|
BIOPSY OF CERVIX
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$2,461.00 |
| Rate for Payer: Aetna Commercial |
$112.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.67
|
| Rate for Payer: Anthem Medicaid |
$39.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,461.00
|
| Rate for Payer: Cash Price |
$1,230.50
|
| Rate for Payer: Cash Price |
$1,230.50
|
| Rate for Payer: Cigna Commercial |
$208.20
|
| Rate for Payer: Healthspan PPO |
$186.25
|
| Rate for Payer: Humana Medicaid |
$39.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.80
|
| Rate for Payer: Molina Healthcare Passport |
$39.02
|
| Rate for Payer: Multiplan PHCS |
$1,476.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,722.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.41
|
|
|
BIOPSY OF CERVIX
|
Facility
|
OP
|
$2,461.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.93 |
| Max. Negotiated Rate |
$2,362.56 |
| Rate for Payer: Aetna Commercial |
$1,894.97
|
| Rate for Payer: Anthem Medicaid |
$846.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,919.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$1,230.50
|
| Rate for Payer: Cash Price |
$1,230.50
|
| Rate for Payer: Cigna Commercial |
$2,042.63
|
| Rate for Payer: First Health Commercial |
$2,337.95
|
| Rate for Payer: Humana Commercial |
$2,091.85
|
| Rate for Payer: Humana KY Medicaid |
$846.34
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$854.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$863.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,165.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,845.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.91
|
| Rate for Payer: PHCS Commercial |
$2,362.56
|
| Rate for Payer: United Healthcare All Payer |
$2,165.68
|
|
|
BIOPSY OF CERVIX
|
Facility
|
IP
|
$2,461.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.93 |
| Max. Negotiated Rate |
$2,362.56 |
| Rate for Payer: Aetna Commercial |
$1,894.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,919.58
|
| Rate for Payer: Cash Price |
$1,230.50
|
| Rate for Payer: Cigna Commercial |
$2,042.63
|
| Rate for Payer: First Health Commercial |
$2,337.95
|
| Rate for Payer: Humana Commercial |
$2,091.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,165.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,845.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.91
|
| Rate for Payer: PHCS Commercial |
$2,362.56
|
| Rate for Payer: United Healthcare All Payer |
$2,165.68
|
|
|
BIOPSY OF CERVIX(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761P2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$112.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.67
|
| Rate for Payer: Anthem Medicaid |
$39.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$405.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$208.20
|
| Rate for Payer: Healthspan PPO |
$186.25
|
| Rate for Payer: Humana Medicaid |
$39.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.80
|
| Rate for Payer: Molina Healthcare Passport |
$39.02
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.41
|
|
|
BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$973.27
|
|
|
Service Code
|
CPT 57500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$695.19 |
| Max. Negotiated Rate |
$973.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
|
|
BIOPSY OF CERVIX(T
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761T2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.28 |
| Max. Negotiated Rate |
$1,973.76 |
| Rate for Payer: Aetna Commercial |
$1,583.12
|
| Rate for Payer: Anthem Medicaid |
$707.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cigna Commercial |
$1,706.48
|
| Rate for Payer: First Health Commercial |
$1,953.20
|
| Rate for Payer: Humana Commercial |
$1,747.60
|
| Rate for Payer: Humana KY Medicaid |
$707.06
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$714.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.36
|
| Rate for Payer: PHCS Commercial |
$1,973.76
|
| Rate for Payer: United Healthcare All Payer |
$1,809.28
|
|
|
BIOPSY OF CERVIX(T
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761T2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.28 |
| Max. Negotiated Rate |
$1,973.76 |
| Rate for Payer: Aetna Commercial |
$1,583.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.68
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cigna Commercial |
$1,706.48
|
| Rate for Payer: First Health Commercial |
$1,953.20
|
| Rate for Payer: Humana Commercial |
$1,747.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.36
|
| Rate for Payer: PHCS Commercial |
$1,973.76
|
| Rate for Payer: United Healthcare All Payer |
$1,809.28
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.74 |
| Max. Negotiated Rate |
$958.08 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$778.44
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$828.34
|
| Rate for Payer: First Health Commercial |
$948.10
|
| Rate for Payer: Humana Commercial |
$848.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$818.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$736.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$878.24
|
| Rate for Payer: Ohio Health Group HMO |
$748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$199.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.38
|
| Rate for Payer: PHCS Commercial |
$958.08
|
| Rate for Payer: United Healthcare All Payer |
$878.24
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.74 |
| Max. Negotiated Rate |
$958.08 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Anthem Medicaid |
$343.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$778.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$828.34
|
| Rate for Payer: First Health Commercial |
$948.10
|
| Rate for Payer: Humana Commercial |
$848.30
|
| Rate for Payer: Humana KY Medicaid |
$343.21
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$346.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$818.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$736.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$878.24
|
| Rate for Payer: Ohio Health Group HMO |
$748.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$199.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.38
|
| Rate for Payer: PHCS Commercial |
$958.08
|
| Rate for Payer: United Healthcare All Payer |
$878.24
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$998.00 |
| Rate for Payer: Aetna Commercial |
$171.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.83
|
| Rate for Payer: Anthem Medicaid |
$83.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$998.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cash Price |
$499.00
|
| Rate for Payer: Cigna Commercial |
$216.30
|
| Rate for Payer: Healthspan PPO |
$209.14
|
| Rate for Payer: Humana Medicaid |
$83.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.19
|
| Rate for Payer: Molina Healthcare Passport |
$83.52
|
| Rate for Payer: Multiplan PHCS |
$598.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$698.60
|
| Rate for Payer: UHCCP Medicaid |
$79.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.36
|
|
|
BIOPSY OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761P2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$171.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.83
|
| Rate for Payer: Anthem Medicaid |
$83.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$216.30
|
| Rate for Payer: Healthspan PPO |
$209.14
|
| Rate for Payer: Humana Medicaid |
$83.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.19
|
| Rate for Payer: Molina Healthcare Passport |
$83.52
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$79.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.36
|
|
|
BIOPSY OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761T2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.44 |
| Max. Negotiated Rate |
$660.48 |
| Rate for Payer: Aetna Commercial |
$529.76
|
| Rate for Payer: Anthem Medicaid |
$236.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$536.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cigna Commercial |
$571.04
|
| Rate for Payer: First Health Commercial |
$653.60
|
| Rate for Payer: Humana Commercial |
$584.80
|
| Rate for Payer: Humana KY Medicaid |
$236.60
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$239.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$564.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$507.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$241.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$605.44
|
| Rate for Payer: Ohio Health Group HMO |
$516.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.28
|
| Rate for Payer: PHCS Commercial |
$660.48
|
| Rate for Payer: United Healthcare All Payer |
$605.44
|
|
|
BIOPSY OF CERVIX W/SCOPE(T
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761T2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.44 |
| Max. Negotiated Rate |
$660.48 |
| Rate for Payer: Aetna Commercial |
$529.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$536.64
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cigna Commercial |
$571.04
|
| Rate for Payer: First Health Commercial |
$653.60
|
| Rate for Payer: Humana Commercial |
$584.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$564.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$507.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$605.44
|
| Rate for Payer: Ohio Health Group HMO |
$516.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.28
|
| Rate for Payer: PHCS Commercial |
$660.48
|
| Rate for Payer: United Healthcare All Payer |
$605.44
|
|
|
BIOPSY OF LIP
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.27
|
| Rate for Payer: Anthem Medicaid |
$47.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$168.57
|
| Rate for Payer: Healthspan PPO |
$151.32
|
| Rate for Payer: Humana Medicaid |
$47.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.37
|
| Rate for Payer: Molina Healthcare Passport |
$47.42
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.60
|
| Rate for Payer: UHCCP Medicaid |
$66.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.89
|
|
|
BIOPSY OF LIP
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
BIOPSY OF LIP
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
BIOPSY OF LIP(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761P1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.27
|
| Rate for Payer: Anthem Medicaid |
$47.42
|
| 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 |
$168.57
|
| Rate for Payer: Healthspan PPO |
$151.32
|
| Rate for Payer: Humana Medicaid |
$47.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.37
|
| Rate for Payer: Molina Healthcare Passport |
$47.42
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$66.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.89
|
|
|
BIOPSY OF LIP(T
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761T1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem Medicaid |
$197.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Humana KY Medicaid |
$197.05
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$199.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.63
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
BIOPSY OF LIP(T
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761T1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.63
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
BIOPSY OF NAIL UNIT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$1,542.00 |
| Rate for Payer: Aetna Commercial |
$126.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.44
|
| Rate for Payer: Anthem Medicaid |
$67.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,542.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$170.80
|
| Rate for Payer: Healthspan PPO |
$148.47
|
| Rate for Payer: Humana Medicaid |
$67.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.27
|
| Rate for Payer: Molina Healthcare Passport |
$67.91
|
| Rate for Payer: Multiplan PHCS |
$925.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,079.40
|
| Rate for Payer: UHCCP Medicaid |
$52.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.59
|
|
|
BIOPSY OF NAIL UNIT
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.46 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.02
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
BIOPSY OF NAIL UNIT
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.46 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.02
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
BIOPSY OF NAIL UNIT (P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761P0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$126.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.44
|
| Rate for Payer: Anthem Medicaid |
$67.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$170.80
|
| Rate for Payer: Healthspan PPO |
$148.47
|
| Rate for Payer: Humana Medicaid |
$67.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.27
|
| Rate for Payer: Molina Healthcare Passport |
$67.91
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.50
|
| Rate for Payer: UHCCP Medicaid |
$52.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.59
|
|
|
BIOPSY OF NAIL UNIT (T
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761T0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.87
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
|
BIOPSY OF NAIL UNIT (T
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761T0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem Medicaid |
$439.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Humana KY Medicaid |
$439.16
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$443.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.87
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
