|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
OP
|
$2,466.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.58 |
| Max. Negotiated Rate |
$2,367.36 |
| Rate for Payer: Aetna Commercial |
$1,898.82
|
| Rate for Payer: Anthem Medicaid |
$848.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,923.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$2,046.78
|
| Rate for Payer: First Health Commercial |
$2,342.70
|
| Rate for Payer: Humana Commercial |
$2,096.10
|
| Rate for Payer: Humana KY Medicaid |
$848.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$856.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,819.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$865.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,849.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.46
|
| Rate for Payer: PHCS Commercial |
$2,367.36
|
| Rate for Payer: United Healthcare All Payer |
$2,170.08
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Professional
|
Both
|
$2,466.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.01
|
| Rate for Payer: Anthem Medicaid |
$97.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: Healthspan PPO |
$210.75
|
| Rate for Payer: Humana Medicaid |
$97.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.35
|
| Rate for Payer: Molina Healthcare Passport |
$97.40
|
| Rate for Payer: Multiplan PHCS |
$1,479.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,726.20
|
| Rate for Payer: UHCCP Medicaid |
$84.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.37
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
761T1981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| 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 |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Facility
|
IP
|
$7,250.50
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.56 |
| Max. Negotiated Rate |
$6,960.48 |
| Rate for Payer: Aetna Commercial |
$5,582.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,655.39
|
| Rate for Payer: Cash Price |
$3,625.25
|
| Rate for Payer: Cigna Commercial |
$6,017.92
|
| Rate for Payer: First Health Commercial |
$6,887.98
|
| Rate for Payer: Humana Commercial |
$6,162.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,945.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,380.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.66
|
| Rate for Payer: PHCS Commercial |
$6,960.48
|
| Rate for Payer: United Healthcare All Payer |
$6,380.44
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Professional
|
Both
|
$7,250.50
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$7,250.50 |
| Rate for Payer: Aetna Commercial |
$575.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.12
|
| Rate for Payer: Anthem Medicaid |
$227.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,250.50
|
| Rate for Payer: Cash Price |
$3,625.25
|
| Rate for Payer: Cash Price |
$3,625.25
|
| Rate for Payer: Cigna Commercial |
$621.27
|
| Rate for Payer: Healthspan PPO |
$734.82
|
| Rate for Payer: Humana Medicaid |
$227.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$500.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.46
|
| Rate for Payer: Molina Healthcare Passport |
$227.90
|
| Rate for Payer: Multiplan PHCS |
$4,350.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,075.35
|
| Rate for Payer: UHCCP Medicaid |
$226.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.18
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Facility
|
OP
|
$7,250.50
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.56 |
| Max. Negotiated Rate |
$6,960.48 |
| Rate for Payer: Aetna Commercial |
$5,582.88
|
| Rate for Payer: Anthem Medicaid |
$2,493.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,655.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,625.25
|
| Rate for Payer: Cash Price |
$3,625.25
|
| Rate for Payer: Cigna Commercial |
$6,017.92
|
| Rate for Payer: First Health Commercial |
$6,887.98
|
| Rate for Payer: Humana Commercial |
$6,162.92
|
| Rate for Payer: Humana KY Medicaid |
$2,493.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,945.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,380.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.66
|
| Rate for Payer: PHCS Commercial |
$6,960.48
|
| Rate for Payer: United Healthcare All Payer |
$6,380.44
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(P
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761P0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$575.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.12
|
| Rate for Payer: Anthem Medicaid |
$227.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$885.00
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$621.27
|
| Rate for Payer: Healthspan PPO |
$734.82
|
| Rate for Payer: Humana Medicaid |
$227.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$500.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.46
|
| Rate for Payer: Molina Healthcare Passport |
$227.90
|
| Rate for Payer: Multiplan PHCS |
$531.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.50
|
| Rate for Payer: UHCCP Medicaid |
$226.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.18
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(T
|
Facility
|
IP
|
$6,365.50
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761T0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.52 |
| Max. Negotiated Rate |
$6,110.88 |
| Rate for Payer: Aetna Commercial |
$4,901.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,965.09
|
| Rate for Payer: Cash Price |
$3,182.75
|
| Rate for Payer: Cigna Commercial |
$5,283.36
|
| Rate for Payer: First Health Commercial |
$6,047.22
|
| Rate for Payer: Humana Commercial |
$5,410.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,219.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,697.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,909.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,601.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,273.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$827.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,973.30
|
| Rate for Payer: PHCS Commercial |
$6,110.88
|
| Rate for Payer: United Healthcare All Payer |
$5,601.64
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(T
|
Facility
|
OP
|
$6,365.50
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761T0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.52 |
| Max. Negotiated Rate |
$6,110.88 |
| Rate for Payer: Aetna Commercial |
$4,901.44
|
| Rate for Payer: Anthem Medicaid |
$2,189.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,965.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,182.75
|
| Rate for Payer: Cash Price |
$3,182.75
|
| Rate for Payer: Cigna Commercial |
$5,283.36
|
| Rate for Payer: First Health Commercial |
$6,047.22
|
| Rate for Payer: Humana Commercial |
$5,410.68
|
| Rate for Payer: Humana KY Medicaid |
$2,189.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,211.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,219.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,697.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,233.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,601.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,273.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$827.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,973.30
|
| Rate for Payer: PHCS Commercial |
$6,110.88
|
| Rate for Payer: United Healthcare All Payer |
$5,601.64
|
|
|
BIOPSY BACK/FLANK - DEEP
|
Facility
|
OP
|
$4,136.50
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.74 |
| Max. Negotiated Rate |
$3,971.04 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Anthem Medicaid |
$1,422.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,068.25
|
| Rate for Payer: Cash Price |
$2,068.25
|
| Rate for Payer: Cigna Commercial |
$3,433.30
|
| Rate for Payer: First Health Commercial |
$3,929.68
|
| Rate for Payer: Humana Commercial |
$3,516.02
|
| Rate for Payer: Humana KY Medicaid |
$1,422.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,391.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,052.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.32
|
| Rate for Payer: PHCS Commercial |
$3,971.04
|
| Rate for Payer: United Healthcare All Payer |
$3,640.12
|
|
|
BIOPSY BACK/FLANK - DEEP
|
Facility
|
IP
|
$4,136.50
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.74 |
| Max. Negotiated Rate |
$3,971.04 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.47
|
| Rate for Payer: Cash Price |
$2,068.25
|
| Rate for Payer: Cigna Commercial |
$3,433.30
|
| Rate for Payer: First Health Commercial |
$3,929.68
|
| Rate for Payer: Humana Commercial |
$3,516.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,391.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,052.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.32
|
| Rate for Payer: PHCS Commercial |
$3,971.04
|
| Rate for Payer: United Healthcare All Payer |
$3,640.12
|
|
|
BIOPSY BACK/FLANK - DEEP
|
Professional
|
Both
|
$4,136.50
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$4,136.50 |
| Rate for Payer: Aetna Commercial |
$485.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.97
|
| Rate for Payer: Anthem Medicaid |
$184.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,136.50
|
| Rate for Payer: Cash Price |
$2,068.25
|
| Rate for Payer: Cash Price |
$2,068.25
|
| Rate for Payer: Cigna Commercial |
$515.84
|
| Rate for Payer: Healthspan PPO |
$534.47
|
| Rate for Payer: Humana Medicaid |
$184.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$427.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.88
|
| Rate for Payer: Molina Healthcare Passport |
$184.20
|
| Rate for Payer: Multiplan PHCS |
$2,481.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,895.55
|
| Rate for Payer: UHCCP Medicaid |
$203.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.04
|
|
|
BIOPSY BACK/FLANK - DEEP(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761P0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$485.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.97
|
| Rate for Payer: Anthem Medicaid |
$184.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$515.84
|
| Rate for Payer: Healthspan PPO |
$534.47
|
| Rate for Payer: Humana Medicaid |
$184.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$427.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.88
|
| Rate for Payer: Molina Healthcare Passport |
$184.20
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$203.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.04
|
|
|
BIOPSY BACK/FLANK - DEEP(T
|
Facility
|
IP
|
$3,286.50
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761T0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.24 |
| Max. Negotiated Rate |
$3,155.04 |
| Rate for Payer: Aetna Commercial |
$2,530.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.47
|
| Rate for Payer: Cash Price |
$1,643.25
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: First Health Commercial |
$3,122.18
|
| Rate for Payer: Humana Commercial |
$2,793.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.82
|
| Rate for Payer: PHCS Commercial |
$3,155.04
|
| Rate for Payer: United Healthcare All Payer |
$2,892.12
|
|
|
BIOPSY BACK/FLANK - DEEP(T
|
Facility
|
OP
|
$3,286.50
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761T0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.24 |
| Max. Negotiated Rate |
$3,155.04 |
| Rate for Payer: Aetna Commercial |
$2,530.60
|
| Rate for Payer: Anthem Medicaid |
$1,130.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,643.25
|
| Rate for Payer: Cash Price |
$1,643.25
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: First Health Commercial |
$3,122.18
|
| Rate for Payer: Humana Commercial |
$2,793.52
|
| Rate for Payer: Humana KY Medicaid |
$1,130.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.82
|
| Rate for Payer: PHCS Commercial |
$3,155.04
|
| Rate for Payer: United Healthcare All Payer |
$2,892.12
|
|
|
BIOPSY BONE DEEP
|
Professional
|
Both
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$3,340.00 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,340.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$2,004.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,338.00
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
|
|
BIOPSY BONE DEEP
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.20 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.40
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
BIOPSY BONE DEEP
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.20 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem Medicaid |
$1,148.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Humana KY Medicaid |
$1,148.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.40
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
BIOPSY BONE DEEP(P
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761P0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$1,290.00 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,290.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$903.00
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
|
|
BIOPSY BONE DEEP(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761T0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BIOPSY BONE DEEP(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761T0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Facility
|
IP
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.74 |
| Max. Negotiated Rate |
$6,622.08 |
| Rate for Payer: Aetna Commercial |
$5,311.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,380.44
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$5,725.34
|
| Rate for Payer: First Health Commercial |
$6,553.10
|
| Rate for Payer: Humana Commercial |
$5,863.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,656.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,090.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,069.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,070.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,173.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.38
|
| Rate for Payer: PHCS Commercial |
$6,622.08
|
| Rate for Payer: United Healthcare All Payer |
$6,070.24
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Professional
|
Both
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.70 |
| Max. Negotiated Rate |
$6,898.00 |
| Rate for Payer: Aetna Commercial |
$921.19
|
| Rate for Payer: Anthem Medicaid |
$214.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,898.00
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$1,008.23
|
| Rate for Payer: Healthspan PPO |
$834.40
|
| Rate for Payer: Humana Medicaid |
$214.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.99
|
| Rate for Payer: Molina Healthcare Passport |
$214.70
|
| Rate for Payer: Multiplan PHCS |
$4,138.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,828.60
|
| Rate for Payer: UHCCP Medicaid |
$2,414.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.85
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Facility
|
OP
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.74 |
| Max. Negotiated Rate |
$6,622.08 |
| Rate for Payer: Aetna Commercial |
$5,311.46
|
| Rate for Payer: Anthem Medicaid |
$2,372.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,380.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$5,725.34
|
| Rate for Payer: First Health Commercial |
$6,553.10
|
| Rate for Payer: Humana Commercial |
$5,863.30
|
| Rate for Payer: Humana KY Medicaid |
$2,372.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,396.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,656.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,090.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,419.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,070.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,173.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.38
|
| Rate for Payer: PHCS Commercial |
$6,622.08
|
| Rate for Payer: United Healthcare All Payer |
$6,070.24
|
|
|
BIOPSY - BONE - OPEN - DEEP(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761P0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.70 |
| Max. Negotiated Rate |
$1,008.23 |
| Rate for Payer: Aetna Commercial |
$921.19
|
| Rate for Payer: Anthem Medicaid |
$214.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,008.23
|
| Rate for Payer: Healthspan PPO |
$834.40
|
| Rate for Payer: Humana Medicaid |
$214.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.99
|
| Rate for Payer: Molina Healthcare Passport |
$214.70
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.85
|
|
