|
BIOPSY BACK/FLANK - DEEP
|
Facility
|
OP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,422.71 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem Medicaid |
$1,422.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| 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 |
$2,068.50
|
| 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: Humana KY Medicaid |
$1,422.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.19
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.26
|
| 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
|
|
|
BIOPSY BACK/FLANK - DEEP(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761P0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$534.47 |
| 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 |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| 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 |
$510.00
|
| 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(T
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761T0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$986.10 |
| Max. Negotiated Rate |
$3,155.52 |
| Rate for Payer: Aetna Commercial |
$2,530.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.86
|
| Rate for Payer: Cash Price |
$1,643.50
|
| Rate for Payer: Cigna Commercial |
$2,728.21
|
| Rate for Payer: First Health Commercial |
$3,122.65
|
| Rate for Payer: Humana Commercial |
$2,793.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,695.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,465.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.03
|
| Rate for Payer: PHCS Commercial |
$3,155.52
|
| Rate for Payer: United Healthcare All Payer |
$2,892.56
|
|
|
BIOPSY BACK/FLANK - DEEP(T
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS 21925
|
| Hospital Charge Code |
761T0411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,130.40 |
| Max. Negotiated Rate |
$3,155.52 |
| Rate for Payer: Aetna Commercial |
$2,530.99
|
| Rate for Payer: Anthem Medicaid |
$1,130.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.86
|
| 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 |
$1,643.50
|
| Rate for Payer: Cash Price |
$1,643.50
|
| Rate for Payer: Cigna Commercial |
$2,728.21
|
| Rate for Payer: First Health Commercial |
$3,122.65
|
| Rate for Payer: Humana Commercial |
$2,793.95
|
| Rate for Payer: Humana KY Medicaid |
$1,130.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,695.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,153.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,465.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.03
|
| Rate for Payer: PHCS Commercial |
$3,155.52
|
| Rate for Payer: United Healthcare All Payer |
$2,892.56
|
|
|
BIOPSY BONE DEEP
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,148.63 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem Medicaid |
$1,148.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| 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 |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Humana KY Medicaid |
$1,148.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
BIOPSY BONE DEEP
|
Professional
|
Both
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Ambetter Exchange |
$121.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.79
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$2,004.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.94
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.49
|
|
|
BIOPSY BONE DEEP
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.00 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
BIOPSY BONE DEEP(P
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761P0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$843.03 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Ambetter Exchange |
$121.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.79
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.94
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.49
|
|
|
BIOPSY BONE DEEP(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761T0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BIOPSY BONE DEEP(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
761T0329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Facility
|
OP
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,372.22 |
| Max. Negotiated Rate |
$6,622.08 |
| Rate for Payer: Aetna Commercial |
$5,311.46
|
| Rate for Payer: Anthem Medicaid |
$2,372.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,380.44
|
| 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 |
$3,449.00
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$5,725.34
|
| Rate for Payer: First Health Commercial |
$6,553.10
|
| Rate for Payer: Humana Commercial |
$5,863.30
|
| Rate for Payer: Humana KY Medicaid |
$2,372.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,396.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,656.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,090.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,419.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,070.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,173.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.62
|
| Rate for Payer: PHCS Commercial |
$6,622.08
|
| Rate for Payer: United Healthcare All Payer |
$6,070.24
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Professional
|
Both
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.70 |
| Max. Negotiated Rate |
$4,138.80 |
| Rate for Payer: Aetna Commercial |
$921.19
|
| Rate for Payer: Ambetter Exchange |
$324.15
|
| Rate for Payer: Anthem Medicaid |
$214.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.98
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$1,008.23
|
| Rate for Payer: Healthspan PPO |
$834.40
|
| Rate for Payer: Humana Medicaid |
$214.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$324.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.99
|
| Rate for Payer: Molina Healthcare Passport |
$214.70
|
| Rate for Payer: Multiplan PHCS |
$4,138.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$421.39
|
| Rate for Payer: UHCCP Medicaid |
$2,414.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.15
|
|
|
BIOPSY - BONE - OPEN - DEEP
|
Facility
|
IP
|
$6,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,069.40 |
| Max. Negotiated Rate |
$6,622.08 |
| Rate for Payer: Aetna Commercial |
$5,311.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,380.44
|
| Rate for Payer: Cash Price |
$3,449.00
|
| Rate for Payer: Cigna Commercial |
$5,725.34
|
| Rate for Payer: First Health Commercial |
$6,553.10
|
| Rate for Payer: Humana Commercial |
$5,863.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,656.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,090.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,069.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,070.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,173.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.62
|
| Rate for Payer: PHCS Commercial |
$6,622.08
|
| Rate for Payer: United Healthcare All Payer |
$6,070.24
|
|
|
BIOPSY - BONE - OPEN - DEEP(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761P0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.70 |
| Max. Negotiated Rate |
$1,008.23 |
| Rate for Payer: Aetna Commercial |
$921.19
|
| Rate for Payer: Ambetter Exchange |
$324.15
|
| Rate for Payer: Anthem Medicaid |
$214.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.98
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,008.23
|
| Rate for Payer: Healthspan PPO |
$834.40
|
| Rate for Payer: Humana Medicaid |
$214.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$324.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.99
|
| Rate for Payer: Molina Healthcare Passport |
$214.70
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$421.39
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.15
|
|
|
BIOPSY - BONE - OPEN - DEEP(T
|
Facility
|
OP
|
$5,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761T0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,028.32 |
| Max. Negotiated Rate |
$5,662.08 |
| Rate for Payer: Aetna Commercial |
$4,541.46
|
| Rate for Payer: Anthem Medicaid |
$2,028.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,600.44
|
| 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 |
$2,949.00
|
| Rate for Payer: Cash Price |
$2,949.00
|
| Rate for Payer: Cigna Commercial |
$4,895.34
|
| Rate for Payer: First Health Commercial |
$5,603.10
|
| Rate for Payer: Humana Commercial |
$5,013.30
|
| Rate for Payer: Humana KY Medicaid |
$2,028.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,048.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,836.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,352.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,069.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,190.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,423.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,718.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,131.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,069.62
|
| Rate for Payer: PHCS Commercial |
$5,662.08
|
| Rate for Payer: United Healthcare All Payer |
$5,190.24
|
|
|
BIOPSY - BONE - OPEN - DEEP(T
|
Facility
|
IP
|
$5,898.00
|
|
|
Service Code
|
HCPCS 20245
|
| Hospital Charge Code |
761T0331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,769.40 |
| Max. Negotiated Rate |
$5,662.08 |
| Rate for Payer: Aetna Commercial |
$4,541.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,600.44
|
| Rate for Payer: Cash Price |
$2,949.00
|
| Rate for Payer: Cigna Commercial |
$4,895.34
|
| Rate for Payer: First Health Commercial |
$5,603.10
|
| Rate for Payer: Humana Commercial |
$5,013.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,836.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,352.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,769.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,190.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,423.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,718.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,131.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,069.62
|
| Rate for Payer: PHCS Commercial |
$5,662.08
|
| Rate for Payer: United Healthcare All Payer |
$5,190.24
|
|
|
BIOPSY BONE SUPERFICIAL
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$1,491.60 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Ambetter Exchange |
$81.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$74.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.04
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$127.98
|
| Rate for Payer: Healthspan PPO |
$225.74
|
| Rate for Payer: Humana Medicaid |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.08
|
| Rate for Payer: Molina Healthcare Passport |
$74.59
|
| Rate for Payer: Multiplan PHCS |
$1,491.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.21
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.70
|
|
|
BIOPSY BONE SUPERFICIAL
|
Facility
|
OP
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.94 |
| Max. Negotiated Rate |
$2,386.56 |
| Rate for Payer: Aetna Commercial |
$1,914.22
|
| Rate for Payer: Anthem Medicaid |
$854.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,939.08
|
| 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 |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$2,063.38
|
| Rate for Payer: First Health Commercial |
$2,361.70
|
| Rate for Payer: Humana Commercial |
$2,113.10
|
| Rate for Payer: Humana KY Medicaid |
$854.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$863.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,038.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,834.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$872.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,187.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,864.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,162.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.34
|
| Rate for Payer: PHCS Commercial |
$2,386.56
|
| Rate for Payer: United Healthcare All Payer |
$2,187.68
|
|
|
BIOPSY BONE SUPERFICIAL
|
Facility
|
IP
|
$2,486.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.80 |
| Max. Negotiated Rate |
$2,386.56 |
| Rate for Payer: Aetna Commercial |
$1,914.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,939.08
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna Commercial |
$2,063.38
|
| Rate for Payer: First Health Commercial |
$2,361.70
|
| Rate for Payer: Humana Commercial |
$2,113.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,038.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,834.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,187.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,864.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,162.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.34
|
| Rate for Payer: PHCS Commercial |
$2,386.56
|
| Rate for Payer: United Healthcare All Payer |
$2,187.68
|
|
|
BIOPSY BONE SUPERFICIAL(P
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761P0328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$118.09
|
| Rate for Payer: Ambetter Exchange |
$81.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$74.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.04
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$127.98
|
| Rate for Payer: Healthspan PPO |
$225.74
|
| Rate for Payer: Humana Medicaid |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.08
|
| Rate for Payer: Molina Healthcare Passport |
$74.59
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.21
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.70
|
|
|
BIOPSY BONE SUPERFICIAL(T
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761T0328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$676.11 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| 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 |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BIOPSY BONE SUPERFICIAL(T
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761T0328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR)
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 20225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
BIOPSY EAR
|
Professional
|
Both
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$2,209.91 |
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Ambetter Exchange |
$60.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.84
|
| Rate for Payer: Anthem Medicaid |
$48.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.86
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cigna Commercial |
$184.77
|
| Rate for Payer: Healthspan PPO |
$169.01
|
| Rate for Payer: Humana Medicaid |
$48.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.56
|
| Rate for Payer: Molina Healthcare Passport |
$48.59
|
| Rate for Payer: Multiplan PHCS |
$2,209.91
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.94
|
| Rate for Payer: UHCCP Medicaid |
$33.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.72
|
|
|
BIOPSY EAR
|
Facility
|
IP
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,104.95 |
| Max. Negotiated Rate |
$3,535.85 |
| Rate for Payer: Aetna Commercial |
$2,836.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.88
|
| Rate for Payer: Cash Price |
$1,841.59
|
| Rate for Payer: Cigna Commercial |
$3,057.04
|
| Rate for Payer: First Health Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial |
$3,130.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,946.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,204.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,541.39
|
| Rate for Payer: PHCS Commercial |
$3,535.85
|
| Rate for Payer: United Healthcare All Payer |
$3,241.20
|
|
