|
BX BREAST 1ST LESION US IMA(T
|
Facility
|
IP
|
$2,755.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
761T0280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$2,644.80 |
| Rate for Payer: Aetna Commercial |
$2,121.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,148.90
|
| Rate for Payer: Cash Price |
$1,377.50
|
| Rate for Payer: Cigna Commercial |
$2,286.65
|
| Rate for Payer: First Health Commercial |
$2,617.25
|
| Rate for Payer: Humana Commercial |
$2,341.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,259.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,033.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$826.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,424.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,396.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,900.95
|
| Rate for Payer: PHCS Commercial |
$2,644.80
|
| Rate for Payer: United Healthcare All Payer |
$2,424.40
|
|
|
BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$1,873.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
76100283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.90 |
| Max. Negotiated Rate |
$1,798.08 |
| Rate for Payer: Aetna Commercial |
$1,442.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.94
|
| Rate for Payer: Cash Price |
$936.50
|
| Rate for Payer: Cigna Commercial |
$1,554.59
|
| Rate for Payer: First Health Commercial |
$1,779.35
|
| Rate for Payer: Humana Commercial |
$1,592.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.37
|
| Rate for Payer: PHCS Commercial |
$1,798.08
|
| Rate for Payer: United Healthcare All Payer |
$1,648.24
|
|
|
BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$1,873.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
76100283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.90 |
| Max. Negotiated Rate |
$1,798.08 |
| Rate for Payer: Aetna Commercial |
$1,442.21
|
| Rate for Payer: Anthem Medicaid |
$644.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.94
|
| Rate for Payer: Cash Price |
$936.50
|
| Rate for Payer: Cigna Commercial |
$1,554.59
|
| Rate for Payer: First Health Commercial |
$1,779.35
|
| Rate for Payer: Humana Commercial |
$1,592.05
|
| Rate for Payer: Humana KY Medicaid |
$644.12
|
| Rate for Payer: Kentucky WC Medicaid |
$650.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.37
|
| Rate for Payer: PHCS Commercial |
$1,798.08
|
| Rate for Payer: United Healthcare All Payer |
$1,648.24
|
|
|
BX BREAST ADD LESION MR IMAG
|
Professional
|
Both
|
$1,873.00
|
|
|
Service Code
|
HCPCS 19086
|
| Hospital Charge Code |
76100283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.15 |
| Max. Negotiated Rate |
$1,261.56 |
| Rate for Payer: Ambetter Exchange |
$83.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.15
|
| Rate for Payer: Anthem Medicaid |
$596.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.40
|
| Rate for Payer: Cash Price |
$936.50
|
| Rate for Payer: Cash Price |
$936.50
|
| Rate for Payer: Cigna Commercial |
$1,261.56
|
| Rate for Payer: Healthspan PPO |
$972.34
|
| Rate for Payer: Humana Medicaid |
$596.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.82
|
| Rate for Payer: Molina Healthcare Passport |
$596.88
|
| Rate for Payer: Multiplan PHCS |
$1,123.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.77
|
| Rate for Payer: UHCCP Medicaid |
$71.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.67
|
|
|
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: Ambetter Exchange |
$83.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.15
|
| Rate for Payer: Anthem Medicaid |
$596.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.40
|
| 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 |
$596.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.82
|
| Rate for Payer: Molina Healthcare Passport |
$596.88
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.77
|
| Rate for Payer: UHCCP Medicaid |
$71.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.67
|
|
|
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 |
$473.40 |
| 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 |
$1,262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,372.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.82
|
| 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 |
$473.40 |
| 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 |
$1,262.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,372.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.82
|
| Rate for Payer: PHCS Commercial |
$1,514.88
|
| Rate for Payer: United Healthcare All Payer |
$1,388.64
|
|
|
BX BREAST ADD LESION STRTCTC
|
Professional
|
Both
|
$3,968.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$2,380.80 |
| Rate for Payer: Ambetter Exchange |
$76.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.24
|
| Rate for Payer: Anthem Medicaid |
$403.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$76.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.68
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cigna Commercial |
$852.57
|
| Rate for Payer: Healthspan PPO |
$658.88
|
| Rate for Payer: Humana Medicaid |
$403.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$76.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.55
|
| Rate for Payer: Molina Healthcare Passport |
$403.48
|
| Rate for Payer: Multiplan PHCS |
$2,380.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$99.32
|
| Rate for Payer: UHCCP Medicaid |
$70.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$76.40
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$3,968.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$3,809.28 |
| Rate for Payer: Aetna Commercial |
$3,055.36
|
| Rate for Payer: Anthem Medicaid |
$1,364.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.04
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cigna Commercial |
$3,293.44
|
| Rate for Payer: First Health Commercial |
$3,769.60
|
| Rate for Payer: Humana Commercial |
$3,372.80
|
| Rate for Payer: Humana KY Medicaid |
$1,364.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,391.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,737.92
|
| Rate for Payer: PHCS Commercial |
$3,809.28
|
| Rate for Payer: United Healthcare All Payer |
$3,491.84
|
|
|
BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$3,968.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
76100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$3,809.28 |
| Rate for Payer: Aetna Commercial |
$3,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.04
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cigna Commercial |
$3,293.44
|
| Rate for Payer: First Health Commercial |
$3,769.60
|
| Rate for Payer: Humana Commercial |
$3,372.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,737.92
|
| Rate for Payer: PHCS Commercial |
$3,809.28
|
| Rate for Payer: United Healthcare All Payer |
$3,491.84
|
|
|
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 |
$852.57 |
| Rate for Payer: Ambetter Exchange |
$76.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.24
|
| Rate for Payer: Anthem Medicaid |
$403.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$76.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.68
|
| 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 |
$403.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$76.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.55
|
| Rate for Payer: Molina Healthcare Passport |
$403.48
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$99.32
|
| Rate for Payer: UHCCP Medicaid |
$70.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$76.40
|
|
|
BX BREAST ADD LESION STRTCT(T
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
761T0279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$2,801.28 |
| Rate for Payer: Aetna Commercial |
$2,246.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,276.04
|
| Rate for Payer: Cash Price |
$1,459.00
|
| Rate for Payer: Cigna Commercial |
$2,421.94
|
| Rate for Payer: First Health Commercial |
$2,772.10
|
| Rate for Payer: Humana Commercial |
$2,480.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,392.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,153.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$875.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,567.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,188.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,538.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,013.42
|
| Rate for Payer: PHCS Commercial |
$2,801.28
|
| Rate for Payer: United Healthcare All Payer |
$2,567.84
|
|
|
BX BREAST ADD LESION STRTCT(T
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
761T0279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$2,801.28 |
| Rate for Payer: Aetna Commercial |
$2,246.86
|
| Rate for Payer: Anthem Medicaid |
$1,003.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,276.04
|
| Rate for Payer: Cash Price |
$1,459.00
|
| Rate for Payer: Cigna Commercial |
$2,421.94
|
| Rate for Payer: First Health Commercial |
$2,772.10
|
| Rate for Payer: Humana Commercial |
$2,480.30
|
| Rate for Payer: Humana KY Medicaid |
$1,003.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,013.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,392.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,153.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$875.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,023.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,567.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,188.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,538.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,013.42
|
| Rate for Payer: PHCS Commercial |
$2,801.28
|
| Rate for Payer: United Healthcare All Payer |
$2,567.84
|
|
|
BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna Commercial |
$1,871.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna Commercial |
$2,016.90
|
| Rate for Payer: First Health Commercial |
$2,308.50
|
| Rate for Payer: Humana Commercial |
$2,065.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,992.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,793.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,822.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.70
|
| Rate for Payer: PHCS Commercial |
$2,332.80
|
| Rate for Payer: United Healthcare All Payer |
$2,138.40
|
|
|
BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna Commercial |
$1,871.10
|
| Rate for Payer: Anthem Medicaid |
$835.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna Commercial |
$2,016.90
|
| Rate for Payer: First Health Commercial |
$2,308.50
|
| Rate for Payer: Humana Commercial |
$2,065.50
|
| Rate for Payer: Humana KY Medicaid |
$835.68
|
| Rate for Payer: Kentucky WC Medicaid |
$844.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,992.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,793.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,822.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.70
|
| Rate for Payer: PHCS Commercial |
$2,332.80
|
| Rate for Payer: United Healthcare All Payer |
$2,138.40
|
|
|
BX BREAST ADD LESION US IMAG
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Ambetter Exchange |
$72.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.16
|
| Rate for Payer: Anthem Medicaid |
$397.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.74
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna Commercial |
$840.60
|
| Rate for Payer: Healthspan PPO |
$649.46
|
| Rate for Payer: Humana Medicaid |
$397.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.68
|
| Rate for Payer: Molina Healthcare Passport |
$397.73
|
| Rate for Payer: Multiplan PHCS |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.96
|
| Rate for Payer: UHCCP Medicaid |
$66.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.28
|
|
|
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: Ambetter Exchange |
$72.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.16
|
| Rate for Payer: Anthem Medicaid |
$397.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.74
|
| 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 |
$397.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.68
|
| Rate for Payer: Molina Healthcare Passport |
$397.73
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.96
|
| Rate for Payer: UHCCP Medicaid |
$66.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.28
|
|
|
BX BREAST ADD LESION US IMA(T
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
761T0281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
BX BREAST ADD LESION US IMA(T
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
761T0281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
BX BREAST OPEN
|
Facility
|
OP
|
$5,747.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,976.39 |
| Max. Negotiated Rate |
$5,517.12 |
| Rate for Payer: Aetna Commercial |
$4,425.19
|
| Rate for Payer: Anthem Medicaid |
$1,976.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,482.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,873.50
|
| Rate for Payer: Cash Price |
$2,873.50
|
| Rate for Payer: Cigna Commercial |
$4,770.01
|
| Rate for Payer: First Health Commercial |
$5,459.65
|
| Rate for Payer: Humana Commercial |
$4,884.95
|
| Rate for Payer: Humana KY Medicaid |
$1,976.39
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,996.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,712.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,241.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,016.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,057.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,310.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,965.43
|
| Rate for Payer: PHCS Commercial |
$5,517.12
|
| Rate for Payer: United Healthcare All Payer |
$5,057.36
|
|
|
BX BREAST OPEN
|
Facility
|
IP
|
$5,747.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,724.10 |
| Max. Negotiated Rate |
$5,517.12 |
| Rate for Payer: Aetna Commercial |
$4,425.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,482.66
|
| Rate for Payer: Cash Price |
$2,873.50
|
| Rate for Payer: Cigna Commercial |
$4,770.01
|
| Rate for Payer: First Health Commercial |
$5,459.65
|
| Rate for Payer: Humana Commercial |
$4,884.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,712.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,241.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,057.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,310.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,965.43
|
| Rate for Payer: PHCS Commercial |
$5,517.12
|
| Rate for Payer: United Healthcare All Payer |
$5,057.36
|
|
|
BX BREAST OPEN
|
Professional
|
Both
|
$5,747.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
76100285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$3,448.20 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: Ambetter Exchange |
$212.54
|
| 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 Individual/Medicaid |
$212.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.05
|
| Rate for Payer: Cash Price |
$2,873.50
|
| Rate for Payer: Cash Price |
$2,873.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.85
|
| Rate for Payer: Molina Healthcare Passport |
$165.54
|
| Rate for Payer: Multiplan PHCS |
$3,448.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$276.30
|
| Rate for Payer: UHCCP Medicaid |
$121.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.54
|
|
|
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 |
$360.00 |
| Rate for Payer: Aetna Commercial |
$310.98
|
| Rate for Payer: Ambetter Exchange |
$212.54
|
| 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 Individual/Medicaid |
$212.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.05
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.54
|
| 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 |
$276.30
|
| Rate for Payer: UHCCP Medicaid |
$121.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.54
|
|
|
BX BREAST OPEN(T
|
Facility
|
IP
|
$5,147.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
761T0285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,544.10 |
| Max. Negotiated Rate |
$4,941.12 |
| Rate for Payer: Aetna Commercial |
$3,963.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.66
|
| Rate for Payer: Cash Price |
$2,573.50
|
| Rate for Payer: Cigna Commercial |
$4,272.01
|
| Rate for Payer: First Health Commercial |
$4,889.65
|
| Rate for Payer: Humana Commercial |
$4,374.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,220.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,798.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,529.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,860.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,551.43
|
| Rate for Payer: PHCS Commercial |
$4,941.12
|
| Rate for Payer: United Healthcare All Payer |
$4,529.36
|
|
|
BX BREAST OPEN(T
|
Facility
|
OP
|
$5,147.00
|
|
|
Service Code
|
HCPCS 19101
|
| Hospital Charge Code |
761T0285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,770.05 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,963.19
|
| Rate for Payer: Anthem Medicaid |
$1,770.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,014.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,573.50
|
| Rate for Payer: Cash Price |
$2,573.50
|
| Rate for Payer: Cigna Commercial |
$4,272.01
|
| Rate for Payer: First Health Commercial |
$4,889.65
|
| Rate for Payer: Humana Commercial |
$4,374.95
|
| Rate for Payer: Humana KY Medicaid |
$1,770.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,220.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,798.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,529.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,860.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,551.43
|
| Rate for Payer: PHCS Commercial |
$4,941.12
|
| Rate for Payer: United Healthcare All Payer |
$4,529.36
|
|
