|
BIOPSY MUSCLE DEEP
|
Facility
|
OP
|
$6,246.17
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$5,996.32 |
| Rate for Payer: Aetna Commercial |
$4,809.55
|
| Rate for Payer: Anthem Medicaid |
$2,148.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,872.01
|
| 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 |
$3,123.08
|
| Rate for Payer: Cash Price |
$3,123.08
|
| Rate for Payer: Cigna Commercial |
$5,184.32
|
| Rate for Payer: First Health Commercial |
$5,933.86
|
| Rate for Payer: Humana Commercial |
$5,309.24
|
| Rate for Payer: Humana KY Medicaid |
$2,148.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,169.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,121.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,609.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,191.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,496.63
|
| Rate for Payer: Ohio Health Group HMO |
$4,684.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,936.31
|
| Rate for Payer: PHCS Commercial |
$5,996.32
|
| Rate for Payer: United Healthcare All Payer |
$5,496.63
|
|
|
BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$6,246.17
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$6,246.17 |
| Rate for Payer: Aetna Commercial |
$221.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.04
|
| Rate for Payer: Anthem Medicaid |
$127.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,246.17
|
| Rate for Payer: Cash Price |
$3,123.08
|
| Rate for Payer: Cash Price |
$3,123.08
|
| Rate for Payer: Cigna Commercial |
$234.90
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$127.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.95
|
| Rate for Payer: Molina Healthcare Passport |
$127.40
|
| Rate for Payer: Multiplan PHCS |
$3,747.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,372.32
|
| Rate for Payer: UHCCP Medicaid |
$86.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.67
|
|
|
BIOPSY, MUSCLE; DEEP
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 20205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
BIOPSY MUSCLE DEEP(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761P0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$221.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.04
|
| Rate for Payer: Anthem Medicaid |
$127.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$234.90
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$127.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.95
|
| Rate for Payer: Molina Healthcare Passport |
$127.40
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.00
|
| Rate for Payer: UHCCP Medicaid |
$86.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.67
|
|
|
BIOPSY MUSCLE DEEP(T
|
Facility
|
IP
|
$5,886.17
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761T0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.20 |
| Max. Negotiated Rate |
$5,650.72 |
| Rate for Payer: Aetna Commercial |
$4,532.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,591.21
|
| Rate for Payer: Cash Price |
$2,943.08
|
| Rate for Payer: Cigna Commercial |
$4,885.52
|
| Rate for Payer: First Health Commercial |
$5,591.86
|
| Rate for Payer: Humana Commercial |
$5,003.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,826.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,343.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,765.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,179.83
|
| Rate for Payer: Ohio Health Group HMO |
$4,414.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,177.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,824.71
|
| Rate for Payer: PHCS Commercial |
$5,650.72
|
| Rate for Payer: United Healthcare All Payer |
$5,179.83
|
|
|
BIOPSY MUSCLE DEEP(T
|
Facility
|
OP
|
$5,886.17
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761T0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.20 |
| Max. Negotiated Rate |
$5,650.72 |
| Rate for Payer: Aetna Commercial |
$4,532.35
|
| Rate for Payer: Anthem Medicaid |
$2,024.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,591.21
|
| 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 |
$2,943.08
|
| Rate for Payer: Cash Price |
$2,943.08
|
| Rate for Payer: Cigna Commercial |
$4,885.52
|
| Rate for Payer: First Health Commercial |
$5,591.86
|
| Rate for Payer: Humana Commercial |
$5,003.24
|
| Rate for Payer: Humana KY Medicaid |
$2,024.25
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,044.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,826.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,343.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,064.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,179.83
|
| Rate for Payer: Ohio Health Group HMO |
$4,414.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,177.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,824.71
|
| Rate for Payer: PHCS Commercial |
$5,650.72
|
| Rate for Payer: United Healthcare All Payer |
$5,179.83
|
|
|
BIOPSY MUSCLE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761P0327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$94.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.91
|
| Rate for Payer: Anthem Medicaid |
$58.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$101.30
|
| Rate for Payer: Healthspan PPO |
$323.89
|
| Rate for Payer: Humana Medicaid |
$58.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.36
|
| Rate for Payer: Molina Healthcare Passport |
$58.20
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$46.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.78
|
|
|
BIOPSY MUSCLE(T
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761T0327
|
|
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 MUSCLE(T
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761T0327
|
|
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 NASOPHARYNX
|
Facility
|
OP
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.37 |
| Max. Negotiated Rate |
$4,647.68 |
| Rate for Payer: Aetna Commercial |
$3,727.82
|
| Rate for Payer: Anthem Medicaid |
$1,664.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$4,018.30
|
| Rate for Payer: First Health Commercial |
$4,599.26
|
| Rate for Payer: Humana Commercial |
$4,115.13
|
| Rate for Payer: Humana KY Medicaid |
$1,664.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,969.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,698.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.81
|
| Rate for Payer: PHCS Commercial |
$4,647.68
|
| Rate for Payer: United Healthcare All Payer |
$4,260.37
|
|
|
BIOPSY NASOPHARYNX
|
Facility
|
IP
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.37 |
| Max. Negotiated Rate |
$4,647.68 |
| Rate for Payer: Aetna Commercial |
$3,727.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.24
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$4,018.30
|
| Rate for Payer: First Health Commercial |
$4,599.26
|
| Rate for Payer: Humana Commercial |
$4,115.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,969.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.81
|
| Rate for Payer: PHCS Commercial |
$4,647.68
|
| Rate for Payer: United Healthcare All Payer |
$4,260.37
|
|
|
BIOPSY NASOPHARYNX
|
Professional
|
Both
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$4,841.33 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.57
|
| Rate for Payer: Anthem Medicaid |
$86.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,841.33
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$197.77
|
| Rate for Payer: Healthspan PPO |
$260.37
|
| Rate for Payer: Humana Medicaid |
$86.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.06
|
| Rate for Payer: Molina Healthcare Passport |
$86.33
|
| Rate for Payer: Multiplan PHCS |
$2,904.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,388.93
|
| Rate for Payer: UHCCP Medicaid |
$97.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.19
|
|
|
BIOPSY NASOPHARYNX(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761P1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.57
|
| Rate for Payer: Anthem Medicaid |
$86.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$197.77
|
| Rate for Payer: Healthspan PPO |
$260.37
|
| Rate for Payer: Humana Medicaid |
$86.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.06
|
| Rate for Payer: Molina Healthcare Passport |
$86.33
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$97.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.19
|
|
|
BIOPSY NASOPHARYNX(T
|
Facility
|
OP
|
$4,441.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761T1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.37 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$3,419.82
|
| Rate for Payer: Anthem Medicaid |
$1,527.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,464.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,220.66
|
| Rate for Payer: Cash Price |
$2,220.66
|
| Rate for Payer: Cigna Commercial |
$3,686.30
|
| Rate for Payer: First Health Commercial |
$4,219.26
|
| Rate for Payer: Humana Commercial |
$3,775.13
|
| Rate for Payer: Humana KY Medicaid |
$1,527.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,542.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,641.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,277.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,558.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,908.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,331.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.81
|
| Rate for Payer: PHCS Commercial |
$4,263.68
|
| Rate for Payer: United Healthcare All Payer |
$3,908.37
|
|
|
BIOPSY NASOPHARYNX(T
|
Facility
|
IP
|
$4,441.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761T1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.37 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$3,419.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,464.24
|
| Rate for Payer: Cash Price |
$2,220.66
|
| Rate for Payer: Cigna Commercial |
$3,686.30
|
| Rate for Payer: First Health Commercial |
$4,219.26
|
| Rate for Payer: Humana Commercial |
$3,775.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,641.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,277.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,908.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,331.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.81
|
| Rate for Payer: PHCS Commercial |
$4,263.68
|
| Rate for Payer: United Healthcare All Payer |
$3,908.37
|
|
|
BIOPSY NERVE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BIOPSY NERVE
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$314.38
|
| Rate for Payer: Anthem Medicaid |
$161.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$285.75
|
| Rate for Payer: Healthspan PPO |
$245.46
|
| Rate for Payer: Humana Medicaid |
$161.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.87
|
| Rate for Payer: Molina Healthcare Passport |
$161.64
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.26
|
|
|
BIOPSY NERVE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BIOPSY NERVE(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
761P2371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$314.38
|
| Rate for Payer: Anthem Medicaid |
$161.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$285.75
|
| Rate for Payer: Healthspan PPO |
$245.46
|
| Rate for Payer: Humana Medicaid |
$161.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.87
|
| Rate for Payer: Molina Healthcare Passport |
$161.64
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.26
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
OP
|
$2,379.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761T0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.27 |
| Max. Negotiated Rate |
$2,283.84 |
| Rate for Payer: Aetna Commercial |
$1,831.83
|
| Rate for Payer: Anthem Medicaid |
$818.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,855.62
|
| 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 |
$1,189.50
|
| Rate for Payer: Cash Price |
$1,189.50
|
| Rate for Payer: Cigna Commercial |
$1,974.57
|
| Rate for Payer: First Health Commercial |
$2,260.05
|
| Rate for Payer: Humana Commercial |
$2,022.15
|
| Rate for Payer: Humana KY Medicaid |
$818.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$826.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,950.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,755.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$834.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,093.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,784.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$309.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$737.49
|
| Rate for Payer: PHCS Commercial |
$2,283.84
|
| Rate for Payer: United Healthcare All Payer |
$2,093.52
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761P0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.39
|
| Rate for Payer: Anthem Medicaid |
$49.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$190.52
|
| Rate for Payer: Healthspan PPO |
$156.31
|
| Rate for Payer: Humana Medicaid |
$49.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.99
|
| Rate for Payer: Molina Healthcare Passport |
$49.01
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$42.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.50
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
IP
|
$2,379.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761T0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.27 |
| Max. Negotiated Rate |
$2,283.84 |
| Rate for Payer: Aetna Commercial |
$1,831.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,855.62
|
| Rate for Payer: Cash Price |
$1,189.50
|
| Rate for Payer: Cigna Commercial |
$1,974.57
|
| Rate for Payer: First Health Commercial |
$2,260.05
|
| Rate for Payer: Humana Commercial |
$2,022.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,950.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,755.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$713.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,093.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,784.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$309.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$737.49
|
| Rate for Payer: PHCS Commercial |
$2,283.84
|
| Rate for Payer: United Healthcare All Payer |
$2,093.52
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$2,629.00 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.39
|
| Rate for Payer: Anthem Medicaid |
$49.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,629.00
|
| Rate for Payer: Cash Price |
$1,314.50
|
| Rate for Payer: Cash Price |
$1,314.50
|
| Rate for Payer: Cigna Commercial |
$190.52
|
| Rate for Payer: Healthspan PPO |
$156.31
|
| Rate for Payer: Humana Medicaid |
$49.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.99
|
| Rate for Payer: Molina Healthcare Passport |
$49.01
|
| Rate for Payer: Multiplan PHCS |
$1,577.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,840.30
|
| Rate for Payer: UHCCP Medicaid |
$42.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.50
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
OP
|
$2,629.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.77 |
| Max. Negotiated Rate |
$2,523.84 |
| Rate for Payer: Aetna Commercial |
$2,024.33
|
| Rate for Payer: Anthem Medicaid |
$904.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,050.62
|
| 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 |
$1,314.50
|
| Rate for Payer: Cash Price |
$1,314.50
|
| Rate for Payer: Cigna Commercial |
$2,182.07
|
| Rate for Payer: First Health Commercial |
$2,497.55
|
| Rate for Payer: Humana Commercial |
$2,234.65
|
| Rate for Payer: Humana KY Medicaid |
$904.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$913.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,155.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,940.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$922.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,313.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,971.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$525.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$814.99
|
| Rate for Payer: PHCS Commercial |
$2,523.84
|
| Rate for Payer: United Healthcare All Payer |
$2,313.52
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
IP
|
$2,629.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.77 |
| Max. Negotiated Rate |
$2,523.84 |
| Rate for Payer: Aetna Commercial |
$2,024.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,050.62
|
| Rate for Payer: Cash Price |
$1,314.50
|
| Rate for Payer: Cigna Commercial |
$2,182.07
|
| Rate for Payer: First Health Commercial |
$2,497.55
|
| Rate for Payer: Humana Commercial |
$2,234.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,155.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,940.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$788.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,313.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,971.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$525.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$814.99
|
| Rate for Payer: PHCS Commercial |
$2,523.84
|
| Rate for Payer: United Healthcare All Payer |
$2,313.52
|
|
