|
NEEDLE BIOPSY AXILLA US(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
|
NEEDLE BIOPSY GUIDANCE
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY GUIDANCE
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
NEEDLE BIOPSY GUIDANCE
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
NEEDLE BIOPSY GUIDANCE (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY GUIDANCE (T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
NEEDLE BIOPSY GUIDANCE (T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
NEEDLE BIOPSY LT AXILLA
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
NEEDLE BIOPSY LT AXILLA
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY LT AXILLA
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
NEEDLE BIOPSY LT AXILLA(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY LT AXILLA(T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
NEEDLE BIOPSY LT AXILLA(T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
NEEDLE BIOPSY LT BREAST US
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem Medicaid |
$492.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Humana KY Medicaid |
$492.46
|
| Rate for Payer: Kentucky WC Medicaid |
$497.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$502.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
NEEDLE BIOPSY LT BREAST US
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$859.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$501.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY LT BREAST US
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$1,374.72 |
| Rate for Payer: Aetna Commercial |
$1,102.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,116.96
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cigna Commercial |
$1,188.56
|
| Rate for Payer: First Health Commercial |
$1,360.40
|
| Rate for Payer: Humana Commercial |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,174.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,056.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,260.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,074.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,245.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.08
|
| Rate for Payer: PHCS Commercial |
$1,374.72
|
| Rate for Payer: United Healthcare All Payer |
$1,260.16
|
|
|
NEEDLE BIOPSY LT BREAST US(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
NEEDLE BIOPSY LT BREAST US(T
|
Facility
|
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
|
NEEDLE BIOPSY LT BREAST US(T
|
Facility
|
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$1,182.72 |
| Rate for Payer: Aetna Commercial |
$948.64
|
| Rate for Payer: Anthem Medicaid |
$423.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.96
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna Commercial |
$1,022.56
|
| Rate for Payer: First Health Commercial |
$1,170.40
|
| Rate for Payer: Humana Commercial |
$1,047.20
|
| Rate for Payer: Humana KY Medicaid |
$423.68
|
| Rate for Payer: Kentucky WC Medicaid |
$428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,010.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$432.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,084.16
|
| Rate for Payer: Ohio Health Group HMO |
$924.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$850.08
|
| Rate for Payer: PHCS Commercial |
$1,182.72
|
| Rate for Payer: United Healthcare All Payer |
$1,084.16
|
|
|
NEEDLE BIOPSY PANCREAS
|
Facility
|
OP
|
$3,166.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
76101970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,088.79 |
| Max. Negotiated Rate |
$3,039.36 |
| Rate for Payer: Aetna Commercial |
$2,437.82
|
| Rate for Payer: Anthem Medicaid |
$1,088.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,469.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cigna Commercial |
$2,627.78
|
| Rate for Payer: First Health Commercial |
$3,007.70
|
| Rate for Payer: Humana Commercial |
$2,691.10
|
| Rate for Payer: Humana KY Medicaid |
$1,088.79
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,336.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,374.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,754.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.54
|
| Rate for Payer: PHCS Commercial |
$3,039.36
|
| Rate for Payer: United Healthcare All Payer |
$2,786.08
|
|
|
NEEDLE BIOPSY PANCREAS
|
Facility
|
IP
|
$3,166.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
76101970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$949.80 |
| Max. Negotiated Rate |
$3,039.36 |
| Rate for Payer: Aetna Commercial |
$2,437.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,469.48
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cigna Commercial |
$2,627.78
|
| Rate for Payer: First Health Commercial |
$3,007.70
|
| Rate for Payer: Humana Commercial |
$2,691.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,336.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,374.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,754.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.54
|
| Rate for Payer: PHCS Commercial |
$3,039.36
|
| Rate for Payer: United Healthcare All Payer |
$2,786.08
|
|
|
NEEDLE BIOPSY PANCREAS
|
Professional
|
Both
|
$3,166.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
76101970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.71 |
| Max. Negotiated Rate |
$1,899.60 |
| Rate for Payer: Aetna Commercial |
$400.38
|
| Rate for Payer: Ambetter Exchange |
$220.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.54
|
| Rate for Payer: Anthem Medicaid |
$200.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$265.02
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Healthspan PPO |
$663.52
|
| Rate for Payer: Humana Medicaid |
$200.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.72
|
| Rate for Payer: Molina Healthcare Passport |
$200.71
|
| Rate for Payer: Multiplan PHCS |
$1,899.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.11
|
| Rate for Payer: UHCCP Medicaid |
$220.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.85
|
|
|
NEEDLE BIOPSY PANCREAS(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
761P1970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.71 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$400.38
|
| Rate for Payer: Ambetter Exchange |
$220.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.54
|
| Rate for Payer: Anthem Medicaid |
$200.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$265.02
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Healthspan PPO |
$663.52
|
| Rate for Payer: Humana Medicaid |
$200.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.72
|
| Rate for Payer: Molina Healthcare Passport |
$200.71
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.11
|
| Rate for Payer: UHCCP Medicaid |
$220.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.85
|
|
|
NEEDLE BIOPSY PANCREAS(T
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
761T1970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$676.11 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
NEEDLE BIOPSY PANCREAS(T
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
761T1970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
