|
BIOPSY - BONE - OPEN - DEEP(T
|
Facility
|
IP
|
$5,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761T0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$766.74 |
| Max. Negotiated Rate |
$5,662.08 |
| Rate for Payer: Aetna Commercial |
$4,541.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,600.44
|
| Rate for Payer: Cash Price |
$2,949.00
|
| Rate for Payer: Cigna Commercial |
$4,895.34
|
| Rate for Payer: First Health Commercial |
$5,603.10
|
| Rate for Payer: Humana Commercial |
$5,013.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,836.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,352.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,769.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,190.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,423.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$766.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,828.38
|
| Rate for Payer: PHCS Commercial |
$5,662.08
|
| Rate for Payer: United Healthcare All Payer |
$5,190.24
|
|
|
BIOPSY - BONE - OPEN - DEEP(T
|
Facility
|
OP
|
$5,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761T0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$766.74 |
| Max. Negotiated Rate |
$5,662.08 |
| Rate for Payer: Aetna Commercial |
$4,541.46
|
| Rate for Payer: Anthem Medicaid |
$2,028.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,600.44
|
| 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 |
$2,949.00
|
| Rate for Payer: Cash Price |
$2,949.00
|
| Rate for Payer: Cigna Commercial |
$4,895.34
|
| Rate for Payer: First Health Commercial |
$5,603.10
|
| Rate for Payer: Humana Commercial |
$5,013.30
|
| Rate for Payer: Humana KY Medicaid |
$2,028.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,048.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,836.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,352.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,069.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,190.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,423.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$766.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,828.38
|
| Rate for Payer: PHCS Commercial |
$5,662.08
|
| Rate for Payer: United Healthcare All Payer |
$5,190.24
|
|
|
BIOPSY BONE SUPERFICIAL
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$2,486.00 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$74.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,486.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$127.98
|
| Rate for Payer: Healthspan PPO |
$225.74
|
| Rate for Payer: Humana Medicaid |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.08
|
| Rate for Payer: Molina Healthcare Passport |
$74.59
|
| Rate for Payer: Multiplan PHCS |
$1,491.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,740.20
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.34
|
|
|
BIOPSY BONE SUPERFICIAL
|
Facility
|
OP
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.18 |
| Max. Negotiated Rate |
$2,386.56 |
| Rate for Payer: Aetna Commercial |
$1,914.22
|
| Rate for Payer: Anthem Medicaid |
$854.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,939.08
|
| 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 |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$2,063.38
|
| Rate for Payer: First Health Commercial |
$2,361.70
|
| Rate for Payer: Humana Commercial |
$2,113.10
|
| Rate for Payer: Humana KY Medicaid |
$854.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$863.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,038.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,834.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$872.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,187.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,864.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$770.66
|
| Rate for Payer: PHCS Commercial |
$2,386.56
|
| Rate for Payer: United Healthcare All Payer |
$2,187.68
|
|
|
BIOPSY BONE SUPERFICIAL
|
Facility
|
IP
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.18 |
| Max. Negotiated Rate |
$2,386.56 |
| Rate for Payer: Aetna Commercial |
$1,914.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,939.08
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$2,063.38
|
| Rate for Payer: First Health Commercial |
$2,361.70
|
| Rate for Payer: Humana Commercial |
$2,113.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,038.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,834.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,187.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,864.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$770.66
|
| Rate for Payer: PHCS Commercial |
$2,386.56
|
| Rate for Payer: United Healthcare All Payer |
$2,187.68
|
|
|
BIOPSY BONE SUPERFICIAL(P
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761P0328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$74.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$127.98
|
| Rate for Payer: Healthspan PPO |
$225.74
|
| Rate for Payer: Humana Medicaid |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.08
|
| Rate for Payer: Molina Healthcare Passport |
$74.59
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.34
|
|
|
BIOPSY BONE SUPERFICIAL(T
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761T0328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| 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 |
$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 |
$1,402.02
|
| 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 |
$1,682.42
|
| 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 |
$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 BONE SUPERFICIAL(T
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761T0328
|
|
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, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 20225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
BIOPSY EAR
|
Facility
|
OP
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.81 |
| Max. Negotiated Rate |
$3,535.85 |
| Rate for Payer: Aetna Commercial |
$2,836.05
|
| Rate for Payer: Anthem Medicaid |
$1,266.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cigna Commercial |
$3,057.04
|
| Rate for Payer: First Health Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial |
$3,130.70
|
| Rate for Payer: Humana KY Medicaid |
$1,266.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.79
|
| Rate for Payer: PHCS Commercial |
$3,535.85
|
| Rate for Payer: United Healthcare All Payer |
$3,241.20
|
|
|
BIOPSY EAR
|
Professional
|
Both
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$3,683.18 |
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.84
|
| Rate for Payer: Anthem Medicaid |
$37.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,683.18
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cigna Commercial |
$184.77
|
| Rate for Payer: Healthspan PPO |
$169.01
|
| Rate for Payer: Humana Medicaid |
$37.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.62
|
| Rate for Payer: Molina Healthcare Passport |
$37.86
|
| Rate for Payer: Multiplan PHCS |
$2,209.91
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,578.23
|
| Rate for Payer: UHCCP Medicaid |
$33.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.24
|
|
|
BIOPSY EAR
|
Facility
|
IP
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.81 |
| Max. Negotiated Rate |
$3,535.85 |
| Rate for Payer: Aetna Commercial |
$2,836.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.88
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cigna Commercial |
$3,057.04
|
| Rate for Payer: First Health Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial |
$3,130.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.79
|
| Rate for Payer: PHCS Commercial |
$3,535.85
|
| Rate for Payer: United Healthcare All Payer |
$3,241.20
|
|
|
BIOPSY EAR(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761P2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.84
|
| Rate for Payer: Anthem Medicaid |
$37.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$184.77
|
| Rate for Payer: Healthspan PPO |
$169.01
|
| Rate for Payer: Humana Medicaid |
$37.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.62
|
| Rate for Payer: Molina Healthcare Passport |
$37.86
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$33.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.24
|
|
|
BIOPSY EAR(T
|
Facility
|
OP
|
$3,483.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761T2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.81 |
| Max. Negotiated Rate |
$3,343.85 |
| Rate for Payer: Aetna Commercial |
$2,682.05
|
| Rate for Payer: Anthem Medicaid |
$1,197.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cigna Commercial |
$2,891.04
|
| Rate for Payer: First Health Commercial |
$3,309.02
|
| Rate for Payer: Humana Commercial |
$2,960.70
|
| Rate for Payer: Humana KY Medicaid |
$1,197.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,570.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,612.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.79
|
| Rate for Payer: PHCS Commercial |
$3,343.85
|
| Rate for Payer: United Healthcare All Payer |
$3,065.20
|
|
|
BIOPSY EAR(T
|
Facility
|
IP
|
$3,483.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761T2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.81 |
| Max. Negotiated Rate |
$3,343.85 |
| Rate for Payer: Aetna Commercial |
$2,682.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.88
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cigna Commercial |
$2,891.04
|
| Rate for Payer: First Health Commercial |
$3,309.02
|
| Rate for Payer: Humana Commercial |
$2,960.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,570.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,612.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.79
|
| Rate for Payer: PHCS Commercial |
$3,343.85
|
| Rate for Payer: United Healthcare All Payer |
$3,065.20
|
|
|
BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$32.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$906.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$144.99
|
| Rate for Payer: Healthspan PPO |
$128.84
|
| Rate for Payer: Humana Medicaid |
$32.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.51
|
| Rate for Payer: Molina Healthcare Passport |
$32.85
|
| Rate for Payer: Multiplan PHCS |
$543.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.20
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.18
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.78 |
| Max. Negotiated Rate |
$869.76 |
| Rate for Payer: Aetna Commercial |
$697.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$706.68
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$751.98
|
| Rate for Payer: First Health Commercial |
$860.70
|
| Rate for Payer: Humana Commercial |
$770.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$668.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$797.28
|
| Rate for Payer: Ohio Health Group HMO |
$679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.86
|
| Rate for Payer: PHCS Commercial |
$869.76
|
| Rate for Payer: United Healthcare All Payer |
$797.28
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.78 |
| Max. Negotiated Rate |
$869.76 |
| Rate for Payer: Aetna Commercial |
$697.62
|
| Rate for Payer: Anthem Medicaid |
$311.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$706.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$751.98
|
| Rate for Payer: First Health Commercial |
$860.70
|
| Rate for Payer: Humana Commercial |
$770.10
|
| Rate for Payer: Humana KY Medicaid |
$311.57
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$314.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$668.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$797.28
|
| Rate for Payer: Ohio Health Group HMO |
$679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.86
|
| Rate for Payer: PHCS Commercial |
$869.76
|
| Rate for Payer: United Healthcare All Payer |
$797.28
|
|
|
BIOPSY EXTERNAL EAR(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761P2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$32.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$144.99
|
| Rate for Payer: Healthspan PPO |
$128.84
|
| Rate for Payer: Humana Medicaid |
$32.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.51
|
| Rate for Payer: Molina Healthcare Passport |
$32.85
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.18
|
|
|
BIOPSY EXTERNAL EAR(T
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761T2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$725.76 |
| Rate for Payer: Aetna Commercial |
$582.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.68
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$627.48
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: Humana Commercial |
$642.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.28
|
| Rate for Payer: Ohio Health Group HMO |
$567.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.36
|
| Rate for Payer: PHCS Commercial |
$725.76
|
| Rate for Payer: United Healthcare All Payer |
$665.28
|
|
|
BIOPSY EXTERNAL EAR(T
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761T2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$725.76 |
| Rate for Payer: Aetna Commercial |
$582.12
|
| Rate for Payer: Anthem Medicaid |
$259.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$627.48
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: Humana Commercial |
$642.60
|
| Rate for Payer: Humana KY Medicaid |
$259.99
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$262.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.28
|
| Rate for Payer: Ohio Health Group HMO |
$567.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.36
|
| Rate for Payer: PHCS Commercial |
$725.76
|
| Rate for Payer: United Healthcare All Payer |
$665.28
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
76100664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.60
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
BIOPSY FINGER JOINT LINING
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
76100664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.18 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$464.54
|
| Rate for Payer: Anthem Medicaid |
$233.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,060.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$518.91
|
| Rate for Payer: Healthspan PPO |
$420.78
|
| Rate for Payer: Humana Medicaid |
$233.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$405.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.84
|
| Rate for Payer: Molina Healthcare Passport |
$233.18
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.51
|
|
|
BIOPSY FINGER JOINT LINING
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
76100665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$444.52
|
| Rate for Payer: Anthem Medicaid |
$190.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$493.79
|
| Rate for Payer: Healthspan PPO |
$402.64
|
| Rate for Payer: Humana Medicaid |
$190.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.32
|
| Rate for Payer: Molina Healthcare Passport |
$190.51
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.42
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
76100665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
