|
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
|
|
|
BIOPSY FINGER JOINT LINING(P
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
761P0665
|
|
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(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
761P0664
|
|
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 FLOOR OF MOUTH
|
Facility
|
IP
|
$2,344.22
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.75 |
| Max. Negotiated Rate |
$2,250.45 |
| Rate for Payer: Aetna Commercial |
$1,805.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,828.49
|
| Rate for Payer: Cash Price |
$1,172.11
|
| Rate for Payer: Cigna Commercial |
$1,945.70
|
| Rate for Payer: First Health Commercial |
$2,227.01
|
| Rate for Payer: Humana Commercial |
$1,992.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,922.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,730.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,062.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,758.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$726.71
|
| Rate for Payer: PHCS Commercial |
$2,250.45
|
| Rate for Payer: United Healthcare All Payer |
$2,062.91
|
|
|
BIOPSY FLOOR OF MOUTH
|
Professional
|
Both
|
$2,344.22
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$2,344.22 |
| Rate for Payer: Aetna Commercial |
$127.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.83
|
| Rate for Payer: Anthem Medicaid |
$42.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,344.22
|
| Rate for Payer: Cash Price |
$1,172.11
|
| Rate for Payer: Cash Price |
$1,172.11
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Healthspan PPO |
$165.97
|
| Rate for Payer: Humana Medicaid |
$42.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.79
|
| Rate for Payer: Molina Healthcare Passport |
$42.93
|
| Rate for Payer: Multiplan PHCS |
$1,406.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,640.95
|
| Rate for Payer: UHCCP Medicaid |
$62.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.36
|
|
|
BIOPSY FLOOR OF MOUTH
|
Facility
|
OP
|
$2,344.22
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.75 |
| Max. Negotiated Rate |
$2,250.45 |
| Rate for Payer: Aetna Commercial |
$1,805.05
|
| Rate for Payer: Anthem Medicaid |
$806.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,828.49
|
| 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 |
$1,172.11
|
| Rate for Payer: Cash Price |
$1,172.11
|
| Rate for Payer: Cigna Commercial |
$1,945.70
|
| Rate for Payer: First Health Commercial |
$2,227.01
|
| Rate for Payer: Humana Commercial |
$1,992.59
|
| Rate for Payer: Humana KY Medicaid |
$806.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$814.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,922.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,730.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$822.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,062.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,758.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$726.71
|
| Rate for Payer: PHCS Commercial |
$2,250.45
|
| Rate for Payer: United Healthcare All Payer |
$2,062.91
|
|
|
BIOPSY FLOOR OF MOUTH(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761P1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$127.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.83
|
| Rate for Payer: Anthem Medicaid |
$42.93
|
| 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 |
$185.62
|
| Rate for Payer: Healthspan PPO |
$165.97
|
| Rate for Payer: Humana Medicaid |
$42.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.79
|
| Rate for Payer: Molina Healthcare Passport |
$42.93
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$62.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.36
|
|
|
BIOPSY FLOOR OF MOUTH(T
|
Facility
|
IP
|
$2,144.22
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761T1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$2,058.45 |
| Rate for Payer: Aetna Commercial |
$1,651.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.49
|
| Rate for Payer: Cash Price |
$1,072.11
|
| Rate for Payer: Cigna Commercial |
$1,779.70
|
| Rate for Payer: First Health Commercial |
$2,037.01
|
| Rate for Payer: Humana Commercial |
$1,822.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.71
|
| Rate for Payer: PHCS Commercial |
$2,058.45
|
| Rate for Payer: United Healthcare All Payer |
$1,886.91
|
|
|
BIOPSY FLOOR OF MOUTH(T
|
Facility
|
OP
|
$2,144.22
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761T1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$2,058.45 |
| Rate for Payer: Aetna Commercial |
$1,651.05
|
| Rate for Payer: Anthem Medicaid |
$737.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.49
|
| 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 |
$1,072.11
|
| Rate for Payer: Cash Price |
$1,072.11
|
| Rate for Payer: Cigna Commercial |
$1,779.70
|
| Rate for Payer: First Health Commercial |
$2,037.01
|
| Rate for Payer: Humana Commercial |
$1,822.59
|
| Rate for Payer: Humana KY Medicaid |
$737.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$744.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.71
|
| Rate for Payer: PHCS Commercial |
$2,058.45
|
| Rate for Payer: United Healthcare All Payer |
$1,886.91
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 25065
|
| Hospital Charge Code |
76100571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Humana KY Medicaid |
$261.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 25065
|
| Hospital Charge Code |
76100571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$231.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.47
|
| Rate for Payer: Anthem Medicaid |
$82.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$250.10
|
| Rate for Payer: Healthspan PPO |
$307.24
|
| Rate for Payer: Humana Medicaid |
$82.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.03
|
| Rate for Payer: Molina Healthcare Passport |
$82.38
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$93.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.20
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 25066
|
| Hospital Charge Code |
76100572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 25066
|
| Hospital Charge Code |
76100572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| 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 |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 25066
|
| Hospital Charge Code |
76100572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.21 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$537.35
|
| Rate for Payer: Anthem Medicaid |
$160.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$707.10
|
| Rate for Payer: Healthspan PPO |
$486.72
|
| Rate for Payer: Humana Medicaid |
$160.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$450.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.41
|
| Rate for Payer: Molina Healthcare Passport |
$160.21
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.81
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 25065
|
| Hospital Charge Code |
76100571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
BIOPSY FOREARM SOFT TISSUES(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 25066
|
| Hospital Charge Code |
761P0572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.21 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$537.35
|
| Rate for Payer: Anthem Medicaid |
$160.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$707.10
|
| Rate for Payer: Healthspan PPO |
$486.72
|
| Rate for Payer: Humana Medicaid |
$160.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$450.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.41
|
| Rate for Payer: Molina Healthcare Passport |
$160.21
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.81
|
|
|
BIOPSY FOREARM SOFT TISSUES(P
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 25065
|
| Hospital Charge Code |
761P0571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$231.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.47
|
| Rate for Payer: Anthem Medicaid |
$82.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$250.10
|
| Rate for Payer: Healthspan PPO |
$307.24
|
| Rate for Payer: Humana Medicaid |
$82.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.03
|
| Rate for Payer: Molina Healthcare Passport |
$82.38
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$93.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.20
|
|
|
BIOPSY INTRANASAL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
76101119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
BIOPSY INTRANASAL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
76101119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| 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 |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
BIOPSY INTRANASAL
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
76101119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$101.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.53
|
| Rate for Payer: Anthem Medicaid |
$38.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$173.24
|
| Rate for Payer: Healthspan PPO |
$158.29
|
| Rate for Payer: Humana Medicaid |
$38.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.56
|
| Rate for Payer: Molina Healthcare Passport |
$38.78
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$50.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.17
|
|
|
BIOPSY INTRANASAL(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
761P1119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$101.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.53
|
| Rate for Payer: Anthem Medicaid |
$38.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$173.24
|
| Rate for Payer: Healthspan PPO |
$158.29
|
| Rate for Payer: Humana Medicaid |
$38.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.56
|
| Rate for Payer: Molina Healthcare Passport |
$38.78
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$50.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.17
|
|
|
BIOPSY LIVER NEEDLE PERC
|
Professional
|
Both
|
$2,750.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
76102851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.25 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$157.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.25
|
| Rate for Payer: Anthem Medicaid |
$96.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,750.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna Commercial |
$141.95
|
| Rate for Payer: Healthspan PPO |
$392.19
|
| Rate for Payer: Humana Medicaid |
$96.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.39
|
| Rate for Payer: Molina Healthcare Passport |
$96.46
|
| Rate for Payer: Multiplan PHCS |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,925.00
|
| Rate for Payer: UHCCP Medicaid |
$92.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.42
|
|
|
BIOPSY LIVER NEEDLE PERC
|
Facility
|
IP
|
$2,750.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
76102851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.50 |
| Max. Negotiated Rate |
$2,640.00 |
| Rate for Payer: Aetna Commercial |
$2,117.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,145.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna Commercial |
$2,282.50
|
| Rate for Payer: First Health Commercial |
$2,612.50
|
| Rate for Payer: Humana Commercial |
$2,337.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,255.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,029.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,420.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$852.50
|
| Rate for Payer: PHCS Commercial |
$2,640.00
|
| Rate for Payer: United Healthcare All Payer |
$2,420.00
|
|
|
BIOPSY LIVER NEEDLE PERC
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
76101945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
