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$1,944.96 |
| Rate for Payer: Aetna Commercial |
$1,560.02
|
| Rate for Payer: Anthem Medicaid |
$696.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.28
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,681.58
|
| Rate for Payer: First Health Commercial |
$1,924.70
|
| Rate for Payer: Humana Commercial |
$1,722.10
|
| Rate for Payer: Humana KY Medicaid |
$696.74
|
| Rate for Payer: Kentucky WC Medicaid |
$703.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.94
|
| Rate for Payer: PHCS Commercial |
$1,944.96
|
| Rate for Payer: United Healthcare All Payer |
$1,782.88
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.44 |
| Max. Negotiated Rate |
$1,215.60 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Ambetter Exchange |
$116.06
|
| Rate for Payer: Anthem Medicaid |
$223.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.27
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$475.13
|
| Rate for Payer: Healthspan PPO |
$291.18
|
| Rate for Payer: Humana Medicaid |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.92
|
| Rate for Payer: Molina Healthcare Passport |
$223.45
|
| Rate for Payer: Multiplan PHCS |
$1,215.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.88
|
| Rate for Payer: UHCCP Medicaid |
$709.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.06
|
|
|
SCAN FOR NEEDLE BIOPSY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350P0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$475.13 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Ambetter Exchange |
$116.06
|
| Rate for Payer: Anthem Medicaid |
$223.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.27
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$475.13
|
| Rate for Payer: Healthspan PPO |
$291.18
|
| Rate for Payer: Humana Medicaid |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.92
|
| Rate for Payer: Molina Healthcare Passport |
$223.45
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.88
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.06
|
|
|
SCAN FOR NEEDLE BIOPSY(T
|
Facility
|
OP
|
$1,876.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350T0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$1,800.96 |
| Rate for Payer: Aetna Commercial |
$1,444.52
|
| Rate for Payer: Anthem Medicaid |
$645.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.28
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: Cigna Commercial |
$1,557.08
|
| Rate for Payer: First Health Commercial |
$1,782.20
|
| Rate for Payer: Humana Commercial |
$1,594.60
|
| Rate for Payer: Humana KY Medicaid |
$645.16
|
| Rate for Payer: Kentucky WC Medicaid |
$651.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.44
|
| Rate for Payer: PHCS Commercial |
$1,800.96
|
| Rate for Payer: United Healthcare All Payer |
$1,650.88
|
|
|
SCAN FOR NEEDLE BIOPSY(T
|
Facility
|
IP
|
$1,876.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350T0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$1,800.96 |
| Rate for Payer: Aetna Commercial |
$1,444.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.28
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: Cigna Commercial |
$1,557.08
|
| Rate for Payer: First Health Commercial |
$1,782.20
|
| Rate for Payer: Humana Commercial |
$1,594.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.44
|
| Rate for Payer: PHCS Commercial |
$1,800.96
|
| Rate for Payer: United Healthcare All Payer |
$1,650.88
|
|
|
SCAN PROC CRANIAL EXTRA
|
Facility
|
OP
|
$3,394.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
76102288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.42 |
| Max. Negotiated Rate |
$3,258.95 |
| Rate for Payer: Aetna Commercial |
$2,613.95
|
| Rate for Payer: Anthem Medicaid |
$1,167.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,647.90
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cigna Commercial |
$2,817.63
|
| Rate for Payer: First Health Commercial |
$3,225.00
|
| Rate for Payer: Humana Commercial |
$2,885.53
|
| Rate for Payer: Humana KY Medicaid |
$1,167.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,179.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,190.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,715.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.37
|
| Rate for Payer: PHCS Commercial |
$3,258.95
|
| Rate for Payer: United Healthcare All Payer |
$2,987.37
|
|
|
SCAN PROC CRANIAL EXTRA
|
Facility
|
IP
|
$3,394.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
76102288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.42 |
| Max. Negotiated Rate |
$3,258.95 |
| Rate for Payer: Aetna Commercial |
$2,613.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,647.90
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cigna Commercial |
$2,817.63
|
| Rate for Payer: First Health Commercial |
$3,225.00
|
| Rate for Payer: Humana Commercial |
$2,885.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,715.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.37
|
| Rate for Payer: PHCS Commercial |
$3,258.95
|
| Rate for Payer: United Healthcare All Payer |
$2,987.37
|
|
