|
UNI-FUSE CATH 5FR*90CM*40CM
|
Facility
|
IP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNI-FUSE CATH 5FR*90CM*40CM
|
Facility
|
OP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem Medicaid |
$1,115.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Humana KY Medicaid |
$1,115.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNI-FUSE CATH 5FR*90CM*50CM
|
Facility
|
OP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem Medicaid |
$1,115.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Humana KY Medicaid |
$1,115.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNI-FUSE CATH 5FR*90CM*50CM
|
Facility
|
IP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNI-FUSE CATH 5FR*90CM*5CM
|
Facility
|
OP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem Medicaid |
$1,115.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Humana KY Medicaid |
$1,115.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNI-FUSE CATH 5FR*90CM*5CM
|
Facility
|
IP
|
$3,245.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.50 |
| Max. Negotiated Rate |
$3,115.20 |
| Rate for Payer: Aetna Commercial |
$2,498.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.10
|
| Rate for Payer: Cash Price |
$1,622.50
|
| Rate for Payer: Cigna Commercial |
$2,693.35
|
| Rate for Payer: First Health Commercial |
$3,082.75
|
| Rate for Payer: Humana Commercial |
$2,758.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.05
|
| Rate for Payer: PHCS Commercial |
$3,115.20
|
| Rate for Payer: United Healthcare All Payer |
$2,855.60
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200113
|
|
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
|
|
|
UNILATERAL BREAST LUMP US
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$529.80 |
| 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 |
$441.50
|
| Rate for Payer: Cash Price |
$441.50
|
| 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: 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 |
$529.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$309.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
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 |
$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
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200113
|
|
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
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.90 |
| Max. Negotiated Rate |
$847.68 |
| Rate for Payer: Aetna Commercial |
$679.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$688.74
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cigna Commercial |
$732.89
|
| Rate for Payer: First Health Commercial |
$838.85
|
| Rate for Payer: Humana Commercial |
$750.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$651.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.04
|
| Rate for Payer: Ohio Health Group HMO |
$662.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.27
|
| Rate for Payer: PHCS Commercial |
$847.68
|
| Rate for Payer: United Healthcare All Payer |
$777.04
|
|
|
UNILATERAL BREAST LUMP US
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$847.68 |
| Rate for Payer: Aetna Commercial |
$679.91
|
| Rate for Payer: Anthem Medicaid |
$303.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$688.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cigna Commercial |
$732.89
|
| Rate for Payer: First Health Commercial |
$838.85
|
| Rate for Payer: Humana Commercial |
$750.55
|
| Rate for Payer: Humana KY Medicaid |
$303.66
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$306.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$651.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$309.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.04
|
| Rate for Payer: Ohio Health Group HMO |
$662.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.27
|
| Rate for Payer: PHCS Commercial |
$847.68
|
| Rate for Payer: United Healthcare All Payer |
$777.04
|
|
|
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: 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 |
$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: 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 |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
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: 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 |
$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: 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 |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
UNILATERAL BREAST LUMP US (T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.10 |
| 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 |
$589.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.53
|
| 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 |
402T0113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| 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 |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| 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 |
$81.36
|
| 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 |
$97.63
|
| 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 |
$589.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.53
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
UNILATERAL BREAST LUMP US(T
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.02
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
UNILATERAL BREAST LUMP US(T
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem Medicaid |
$260.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Humana KY Medicaid |
$260.68
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.02
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
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 |
$700.00 |
| 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
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
401P0005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$210.02 |
| Rate for Payer: Ambetter Exchange |
$113.66
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$136.39
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$210.02
|
| Rate for Payer: Humana Medicaid |
$101.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.13
|
| Rate for Payer: Molina Healthcare Passport |
$101.11
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.76
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.66
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
401T0005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Ambetter Exchange |
$113.66
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$136.39
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$210.02
|
| Rate for Payer: Humana Medicaid |
$101.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.13
|
| Rate for Payer: Molina Healthcare Passport |
$101.11
|
| Rate for Payer: Multiplan PHCS |
$460.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.76
|
| Rate for Payer: UHCCP Medicaid |
$268.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.66
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
UNILATERAL LT DIAGNOSTIC W/CAD
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
401T0005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
