|
BX BREAST ADD LESION MR IMA(P
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
761P0283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.15 |
| Max. Negotiated Rate |
$1,261.56 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.15
|
| Rate for Payer: Anthem Medicaid |
$72.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$1,261.56
|
| Rate for Payer: Healthspan PPO |
$972.34
|
| Rate for Payer: Humana Medicaid |
$72.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.16
|
| Rate for Payer: Molina Healthcare Passport |
$72.71
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.50
|
| Rate for Payer: UHCCP Medicaid |
$71.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.44
|
|
|
BX BREAST ADD LESION MR IMA(T
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
761T0283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,514.88 |
| Rate for Payer: Aetna Commercial |
$1,215.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.84
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,309.74
|
| Rate for Payer: First Health Commercial |
$1,499.10
|
| Rate for Payer: Humana Commercial |
$1,341.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.18
|
| Rate for Payer: PHCS Commercial |
$1,514.88
|
| Rate for Payer: United Healthcare All Payer |
$1,388.64
|
|
|
BX BREAST ADD LESION MR IMA(T
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
761T0283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,514.88 |
| Rate for Payer: Aetna Commercial |
$1,215.06
|
| Rate for Payer: Anthem Medicaid |
$542.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.84
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,309.74
|
| Rate for Payer: First Health Commercial |
$1,499.10
|
| Rate for Payer: Humana Commercial |
$1,341.30
|
| Rate for Payer: Humana KY Medicaid |
$542.67
|
| Rate for Payer: Kentucky WC Medicaid |
$548.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.18
|
| Rate for Payer: PHCS Commercial |
$1,514.88
|
| Rate for Payer: United Healthcare All Payer |
$1,388.64
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$492.70 |
| Max. Negotiated Rate |
$3,638.40 |
| Rate for Payer: Aetna Commercial |
$2,918.30
|
| Rate for Payer: Anthem Medicaid |
$1,303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,956.20
|
| Rate for Payer: Cash Price |
$1,895.00
|
| Rate for Payer: Cigna Commercial |
$3,145.70
|
| Rate for Payer: First Health Commercial |
$3,600.50
|
| Rate for Payer: Humana Commercial |
$3,221.50
|
| Rate for Payer: Humana KY Medicaid |
$1,303.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,107.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,797.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,137.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,335.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,842.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.90
|
| Rate for Payer: PHCS Commercial |
$3,638.40
|
| Rate for Payer: United Healthcare All Payer |
$3,335.20
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$492.70 |
| Max. Negotiated Rate |
$3,638.40 |
| Rate for Payer: Aetna Commercial |
$2,918.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,956.20
|
| Rate for Payer: Cash Price |
$1,895.00
|
| Rate for Payer: Cigna Commercial |
$3,145.70
|
| Rate for Payer: First Health Commercial |
$3,600.50
|
| Rate for Payer: Humana Commercial |
$3,221.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,107.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,797.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,137.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,335.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,842.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.90
|
| Rate for Payer: PHCS Commercial |
$3,638.40
|
| Rate for Payer: United Healthcare All Payer |
$3,335.20
|
|
|
BX BREAST ADD LESION STRTCTC
|
Professional
|
Both
|
$3,790.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$3,790.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.24
|
| Rate for Payer: Anthem Medicaid |
$69.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,790.00
|
| Rate for Payer: Cash Price |
$1,895.00
|
| Rate for Payer: Cash Price |
$1,895.00
|
| Rate for Payer: Cigna Commercial |
$852.57
|
| Rate for Payer: Healthspan PPO |
$658.88
|
| Rate for Payer: Humana Medicaid |
$69.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.39
|
| Rate for Payer: Molina Healthcare Passport |
$69.99
|
| Rate for Payer: Multiplan PHCS |
$2,274.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,653.00
|
| Rate for Payer: UHCCP Medicaid |
$70.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.69
|
|
|
BX BREAST ADD LESION STRTCT(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
761P0279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.24
|
| Rate for Payer: Anthem Medicaid |
$69.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$852.57
|
| Rate for Payer: Healthspan PPO |
$658.88
|
| Rate for Payer: Humana Medicaid |
$69.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.39
|
| Rate for Payer: Molina Healthcare Passport |
$69.99
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$70.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.69
|
|
|
BX BREAST ADD LESION STRTCT(T
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
761T0279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.20 |
| Max. Negotiated Rate |
$2,630.40 |
| Rate for Payer: Aetna Commercial |
$2,109.80
|
| Rate for Payer: Anthem Medicaid |
$942.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,137.20
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,274.20
|
| Rate for Payer: First Health Commercial |
$2,603.00
|
| Rate for Payer: Humana Commercial |
$2,329.00
|
| Rate for Payer: Humana KY Medicaid |
$942.29
|
| Rate for Payer: Kentucky WC Medicaid |
$951.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,246.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,022.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$961.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,411.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$849.40
|
| Rate for Payer: PHCS Commercial |
$2,630.40
|
| Rate for Payer: United Healthcare All Payer |
$2,411.20
|
|
|
BX BREAST ADD LESION STRTCT(T
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
761T0279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.20 |
| Max. Negotiated Rate |
$2,630.40 |
| Rate for Payer: Aetna Commercial |
$2,109.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,137.20
|
| Rate for Payer: Cash Price |
$1,370.00
|
| Rate for Payer: Cigna Commercial |
$2,274.20
|
| Rate for Payer: First Health Commercial |
$2,603.00
|
| Rate for Payer: Humana Commercial |
$2,329.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,246.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,022.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,411.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$849.40
|
| Rate for Payer: PHCS Commercial |
$2,630.40
|
| Rate for Payer: United Healthcare All Payer |
$2,411.20
|
|
|
BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$2,328.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.64 |
| Max. Negotiated Rate |
$2,234.88 |
| Rate for Payer: Aetna Commercial |
$1,792.56
|
| Rate for Payer: Anthem Medicaid |
$800.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,815.84
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cigna Commercial |
$1,932.24
|
| Rate for Payer: First Health Commercial |
$2,211.60
|
| Rate for Payer: Humana Commercial |
$1,978.80
|
| Rate for Payer: Humana KY Medicaid |
$800.60
|
| Rate for Payer: Kentucky WC Medicaid |
$808.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,908.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,718.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$816.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,048.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,746.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.68
|
| Rate for Payer: PHCS Commercial |
$2,234.88
|
| Rate for Payer: United Healthcare All Payer |
$2,048.64
|
|
|
BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$2,328.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.64 |
| Max. Negotiated Rate |
$2,234.88 |
| Rate for Payer: Aetna Commercial |
$1,792.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,815.84
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cigna Commercial |
$1,932.24
|
| Rate for Payer: First Health Commercial |
$2,211.60
|
| Rate for Payer: Humana Commercial |
$1,978.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,908.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,718.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,048.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,746.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.68
|
| Rate for Payer: PHCS Commercial |
$2,234.88
|
| Rate for Payer: United Healthcare All Payer |
$2,048.64
|
|
|
BX BREAST ADD LESION US IMAG
|
Professional
|
Both
|
$2,328.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.16
|
| Rate for Payer: Anthem Medicaid |
$65.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,328.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cash Price |
$1,164.00
|
| Rate for Payer: Cigna Commercial |
$840.60
|
| Rate for Payer: Healthspan PPO |
$649.46
|
| Rate for Payer: Humana Medicaid |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.11
|
| Rate for Payer: Molina Healthcare Passport |
$65.79
|
| Rate for Payer: Multiplan PHCS |
$1,396.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,629.60
|
| Rate for Payer: UHCCP Medicaid |
$66.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.45
|
|
|
BX BREAST ADD LESION US IMA(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
761P0281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$840.60 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.16
|
| Rate for Payer: Anthem Medicaid |
$65.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$840.60
|
| Rate for Payer: Healthspan PPO |
$649.46
|
| Rate for Payer: Humana Medicaid |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.11
|
| Rate for Payer: Molina Healthcare Passport |
$65.79
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$66.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.45
|
|
|
BX BREAST ADD LESION US IMA(T
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
761T0281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,514.88 |
| Rate for Payer: Aetna Commercial |
$1,215.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.84
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,309.74
|
| Rate for Payer: First Health Commercial |
$1,499.10
|
| Rate for Payer: Humana Commercial |
$1,341.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.18
|
| Rate for Payer: PHCS Commercial |
$1,514.88
|
| Rate for Payer: United Healthcare All Payer |
$1,388.64
|
|
|
BX BREAST ADD LESION US IMA(T
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
761T0281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$1,514.88 |
| Rate for Payer: Aetna Commercial |
$1,215.06
|
| Rate for Payer: Anthem Medicaid |
$542.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.84
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,309.74
|
| Rate for Payer: First Health Commercial |
$1,499.10
|
| Rate for Payer: Humana Commercial |
$1,341.30
|
| Rate for Payer: Humana KY Medicaid |
$542.67
|
| Rate for Payer: Kentucky WC Medicaid |
$548.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.18
|
| Rate for Payer: PHCS Commercial |
$1,514.88
|
| Rate for Payer: United Healthcare All Payer |
$1,388.64
|
|
|
BX BREAST OPEN
|
Facility
|
IP
|
$5,746.10
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.99 |
| Max. Negotiated Rate |
$5,516.26 |
| Rate for Payer: Aetna Commercial |
$4,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,481.96
|
| Rate for Payer: Cash Price |
$2,873.05
|
| Rate for Payer: Cigna Commercial |
$4,769.26
|
| Rate for Payer: First Health Commercial |
$5,458.80
|
| Rate for Payer: Humana Commercial |
$4,884.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,711.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,240.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,723.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,056.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,309.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,149.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,781.29
|
| Rate for Payer: PHCS Commercial |
$5,516.26
|
| Rate for Payer: United Healthcare All Payer |
$5,056.57
|
|
|
BX BREAST OPEN
|
Facility
|
OP
|
$5,746.10
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.99 |
| Max. Negotiated Rate |
$5,516.26 |
| Rate for Payer: Aetna Commercial |
$4,424.50
|
| Rate for Payer: Anthem Medicaid |
$1,976.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,481.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,873.05
|
| Rate for Payer: Cash Price |
$2,873.05
|
| Rate for Payer: Cigna Commercial |
$4,769.26
|
| Rate for Payer: First Health Commercial |
$5,458.80
|
| Rate for Payer: Humana Commercial |
$4,884.18
|
| Rate for Payer: Humana KY Medicaid |
$1,976.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,996.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,711.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,240.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,015.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,056.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,309.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,149.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$746.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,781.29
|
| Rate for Payer: PHCS Commercial |
$5,516.26
|
| Rate for Payer: United Healthcare All Payer |
$5,056.57
|
|
|
BX BREAST OPEN
|
Professional
|
Both
|
$5,746.10
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$5,746.10 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.59
|
| Rate for Payer: Anthem Medicaid |
$165.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,746.10
|
| Rate for Payer: Cash Price |
$2,873.05
|
| Rate for Payer: Cash Price |
$2,873.05
|
| Rate for Payer: Cigna Commercial |
$295.25
|
| Rate for Payer: Healthspan PPO |
$357.79
|
| Rate for Payer: Humana Medicaid |
$165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$277.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.85
|
| Rate for Payer: Molina Healthcare Passport |
$165.54
|
| Rate for Payer: Multiplan PHCS |
$3,447.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,022.27
|
| Rate for Payer: UHCCP Medicaid |
$121.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.20
|
|
|
BX BREAST OPEN(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
761P0285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.59
|
| Rate for Payer: Anthem Medicaid |
$165.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$295.25
|
| Rate for Payer: Healthspan PPO |
$357.79
|
| Rate for Payer: Humana Medicaid |
$165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$277.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.85
|
| Rate for Payer: Molina Healthcare Passport |
$165.54
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$121.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.20
|
|
|
BX BREAST OPEN(T
|
Facility
|
OP
|
$5,146.10
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
761T0285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$668.99 |
| Max. Negotiated Rate |
$4,940.26 |
| Rate for Payer: Aetna Commercial |
$3,962.50
|
| Rate for Payer: Anthem Medicaid |
$1,769.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,573.05
|
| Rate for Payer: Cash Price |
$2,573.05
|
| Rate for Payer: Cigna Commercial |
$4,271.26
|
| Rate for Payer: First Health Commercial |
$4,888.80
|
| Rate for Payer: Humana Commercial |
$4,374.18
|
| Rate for Payer: Humana KY Medicaid |
$1,769.74
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.29
|
| Rate for Payer: PHCS Commercial |
$4,940.26
|
| Rate for Payer: United Healthcare All Payer |
$4,528.57
|
|
|
BX BREAST OPEN(T
|
Facility
|
IP
|
$5,146.10
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
761T0285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$668.99 |
| Max. Negotiated Rate |
$4,940.26 |
| Rate for Payer: Aetna Commercial |
$3,962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.96
|
| Rate for Payer: Cash Price |
$2,573.05
|
| Rate for Payer: Cigna Commercial |
$4,271.26
|
| Rate for Payer: First Health Commercial |
$4,888.80
|
| Rate for Payer: Humana Commercial |
$4,374.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,595.29
|
| Rate for Payer: PHCS Commercial |
$4,940.26
|
| Rate for Payer: United Healthcare All Payer |
$4,528.57
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.41 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem Medicaid |
$397.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Humana KY Medicaid |
$397.89
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$401.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.67
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$1,157.00 |
| Rate for Payer: Aetna Commercial |
$209.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.03
|
| Rate for Payer: Anthem Medicaid |
$59.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,157.00
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$232.91
|
| Rate for Payer: Healthspan PPO |
$226.24
|
| Rate for Payer: Humana Medicaid |
$59.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.01
|
| Rate for Payer: Molina Healthcare Passport |
$59.81
|
| Rate for Payer: Multiplan PHCS |
$694.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.90
|
| Rate for Payer: UHCCP Medicaid |
$108.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.41
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.41 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.67
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
BX/CURETT OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761P2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$209.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.03
|
| Rate for Payer: Anthem Medicaid |
$59.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$232.91
|
| Rate for Payer: Healthspan PPO |
$226.24
|
| Rate for Payer: Humana Medicaid |
$59.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.01
|
| Rate for Payer: Molina Healthcare Passport |
$59.81
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$108.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.41
|
|
