|
BIO-MOD GLEN KEEL ALLPLY LG 4M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 7M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 7M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 4M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 4M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 7M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 7M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 4M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 4M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 7M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 7M
|
Facility
|
IP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
OP
|
$2,023.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
761T1981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.71 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,557.71
|
| Rate for Payer: Anthem Medicaid |
$695.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cigna Commercial |
$1,679.09
|
| Rate for Payer: First Health Commercial |
$1,921.85
|
| Rate for Payer: Humana Commercial |
$1,719.55
|
| Rate for Payer: Humana KY Medicaid |
$695.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$702.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.87
|
| Rate for Payer: PHCS Commercial |
$1,942.08
|
| Rate for Payer: United Healthcare All Payer |
$1,780.24
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
IP
|
$2,523.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.90 |
| Max. Negotiated Rate |
$2,422.08 |
| Rate for Payer: Aetna Commercial |
$1,942.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,967.94
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$2,094.09
|
| Rate for Payer: First Health Commercial |
$2,396.85
|
| Rate for Payer: Humana Commercial |
$2,144.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,068.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,861.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,220.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,018.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.87
|
| Rate for Payer: PHCS Commercial |
$2,422.08
|
| Rate for Payer: United Healthcare All Payer |
$2,220.24
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Professional
|
Both
|
$2,523.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Ambetter Exchange |
$77.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.01
|
| Rate for Payer: Anthem Medicaid |
$97.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.06
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: Healthspan PPO |
$210.75
|
| Rate for Payer: Humana Medicaid |
$97.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.35
|
| Rate for Payer: Molina Healthcare Passport |
$97.40
|
| Rate for Payer: Multiplan PHCS |
$1,513.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.81
|
| Rate for Payer: UHCCP Medicaid |
$84.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.55
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.66 |
| Max. Negotiated Rate |
$2,422.08 |
| Rate for Payer: Aetna Commercial |
$1,942.71
|
| Rate for Payer: Anthem Medicaid |
$867.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,967.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$2,094.09
|
| Rate for Payer: First Health Commercial |
$2,396.85
|
| Rate for Payer: Humana Commercial |
$2,144.55
|
| Rate for Payer: Humana KY Medicaid |
$867.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$876.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,068.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,861.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$885.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,220.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,018.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.87
|
| Rate for Payer: PHCS Commercial |
$2,422.08
|
| Rate for Payer: United Healthcare All Payer |
$2,220.24
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
761P1981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Ambetter Exchange |
$77.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.01
|
| Rate for Payer: Anthem Medicaid |
$97.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.06
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: Healthspan PPO |
$210.75
|
| Rate for Payer: Humana Medicaid |
$97.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.35
|
| Rate for Payer: Molina Healthcare Passport |
$97.40
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.81
|
| Rate for Payer: UHCCP Medicaid |
$84.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.55
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
IP
|
$2,023.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
761T1981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.90 |
| Max. Negotiated Rate |
$1,942.08 |
| Rate for Payer: Aetna Commercial |
$1,557.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.94
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cigna Commercial |
$1,679.09
|
| Rate for Payer: First Health Commercial |
$1,921.85
|
| Rate for Payer: Humana Commercial |
$1,719.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.87
|
| Rate for Payer: PHCS Commercial |
$1,942.08
|
| Rate for Payer: United Healthcare All Payer |
$1,780.24
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Facility
|
OP
|
$7,251.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,493.62 |
| Max. Negotiated Rate |
$6,960.96 |
| Rate for Payer: Aetna Commercial |
$5,583.27
|
| Rate for Payer: Anthem Medicaid |
$2,493.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,655.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,625.50
|
| Rate for Payer: Cash Price |
$3,625.50
|
| Rate for Payer: Cigna Commercial |
$6,018.33
|
| Rate for Payer: First Health Commercial |
$6,888.45
|
| Rate for Payer: Humana Commercial |
$6,163.35
|
| Rate for Payer: Humana KY Medicaid |
$2,493.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,945.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,380.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.19
|
| Rate for Payer: PHCS Commercial |
$6,960.96
|
| Rate for Payer: United Healthcare All Payer |
$6,380.88
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Facility
|
IP
|
$7,251.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,175.30 |
| Max. Negotiated Rate |
$6,960.96 |
| Rate for Payer: Aetna Commercial |
$5,583.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,655.78
|
| Rate for Payer: Cash Price |
$3,625.50
|
| Rate for Payer: Cigna Commercial |
$6,018.33
|
| Rate for Payer: First Health Commercial |
$6,888.45
|
| Rate for Payer: Humana Commercial |
$6,163.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,945.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,380.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.19
|
| Rate for Payer: PHCS Commercial |
$6,960.96
|
| Rate for Payer: United Healthcare All Payer |
$6,380.88
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE
|
Professional
|
Both
|
$7,251.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$4,350.60 |
| Rate for Payer: Aetna Commercial |
$575.75
|
| Rate for Payer: Ambetter Exchange |
$406.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.12
|
| Rate for Payer: Anthem Medicaid |
$227.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$406.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$406.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$487.21
|
| Rate for Payer: Cash Price |
$3,625.50
|
| Rate for Payer: Cash Price |
$3,625.50
|
| Rate for Payer: Cigna Commercial |
$621.27
|
| Rate for Payer: Healthspan PPO |
$734.82
|
| Rate for Payer: Humana Medicaid |
$227.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$500.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$406.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.46
|
| Rate for Payer: Molina Healthcare Passport |
$227.90
|
| Rate for Payer: Multiplan PHCS |
$4,350.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$527.81
|
| Rate for Payer: UHCCP Medicaid |
$226.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$406.01
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(P
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761P0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$734.82 |
| Rate for Payer: Aetna Commercial |
$575.75
|
| Rate for Payer: Ambetter Exchange |
$406.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$216.12
|
| Rate for Payer: Anthem Medicaid |
$227.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$406.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$406.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$487.21
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$621.27
|
| Rate for Payer: Healthspan PPO |
$734.82
|
| Rate for Payer: Humana Medicaid |
$227.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$500.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$406.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.46
|
| Rate for Payer: Molina Healthcare Passport |
$227.90
|
| Rate for Payer: Multiplan PHCS |
$531.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$527.81
|
| Rate for Payer: UHCCP Medicaid |
$226.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$406.01
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(T
|
Facility
|
OP
|
$6,366.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761T0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,189.27 |
| Max. Negotiated Rate |
$6,111.36 |
| Rate for Payer: Aetna Commercial |
$4,901.82
|
| Rate for Payer: Anthem Medicaid |
$2,189.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,965.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,183.00
|
| Rate for Payer: Cash Price |
$3,183.00
|
| Rate for Payer: Cigna Commercial |
$5,283.78
|
| Rate for Payer: First Health Commercial |
$6,047.70
|
| Rate for Payer: Humana Commercial |
$5,411.10
|
| Rate for Payer: Humana KY Medicaid |
$2,189.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,211.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,220.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,698.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,233.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,602.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,774.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,092.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,538.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,392.54
|
| Rate for Payer: PHCS Commercial |
$6,111.36
|
| Rate for Payer: United Healthcare All Payer |
$5,602.08
|
|
|
BIOPSY ARM/ELBOW SOFT TISSU(T
|
Facility
|
IP
|
$6,366.00
|
|
|
Service Code
|
HCPCS 24066
|
| Hospital Charge Code |
761T0499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,909.80 |
| Max. Negotiated Rate |
$6,111.36 |
| Rate for Payer: Aetna Commercial |
$4,901.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,965.48
|
| Rate for Payer: Cash Price |
$3,183.00
|
| Rate for Payer: Cigna Commercial |
$5,283.78
|
| Rate for Payer: First Health Commercial |
$6,047.70
|
| Rate for Payer: Humana Commercial |
$5,411.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,220.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,698.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,909.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,602.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,774.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,092.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,538.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,392.54
|
| Rate for Payer: PHCS Commercial |
$6,111.36
|
| Rate for Payer: United Healthcare All Payer |
$5,602.08
|
|
|
BIOPSY BACK/FLANK - DEEP
|
Professional
|
Both
|
$4,137.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$2,482.20 |
| Rate for Payer: Aetna Commercial |
$485.70
|
| Rate for Payer: Ambetter Exchange |
$359.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.97
|
| Rate for Payer: Anthem Medicaid |
$184.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$359.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$359.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.27
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$515.84
|
| Rate for Payer: Healthspan PPO |
$534.47
|
| Rate for Payer: Humana Medicaid |
$184.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$427.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$359.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.88
|
| Rate for Payer: Molina Healthcare Passport |
$184.20
|
| Rate for Payer: Multiplan PHCS |
$2,482.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$467.21
|
| Rate for Payer: UHCCP Medicaid |
$203.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$359.39
|
|
|
BIOPSY BACK/FLANK - DEEP
|
Facility
|
IP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,241.10 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$3,433.71
|
| Rate for Payer: First Health Commercial |
$3,930.15
|
| Rate for Payer: Humana Commercial |
$3,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.53
|
| Rate for Payer: PHCS Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare All Payer |
$3,640.56
|
|
