|
UNI-FUSE CATH 5FR*90CM*10CM
|
Facility
|
IP
|
$1,811.44
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.49 |
| Max. Negotiated Rate |
$1,738.98 |
| Rate for Payer: Aetna Commercial |
$1,394.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.92
|
| Rate for Payer: Cash Price |
$905.72
|
| Rate for Payer: Cigna Commercial |
$1,503.50
|
| Rate for Payer: First Health Commercial |
$1,720.87
|
| Rate for Payer: Humana Commercial |
$1,539.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.55
|
| Rate for Payer: PHCS Commercial |
$1,738.98
|
| Rate for Payer: United Healthcare All Payer |
$1,594.07
|
|
|
UNI-FUSE CATH 5FR*90CM*10CM
|
Facility
|
OP
|
$1,811.44
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.49 |
| Max. Negotiated Rate |
$1,738.98 |
| Rate for Payer: Aetna Commercial |
$1,394.81
|
| Rate for Payer: Anthem Medicaid |
$622.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.92
|
| Rate for Payer: Cash Price |
$905.72
|
| Rate for Payer: Cigna Commercial |
$1,503.50
|
| Rate for Payer: First Health Commercial |
$1,720.87
|
| Rate for Payer: Humana Commercial |
$1,539.72
|
| Rate for Payer: Humana KY Medicaid |
$622.95
|
| Rate for Payer: Kentucky WC Medicaid |
$629.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.55
|
| Rate for Payer: PHCS Commercial |
$1,738.98
|
| Rate for Payer: United Healthcare All Payer |
$1,594.07
|
|
|
UNI-FUSE CATH 5FR*90CM*20CM
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*20CM
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*30CM
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*30CM
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*40CM
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*40CM
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*50CM
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*50CM
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*5CM
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNI-FUSE CATH 5FR*90CM*5CM
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
UNILATERAL BREAST LUMP US
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| 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: 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 |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.58 |
| 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 |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| 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 |
$78.58
|
| 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 |
$94.30
|
| 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 |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.06 |
| 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 |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.58 |
| 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 |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| 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 |
$78.58
|
| 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 |
$94.30
|
| 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 |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.06 |
| 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 |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
UNILATERAL BREAST LUMP US
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| 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: 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 |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
|
|
UNILATERAL BREAST LUMP US (P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402P0113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$141.32 |
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| 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: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
|
|
UNILATERAL BREAST LUMP US(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402P0012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$141.32 |
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| 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: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
|
|
UNILATERAL BREAST LUMP US (T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
UNILATERAL BREAST LUMP US (T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
UNILATERAL BREAST LUMP US(T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
UNILATERAL BREAST LUMP US(T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
UNILATERAL BROW LIFT IN OFC
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200722
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
