|
BIOPSY OF PALATE
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Aetna Commercial |
$1,755.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,892.40
|
| Rate for Payer: First Health Commercial |
$2,166.00
|
| Rate for Payer: Humana Commercial |
$1,938.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,869.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,682.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,006.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$706.80
|
| Rate for Payer: PHCS Commercial |
$2,188.80
|
| Rate for Payer: United Healthcare All Payer |
$2,006.40
|
|
|
BIOPSY OF PALATE
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Aetna Commercial |
$1,755.60
|
| Rate for Payer: Anthem Medicaid |
$784.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,778.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,892.40
|
| Rate for Payer: First Health Commercial |
$2,166.00
|
| Rate for Payer: Humana Commercial |
$1,938.00
|
| Rate for Payer: Humana KY Medicaid |
$784.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$792.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,869.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,682.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$799.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,006.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$706.80
|
| Rate for Payer: PHCS Commercial |
$2,188.80
|
| Rate for Payer: United Healthcare All Payer |
$2,006.40
|
|
|
BIOPSY OF PALATE
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$155.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.99
|
| Rate for Payer: Anthem Medicaid |
$49.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,280.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Healthspan PPO |
$172.76
|
| Rate for Payer: Humana Medicaid |
$49.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.50
|
| Rate for Payer: Molina Healthcare Passport |
$49.51
|
| Rate for Payer: Multiplan PHCS |
$1,368.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,596.00
|
| Rate for Payer: UHCCP Medicaid |
$69.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.01
|
|
|
BIOPSY OF PALATE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761P1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$155.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.99
|
| Rate for Payer: Anthem Medicaid |
$49.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Healthspan PPO |
$172.76
|
| Rate for Payer: Humana Medicaid |
$49.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.50
|
| Rate for Payer: Molina Healthcare Passport |
$49.51
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$69.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.01
|
|
|
BIOPSY OF PALATE(T
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761T1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| 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 |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
BIOPSY OF PALATE(T
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761T1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
BIOPSY OF PENIS
|
Facility
|
OP
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.54 |
| Max. Negotiated Rate |
$3,541.20 |
| Rate for Payer: Aetna Commercial |
$2,840.34
|
| Rate for Payer: Anthem Medicaid |
$1,268.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.22
|
| 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 |
$1,844.38
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$3,061.66
|
| Rate for Payer: First Health Commercial |
$3,504.31
|
| Rate for Payer: Humana Commercial |
$3,135.44
|
| Rate for Payer: Humana KY Medicaid |
$1,268.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.51
|
| Rate for Payer: PHCS Commercial |
$3,541.20
|
| Rate for Payer: United Healthcare All Payer |
$3,246.10
|
|
|
BIOPSY OF PENIS
|
Facility
|
IP
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.54 |
| Max. Negotiated Rate |
$3,541.20 |
| Rate for Payer: Aetna Commercial |
$2,840.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.22
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$3,061.66
|
| Rate for Payer: First Health Commercial |
$3,504.31
|
| Rate for Payer: Humana Commercial |
$3,135.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.51
|
| Rate for Payer: PHCS Commercial |
$3,541.20
|
| Rate for Payer: United Healthcare All Payer |
$3,246.10
|
|
|
BIOPSY OF PENIS
|
Professional
|
Both
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$3,688.75 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.74
|
| Rate for Payer: Anthem Medicaid |
$74.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,688.75
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$268.73
|
| Rate for Payer: Healthspan PPO |
$279.98
|
| Rate for Payer: Humana Medicaid |
$74.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.39
|
| Rate for Payer: Molina Healthcare Passport |
$74.89
|
| Rate for Payer: Multiplan PHCS |
$2,213.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,582.12
|
| Rate for Payer: UHCCP Medicaid |
$63.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.64
|
|
|
BIOPSY OF PENIS (P
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761P2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.74
|
| Rate for Payer: Anthem Medicaid |
$74.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.00
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$268.73
|
| Rate for Payer: Healthspan PPO |
$279.98
|
| Rate for Payer: Humana Medicaid |
$74.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.39
|
| Rate for Payer: Molina Healthcare Passport |
$74.89
|
| Rate for Payer: Multiplan PHCS |
$237.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$276.50
|
| Rate for Payer: UHCCP Medicaid |
$63.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.64
|
|
|
BIOPSY OF PENIS; (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 54100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
BIOPSY OF PENIS (T
|
Facility
|
IP
|
$3,293.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761T2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.19 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.06
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
BIOPSY OF PENIS (T
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761T2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.19 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| 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 |
$1,646.88
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.06
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
BIOPSY OF PROSTATE
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$3,129.60 |
| Rate for Payer: Aetna Commercial |
$2,510.20
|
| Rate for Payer: Anthem Medicaid |
$1,121.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,542.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,630.00
|
| Rate for Payer: Cash Price |
$1,630.00
|
| Rate for Payer: Cigna Commercial |
$2,705.80
|
| Rate for Payer: First Health Commercial |
$3,097.00
|
| Rate for Payer: Humana Commercial |
$2,771.00
|
| Rate for Payer: Humana KY Medicaid |
$1,121.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,673.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,405.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,143.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,868.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.60
|
| Rate for Payer: PHCS Commercial |
$3,129.60
|
| Rate for Payer: United Healthcare All Payer |
$2,868.80
|
|
|
BIOPSY OF PROSTATE
|
Professional
|
Both
|
$3,260.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$3,260.00 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.41
|
| Rate for Payer: Anthem Medicaid |
$69.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,260.00
|
| Rate for Payer: Cash Price |
$1,630.00
|
| Rate for Payer: Cash Price |
$1,630.00
|
| Rate for Payer: Cigna Commercial |
$368.18
|
| Rate for Payer: Healthspan PPO |
$351.83
|
| Rate for Payer: Humana Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.23
|
| Rate for Payer: Molina Healthcare Passport |
$69.83
|
| Rate for Payer: Multiplan PHCS |
$1,956.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,282.00
|
| Rate for Payer: UHCCP Medicaid |
$68.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.53
|
|
|
BIOPSY OF PROSTATE
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$3,129.60 |
| Rate for Payer: Aetna Commercial |
$2,510.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,542.80
|
| Rate for Payer: Cash Price |
$1,630.00
|
| Rate for Payer: Cigna Commercial |
$2,705.80
|
| Rate for Payer: First Health Commercial |
$3,097.00
|
| Rate for Payer: Humana Commercial |
$2,771.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,673.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,405.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,868.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.60
|
| Rate for Payer: PHCS Commercial |
$3,129.60
|
| Rate for Payer: United Healthcare All Payer |
$2,868.80
|
|
|
BIOPSY OF PROSTATE(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761P2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.41
|
| Rate for Payer: Anthem Medicaid |
$69.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$368.18
|
| Rate for Payer: Healthspan PPO |
$351.83
|
| Rate for Payer: Humana Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.23
|
| Rate for Payer: Molina Healthcare Passport |
$69.83
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.50
|
| Rate for Payer: UHCCP Medicaid |
$68.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.53
|
|
|
BIOPSY OF PROSTATE(T
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761T2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem Medicaid |
$909.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Humana KY Medicaid |
$909.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$918.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$927.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
BIOPSY OF PROSTATE(T
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761T2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem Medicaid |
$369.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Humana KY Medicaid |
$369.35
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$373.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
OP
|
$5,035.50
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$4,834.08 |
| Rate for Payer: Aetna Commercial |
$3,877.34
|
| Rate for Payer: Anthem Medicaid |
$1,731.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.69
|
| 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 |
$2,517.75
|
| Rate for Payer: Cash Price |
$2,517.75
|
| Rate for Payer: Cigna Commercial |
$4,179.46
|
| Rate for Payer: First Health Commercial |
$4,783.72
|
| Rate for Payer: Humana Commercial |
$4,280.18
|
| Rate for Payer: Humana KY Medicaid |
$1,731.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,129.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,716.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,431.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.00
|
| Rate for Payer: PHCS Commercial |
$4,834.08
|
| Rate for Payer: United Healthcare All Payer |
$4,431.24
|
|
|
BIOPSY OF SALIVARY GLAND
|
Professional
|
Both
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$1,074.00 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.88
|
| Rate for Payer: Anthem Medicaid |
$35.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,074.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$142.65
|
| Rate for Payer: Healthspan PPO |
$126.43
|
| Rate for Payer: Humana Medicaid |
$35.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.63
|
| Rate for Payer: Molina Healthcare Passport |
$35.91
|
| Rate for Payer: Multiplan PHCS |
$644.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$751.80
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.27
|
|
|
BIOPSY OF SALIVARY GLAND
|
Professional
|
Both
|
$5,035.50
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$5,035.50 |
| Rate for Payer: Aetna Commercial |
$333.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.22
|
| Rate for Payer: Anthem Medicaid |
$120.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,035.50
|
| Rate for Payer: Cash Price |
$2,517.75
|
| Rate for Payer: Cash Price |
$2,517.75
|
| Rate for Payer: Cigna Commercial |
$419.74
|
| Rate for Payer: Healthspan PPO |
$358.51
|
| Rate for Payer: Humana Medicaid |
$120.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.75
|
| Rate for Payer: Molina Healthcare Passport |
$120.34
|
| Rate for Payer: Multiplan PHCS |
$3,021.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,524.85
|
| Rate for Payer: UHCCP Medicaid |
$151.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.54
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
IP
|
$5,035.50
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$4,834.08 |
| Rate for Payer: First Health Commercial |
$4,783.72
|
| Rate for Payer: Aetna Commercial |
$3,877.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.69
|
| Rate for Payer: Cash Price |
$2,517.75
|
| Rate for Payer: Cigna Commercial |
$4,179.46
|
| Rate for Payer: Humana Commercial |
$4,280.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,129.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,716.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,431.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.00
|
| Rate for Payer: PHCS Commercial |
$4,834.08
|
| Rate for Payer: United Healthcare All Payer |
$4,431.24
|
|
