|
BIOPSY OF VULVA/PERINEUM1LE(T
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
761T2160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.26 |
| Max. Negotiated Rate |
$1,825.92 |
| Rate for Payer: Aetna Commercial |
$1,464.54
|
| Rate for Payer: Anthem Medicaid |
$654.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$1,578.66
|
| Rate for Payer: First Health Commercial |
$1,806.90
|
| Rate for Payer: Humana Commercial |
$1,616.70
|
| Rate for Payer: Humana KY Medicaid |
$654.10
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$660.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.62
|
| Rate for Payer: PHCS Commercial |
$1,825.92
|
| Rate for Payer: United Healthcare All Payer |
$1,673.76
|
|
|
BIOPSY OF VULVA/PERINEUM1LE(T
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
761T2160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.26 |
| Max. Negotiated Rate |
$1,825.92 |
| Rate for Payer: Aetna Commercial |
$1,464.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.56
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$1,578.66
|
| Rate for Payer: First Health Commercial |
$1,806.90
|
| Rate for Payer: Humana Commercial |
$1,616.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.62
|
| Rate for Payer: PHCS Commercial |
$1,825.92
|
| Rate for Payer: United Healthcare All Payer |
$1,673.76
|
|
|
BIOPSY OF VULVA/PERINEUM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
761P2161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.24
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$59.78
|
| Rate for Payer: Healthspan PPO |
$56.30
|
| Rate for Payer: Humana Medicaid |
$19.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.65
|
| Rate for Payer: Molina Healthcare Passport |
$19.26
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$21.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.45
|
|
|
BIOPSY OF VULVA/PERINEUM(T
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
761T2161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.77
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
BIOPSY OF VULVA/PERINEUM(T
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
761T2161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.77
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 38525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INGUINOFEMORAL NODE(S)
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 38531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
BIOPSY OROPHARYNX
|
Facility
|
OP
|
$3,502.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
76101699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.26 |
| Max. Negotiated Rate |
$3,361.92 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: Anthem Medicaid |
$1,204.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,731.56
|
| 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 |
$1,751.00
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cigna Commercial |
$2,906.66
|
| Rate for Payer: First Health Commercial |
$3,326.90
|
| Rate for Payer: Humana Commercial |
$2,976.70
|
| Rate for Payer: Humana KY Medicaid |
$1,204.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,216.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,871.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,584.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,228.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,081.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.62
|
| Rate for Payer: PHCS Commercial |
$3,361.92
|
| Rate for Payer: United Healthcare All Payer |
$3,081.76
|
|
|
BIOPSY OROPHARYNX
|
Facility
|
IP
|
$3,502.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
76101699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.26 |
| Max. Negotiated Rate |
$3,361.92 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,731.56
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cigna Commercial |
$2,906.66
|
| Rate for Payer: First Health Commercial |
$3,326.90
|
| Rate for Payer: Humana Commercial |
$2,976.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,871.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,584.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,081.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.62
|
| Rate for Payer: PHCS Commercial |
$3,361.92
|
| Rate for Payer: United Healthcare All Payer |
$3,081.76
|
|
|
BIOPSY OROPHARYNX
|
Professional
|
Both
|
$3,502.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
76101699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$3,502.00 |
| Rate for Payer: Aetna Commercial |
$160.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.03
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,502.00
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cigna Commercial |
$208.37
|
| Rate for Payer: Healthspan PPO |
$182.67
|
| Rate for Payer: Humana Medicaid |
$51.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.21
|
| Rate for Payer: Molina Healthcare Passport |
$51.19
|
| Rate for Payer: Multiplan PHCS |
$2,101.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,451.40
|
| Rate for Payer: UHCCP Medicaid |
$70.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.70
|
|
|
BIOPSY; OROPHARYNX
|
Facility
|
OP
|
$1,846.31
|
|
|
Service Code
|
CPT 42800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,318.79 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
|
|
BIOPSY OROPHARYNX(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761P1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$160.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.03
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| 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 |
$208.37
|
| Rate for Payer: Healthspan PPO |
$182.67
|
| Rate for Payer: Humana Medicaid |
$51.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.21
|
| Rate for Payer: Molina Healthcare Passport |
$51.19
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$70.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.70
|
|
|
BIOPSY OROPHARYNX(T
|
Facility
|
IP
|
$3,252.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761T1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.76 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Aetna Commercial |
$2,504.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.56
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,699.16
|
| Rate for Payer: First Health Commercial |
$3,089.40
|
| Rate for Payer: Humana Commercial |
$2,764.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.12
|
| Rate for Payer: PHCS Commercial |
$3,121.92
|
| Rate for Payer: United Healthcare All Payer |
$2,861.76
|
|
|
BIOPSY OROPHARYNX(T
|
Facility
|
OP
|
$3,252.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761T1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.76 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Aetna Commercial |
$2,504.04
|
| Rate for Payer: Anthem Medicaid |
$1,118.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.56
|
| 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 |
$1,626.00
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,699.16
|
| Rate for Payer: First Health Commercial |
$3,089.40
|
| Rate for Payer: Humana Commercial |
$2,764.20
|
| Rate for Payer: Humana KY Medicaid |
$1,118.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.12
|
| Rate for Payer: PHCS Commercial |
$3,121.92
|
| Rate for Payer: United Healthcare All Payer |
$2,861.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$3,433.92 |
| Rate for Payer: Aetna Commercial |
$2,754.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.06
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$2,968.91
|
| Rate for Payer: First Health Commercial |
$3,398.15
|
| Rate for Payer: Humana Commercial |
$3,040.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,108.87
|
| Rate for Payer: PHCS Commercial |
$3,433.92
|
| Rate for Payer: United Healthcare All Payer |
$3,147.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$3,433.92 |
| Rate for Payer: Aetna Commercial |
$2,754.29
|
| Rate for Payer: Anthem Medicaid |
$1,230.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.06
|
| 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 |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$2,968.91
|
| Rate for Payer: First Health Commercial |
$3,398.15
|
| Rate for Payer: Humana Commercial |
$3,040.45
|
| Rate for Payer: Humana KY Medicaid |
$1,230.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,242.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,108.87
|
| Rate for Payer: PHCS Commercial |
$3,433.92
|
| Rate for Payer: United Healthcare All Payer |
$3,147.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Professional
|
Both
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$3,577.00 |
| Rate for Payer: Aetna Commercial |
$226.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.60
|
| Rate for Payer: Anthem Medicaid |
$73.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,577.00
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Healthspan PPO |
$316.88
|
| Rate for Payer: Humana Medicaid |
$73.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.77
|
| Rate for Payer: Molina Healthcare Passport |
$73.30
|
| Rate for Payer: Multiplan PHCS |
$2,146.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,503.90
|
| Rate for Payer: UHCCP Medicaid |
$83.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.03
|
|
|
BIOPSY - SOFT TISSUE OF NECK(P
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761P0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$316.88 |
| Rate for Payer: Aetna Commercial |
$226.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.60
|
| Rate for Payer: Anthem Medicaid |
$73.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$316.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Healthspan PPO |
$316.88
|
| Rate for Payer: Humana Medicaid |
$73.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.77
|
| Rate for Payer: Molina Healthcare Passport |
$73.30
|
| Rate for Payer: Multiplan PHCS |
$189.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.20
|
| Rate for Payer: UHCCP Medicaid |
$83.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.03
|
|
|
BIOPSY - SOFT TISSUE OF NECK(T
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761T0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.93 |
| Max. Negotiated Rate |
$3,130.56 |
| Rate for Payer: Aetna Commercial |
$2,510.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.58
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cigna Commercial |
$2,706.63
|
| Rate for Payer: First Health Commercial |
$3,097.95
|
| Rate for Payer: Humana Commercial |
$2,771.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.91
|
| Rate for Payer: PHCS Commercial |
$3,130.56
|
| Rate for Payer: United Healthcare All Payer |
$2,869.68
|
|
|
BIOPSY - SOFT TISSUE OF NECK(T
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761T0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.93 |
| Max. Negotiated Rate |
$3,130.56 |
| Rate for Payer: Aetna Commercial |
$2,510.97
|
| Rate for Payer: Anthem Medicaid |
$1,121.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.58
|
| 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 |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cigna Commercial |
$2,706.63
|
| Rate for Payer: First Health Commercial |
$3,097.95
|
| Rate for Payer: Humana Commercial |
$2,771.85
|
| Rate for Payer: Humana KY Medicaid |
$1,121.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,143.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.91
|
| Rate for Payer: PHCS Commercial |
$3,130.56
|
| Rate for Payer: United Healthcare All Payer |
$2,869.68
|
|
|
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 27323
|
|
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 - SOFT TISSUE - THIGH
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$254.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.77
|
| Rate for Payer: Anthem Medicaid |
$93.71
|
| 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 |
$271.35
|
| Rate for Payer: Healthspan PPO |
$330.15
|
| Rate for Payer: Humana Medicaid |
$93.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.58
|
| Rate for Payer: Molina Healthcare Passport |
$93.71
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.65
|
|
|
BIOPSY - SOFT TISSUE - THIGH
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
BIOPSY - SOFT TISSUE - THIGH
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
