|
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 |
$1,791.38 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,531.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.21
|
| 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 |
$1,562.70 |
| 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 |
$4,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,531.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.21
|
| Rate for Payer: PHCS Commercial |
$5,000.64
|
| Rate for Payer: United Healthcare All Payer |
$4,583.92
|
|
|
CEREBROSPINAL FLUID SCAN
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
34000029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$390.33 |
| 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 |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| 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 |
$497.35
|
| 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 |
$596.82
|
| 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 |
$908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.15
|
| 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 |
$340.50 |
| 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 |
$908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.15
|
| Rate for Payer: PHCS Commercial |
$1,089.60
|
| Rate for Payer: United Healthcare All Payer |
$998.80
|
|
|
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 |
$681.00 |
| Rate for Payer: Aetna Commercial |
$475.92
|
| Rate for Payer: Ambetter Exchange |
$268.66
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$268.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$268.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.39
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$268.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.66
|
| 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 |
$349.26
|
| Rate for Payer: UHCCP Medicaid |
$397.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$268.66
|
|
|
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: Ambetter Exchange |
$268.66
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$268.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$268.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.39
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$268.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.66
|
| 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 |
$349.26
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$268.66
|
|
|
CEREBROSPINAL FLUID SCAN(T
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 78630
|
| Hospital Charge Code |
340T0029
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$326.70 |
| 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 |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| 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 |
$497.35
|
| 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 |
$596.82
|
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| 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 |
$285.00 |
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| 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 |
$36.54 |
| Max. Negotiated Rate |
$116.93 |
| Rate for Payer: Aetna Commercial |
$93.79
|
| Rate for Payer: Anthem Medicaid |
$41.89
|
| 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: Humana KY Medicaid |
$41.89
|
| 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 |
$36.54
|
| 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 |
$97.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.04
|
| Rate for Payer: PHCS Commercial |
$116.93
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
CEREBYX 50mg (100mg Vial)
|
Facility
|
IP
|
$121.80
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
25002712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.54 |
| 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 |
$97.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.04
|
| 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 |
$164.79 |
| 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 |
$439.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.02
|
| 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 |
$164.79 |
| Max. Negotiated Rate |
$527.33 |
| Rate for Payer: Aetna Commercial |
$422.96
|
| Rate for Payer: Anthem Medicaid |
$188.90
|
| 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: Humana KY Medicaid |
$188.90
|
| 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 |
$164.79
|
| 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 |
$439.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.02
|
| Rate for Payer: PHCS Commercial |
$527.33
|
| Rate for Payer: United Healthcare All Payer |
$483.38
|
|
|
CERVICAL LYMPH COMPLETE
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
76101605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
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 |
$1,892.26 |
| Rate for Payer: Aetna Commercial |
$1,892.26
|
| Rate for Payer: Ambetter Exchange |
$1,273.61
|
| Rate for Payer: Anthem Medicaid |
$832.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,273.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,273.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,528.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,273.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.61
|
| 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 |
$1,655.69
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,273.61
|
|
|
CERVICAL LYMPH COMPLETE
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38720
|
| Hospital Charge Code |
76101605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| 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 |
$6,025.70
|
| 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 |
$7,230.84
|
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| 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 |
$1,892.26 |
| Rate for Payer: Aetna Commercial |
$1,892.26
|
| Rate for Payer: Ambetter Exchange |
$1,273.61
|
| Rate for Payer: Anthem Medicaid |
$832.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,273.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,273.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,528.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,273.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.61
|
| 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 |
$1,655.69
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$840.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,273.61
|
|
|
CERVICAL LYMPH NECK
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
76101606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| 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 |
$2,051.96 |
| Rate for Payer: Aetna Commercial |
$2,051.96
|
| Rate for Payer: Ambetter Exchange |
$1,372.72
|
| Rate for Payer: Anthem Medicaid |
$821.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,372.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,372.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,647.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,372.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.72
|
| 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 |
$1,784.54
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$829.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,372.72
|
|
|
CERVICAL LYMPH NECK
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
76101606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| 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 |
$2,051.96 |
| Rate for Payer: Aetna Commercial |
$2,051.96
|
| Rate for Payer: Ambetter Exchange |
$1,372.72
|
| Rate for Payer: Anthem Medicaid |
$821.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,372.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,372.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,647.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,372.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.72
|
| 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 |
$1,784.54
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$829.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,372.72
|
|
|
CERVICAL SPINE 2-3V
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
CERVICAL SPINE 2-3V
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
CERVICAL SPINE 2-3V
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$258.60 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Ambetter Exchange |
$35.78
|
| Rate for Payer: Anthem Medicaid |
$25.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.94
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$52.35
|
| Rate for Payer: Humana Medicaid |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.15
|
| Rate for Payer: Molina Healthcare Passport |
$25.64
|
| Rate for Payer: Multiplan PHCS |
$258.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.51
|
| Rate for Payer: UHCCP Medicaid |
$150.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.78
|
|
|
CERVICAL SPINE 2-3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320P0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Ambetter Exchange |
$35.78
|
| Rate for Payer: Anthem Medicaid |
$25.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$52.35
|
| Rate for Payer: Humana Medicaid |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.15
|
| Rate for Payer: Molina Healthcare Passport |
$25.64
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.51
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.78
|
|
|
CERVICAL SPINE 2-3V(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320T0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
