|
CERCLAGE OF CERVIX - PREG -
|
Facility
|
IP
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$872.17 |
| Max. Negotiated Rate |
$6,440.64 |
| Rate for Payer: Aetna Commercial |
$5,165.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.02
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$5,568.47
|
| Rate for Payer: First Health Commercial |
$6,373.55
|
| Rate for Payer: Humana Commercial |
$5,702.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,903.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.79
|
| Rate for Payer: PHCS Commercial |
$6,440.64
|
| Rate for Payer: United Healthcare All Payer |
$5,903.92
|
|
|
CERCLAGE OF CERVIX - PREG -(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
720P0014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$255.67
|
| Rate for Payer: Anthem Medicaid |
$130.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$236.17
|
| Rate for Payer: Healthspan PPO |
$185.56
|
| Rate for Payer: Humana Medicaid |
$130.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.09
|
| Rate for Payer: Molina Healthcare Passport |
$130.48
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.78
|
|
|
CERCLAGE OF CERVIX - PREG -(T
|
Facility
|
OP
|
$5,209.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
720T0014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$677.17 |
| Max. Negotiated Rate |
$5,000.64 |
| Rate for Payer: Aetna Commercial |
$4,010.93
|
| Rate for Payer: Anthem Medicaid |
$1,791.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cigna Commercial |
$4,323.47
|
| Rate for Payer: First Health Commercial |
$4,948.55
|
| Rate for Payer: Humana Commercial |
$4,427.65
|
| Rate for Payer: Humana KY Medicaid |
$1,791.38
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,271.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,614.79
|
| Rate for Payer: PHCS Commercial |
$5,000.64
|
| Rate for Payer: United Healthcare All Payer |
$4,583.92
|
|
|
CERCLAGE OF CERVIX - PREG -(T
|
Facility
|
IP
|
$5,209.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
720T0014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$677.17 |
| Max. Negotiated Rate |
$5,000.64 |
| Rate for Payer: Aetna Commercial |
$4,010.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.02
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cigna Commercial |
$4,323.47
|
| Rate for Payer: First Health Commercial |
$4,948.55
|
| Rate for Payer: Humana Commercial |
$4,427.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,271.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,562.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,614.79
|
| Rate for Payer: PHCS Commercial |
$5,000.64
|
| Rate for Payer: United Healthcare All Payer |
$4,583.92
|
|
|
CEREBROSPINAL FLUID SCAN
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
34000029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$1,135.00 |
| Rate for Payer: Aetna Commercial |
$475.92
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,135.00
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$382.77
|
| Rate for Payer: Healthspan PPO |
$475.68
|
| Rate for Payer: Humana Medicaid |
$165.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.08
|
| Rate for Payer: Molina Healthcare Passport |
$165.76
|
| Rate for Payer: Multiplan PHCS |
$681.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.50
|
| Rate for Payer: UHCCP Medicaid |
$397.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.42
|
|
|
CEREBROSPINAL FLUID SCAN
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
34000029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$147.55 |
| Max. Negotiated Rate |
$1,089.60 |
| Rate for Payer: Aetna Commercial |
$873.95
|
| Rate for Payer: Anthem Medicaid |
$390.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$942.05
|
| Rate for Payer: First Health Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial |
$964.75
|
| Rate for Payer: Humana KY Medicaid |
$390.33
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$394.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.80
|
| Rate for Payer: Ohio Health Group HMO |
$851.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.85
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
|
CEREBROSPINAL FLUID SCAN
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
34000029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$147.55 |
| Max. Negotiated Rate |
$1,089.60 |
| Rate for Payer: Aetna Commercial |
$873.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.30
|
| Rate for Payer: Cash Price |
$567.50
|
| Rate for Payer: Cigna Commercial |
$942.05
|
| Rate for Payer: First Health Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial |
$964.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.80
|
| Rate for Payer: Ohio Health Group HMO |
$851.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.85
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
|
CEREBROSPINAL FLUID SCAN(P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
340P0029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$475.92 |
| Rate for Payer: Aetna Commercial |
$475.92
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$382.77
|
| Rate for Payer: Healthspan PPO |
$475.68
|
| Rate for Payer: Humana Medicaid |
$165.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.08
|
| Rate for Payer: Molina Healthcare Passport |
$165.76
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.42
|
|
|
CEREBROSPINAL FLUID SCAN(T
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
340T0029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CEREBROSPINAL FLUID SCAN(T
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
340T0029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CEREBYX 50mg (100mg Vial)
|
Facility
|
OP
|
$121.80
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
25002712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$116.93 |
| Rate for Payer: Anthem Medicaid |
$41.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna Commercial |
$101.09
|
| Rate for Payer: First Health Commercial |
$115.71
|
| Rate for Payer: Humana Commercial |
$103.53
|
| Rate for Payer: Humana KY Medicaid |
$41.89
|
| Rate for Payer: Humana Medicare Advantage |
$4.80
|
| Rate for Payer: Kentucky WC Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.18
|
| Rate for Payer: Ohio Health Group HMO |
$91.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.76
|
| Rate for Payer: PHCS Commercial |
$116.93
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
| Rate for Payer: Aetna Commercial |
$93.79
|
|
|
CEREBYX 50mg (100mg Vial)
|
Facility
|
IP
|
$121.80
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
25002712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$116.93 |
| Rate for Payer: Aetna Commercial |
$93.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.00
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna Commercial |
$101.09
|
| Rate for Payer: First Health Commercial |
$115.71
|
| Rate for Payer: Humana Commercial |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.18
|
| Rate for Payer: Ohio Health Group HMO |
$91.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.76
|
| Rate for Payer: PHCS Commercial |
$116.93
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
CEREBYX 50MGPE (500MGPE SDV)
|
Facility
|
IP
|
$549.30
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
25002711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$527.33 |
| Rate for Payer: Aetna Commercial |
$422.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.45
|
| Rate for Payer: Cash Price |
$274.65
|
| Rate for Payer: Cigna Commercial |
$455.92
|
| Rate for Payer: First Health Commercial |
$521.84
|
| Rate for Payer: Humana Commercial |
$466.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$450.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$483.38
|
| Rate for Payer: Ohio Health Group HMO |
$411.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.28
|
| Rate for Payer: PHCS Commercial |
$527.33
|
| Rate for Payer: United Healthcare All Payer |
$483.38
|
|
|
CEREBYX 50MGPE (500MGPE SDV)
|
Facility
|
OP
|
$549.30
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
25002711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$527.33 |
| Rate for Payer: Aetna Commercial |
$422.96
|
| Rate for Payer: Anthem Medicaid |
$188.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$274.65
|
| Rate for Payer: Cash Price |
$274.65
|
| Rate for Payer: Cigna Commercial |
$455.92
|
| Rate for Payer: First Health Commercial |
$521.84
|
| Rate for Payer: Humana Commercial |
$466.90
|
| Rate for Payer: Humana KY Medicaid |
$188.90
|
| Rate for Payer: Humana Medicare Advantage |
$4.80
|
| Rate for Payer: Kentucky WC Medicaid |
$190.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$450.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$483.38
|
| Rate for Payer: Ohio Health Group HMO |
$411.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.28
|
| Rate for Payer: PHCS Commercial |
$527.33
|
| Rate for Payer: United Healthcare All Payer |
$483.38
|
|
|
CERVICAL LYMPH COMPLETE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
76101605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.11 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,892.26
|
| Rate for Payer: Anthem Medicaid |
$832.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,737.18
|
| Rate for Payer: Healthspan PPO |
$1,513.04
|
| Rate for Payer: Humana Medicaid |
$832.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,727.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$848.75
|
| Rate for Payer: Molina Healthcare Passport |
$832.11
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.43
|
|
|
CERVICAL LYMPH COMPLETE
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
76101605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
CERVICAL LYMPH COMPLETE
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
76101605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
CERVICAL LYMPH COMPLETE(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
761P1605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.11 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,892.26
|
| Rate for Payer: Anthem Medicaid |
$832.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,737.18
|
| Rate for Payer: Healthspan PPO |
$1,513.04
|
| Rate for Payer: Humana Medicaid |
$832.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,727.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$848.75
|
| Rate for Payer: Molina Healthcare Passport |
$832.11
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.43
|
|
|
CERVICAL LYMPH NECK
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
76101606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
CERVICAL LYMPH NECK
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
76101606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$821.68 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,051.96
|
| Rate for Payer: Anthem Medicaid |
$821.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,876.12
|
| Rate for Payer: Healthspan PPO |
$1,640.73
|
| Rate for Payer: Humana Medicaid |
$821.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,866.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$838.11
|
| Rate for Payer: Molina Healthcare Passport |
$821.68
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$829.90
|
|
|
CERVICAL LYMPH NECK
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
76101606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
CERVICAL LYMPH NECK(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
761P1606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$821.68 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,051.96
|
| Rate for Payer: Anthem Medicaid |
$821.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,876.12
|
| Rate for Payer: Healthspan PPO |
$1,640.73
|
| Rate for Payer: Humana Medicaid |
$821.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,866.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$838.11
|
| Rate for Payer: Molina Healthcare Passport |
$821.68
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$829.90
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$34,572.89
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$23,460.17 |
| Max. Negotiated Rate |
$34,572.89 |
| Rate for Payer: Anthem Medicaid |
$23,460.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,694.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,572.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,338.14
|
| Rate for Payer: Humana KY Medicaid |
$23,460.17
|
| Rate for Payer: Humana Medicare Advantage |
$24,694.92
|
| Rate for Payer: Kentucky WC Medicaid |
$23,694.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,633.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,929.38
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$57,543.49
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$39,047.37 |
| Max. Negotiated Rate |
$57,543.49 |
| Rate for Payer: Anthem Medicaid |
$39,047.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41,102.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57,543.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$55,488.36
|
| Rate for Payer: Humana KY Medicaid |
$39,047.37
|
| Rate for Payer: Humana Medicare Advantage |
$41,102.49
|
| Rate for Payer: Kentucky WC Medicaid |
$39,437.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49,322.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,828.31
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$28,784.62
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$19,532.42 |
| Max. Negotiated Rate |
$28,784.62 |
| Rate for Payer: Anthem Medicaid |
$19,532.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,560.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,784.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,756.59
|
| Rate for Payer: Humana KY Medicaid |
$19,532.42
|
| Rate for Payer: Humana Medicare Advantage |
$20,560.44
|
| Rate for Payer: Kentucky WC Medicaid |
$19,727.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,672.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,923.07
|
|
