|
BIOPSY EAR
|
Facility
|
OP
|
$3,683.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
76102405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$3,535.85 |
| Rate for Payer: Aetna Commercial |
$2,836.05
|
| Rate for Payer: Anthem Medicaid |
$1,266.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,841.59
|
| 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: Humana KY Medicaid |
$1,266.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.54
|
| 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 |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.06
|
| 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
|
|
|
BIOPSY EAR(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761P2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$184.77 |
| 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 |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$120.00
|
| 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(T
|
Facility
|
IP
|
$3,483.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761T2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,044.95 |
| Max. Negotiated Rate |
$3,343.85 |
| Rate for Payer: Aetna Commercial |
$2,682.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.88
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cigna Commercial |
$2,891.04
|
| Rate for Payer: First Health Commercial |
$3,309.02
|
| Rate for Payer: Humana Commercial |
$2,960.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,570.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,612.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,786.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,030.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,403.39
|
| Rate for Payer: PHCS Commercial |
$3,343.85
|
| Rate for Payer: United Healthcare All Payer |
$3,065.20
|
|
|
BIOPSY EAR(T
|
Facility
|
OP
|
$3,483.18
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
761T2405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,197.87 |
| Max. Negotiated Rate |
$3,343.85 |
| Rate for Payer: Aetna Commercial |
$2,682.05
|
| Rate for Payer: Anthem Medicaid |
$1,197.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cash Price |
$1,741.59
|
| Rate for Payer: Cigna Commercial |
$2,891.04
|
| Rate for Payer: First Health Commercial |
$3,309.02
|
| Rate for Payer: Humana Commercial |
$2,960.70
|
| Rate for Payer: Humana KY Medicaid |
$1,197.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,856.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,570.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,065.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,612.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,786.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,030.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,403.39
|
| Rate for Payer: PHCS Commercial |
$3,343.85
|
| Rate for Payer: United Healthcare All Payer |
$3,065.20
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$869.76 |
| Rate for Payer: Aetna Commercial |
$697.62
|
| Rate for Payer: Anthem Medicaid |
$311.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$706.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$751.98
|
| Rate for Payer: First Health Commercial |
$860.70
|
| Rate for Payer: Humana Commercial |
$770.10
|
| Rate for Payer: Humana KY Medicaid |
$311.57
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$314.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$668.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$797.28
|
| Rate for Payer: Ohio Health Group HMO |
$679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.14
|
| Rate for Payer: PHCS Commercial |
$869.76
|
| Rate for Payer: United Healthcare All Payer |
$797.28
|
|
|
BIOPSY EXTERNAL EAR
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$543.60 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Ambetter Exchange |
$43.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$41.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.97
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$144.99
|
| Rate for Payer: Healthspan PPO |
$128.84
|
| Rate for Payer: Humana Medicaid |
$41.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.53
|
| Rate for Payer: Molina Healthcare Passport |
$41.70
|
| Rate for Payer: Multiplan PHCS |
$543.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.30
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.31
|
|
|
BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
76102404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$869.76 |
| Rate for Payer: Aetna Commercial |
$697.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$706.68
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$751.98
|
| Rate for Payer: First Health Commercial |
$860.70
|
| Rate for Payer: Humana Commercial |
$770.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$668.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$797.28
|
| Rate for Payer: Ohio Health Group HMO |
$679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.14
|
| Rate for Payer: PHCS Commercial |
$869.76
|
| Rate for Payer: United Healthcare All Payer |
$797.28
|
|
|
BIOPSY EXTERNAL EAR(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761P2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$144.99 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Ambetter Exchange |
$43.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$41.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.97
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$144.99
|
| Rate for Payer: Healthspan PPO |
$128.84
|
| Rate for Payer: Humana Medicaid |
$41.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.53
|
| Rate for Payer: Molina Healthcare Passport |
$41.70
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.30
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.31
|
|
|
BIOPSY EXTERNAL EAR(T
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761T2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$725.76 |
| Rate for Payer: Aetna Commercial |
$582.12
|
| Rate for Payer: Anthem Medicaid |
$259.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$627.48
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: Humana Commercial |
$642.60
|
| Rate for Payer: Humana KY Medicaid |
$259.99
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$262.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.28
|
| Rate for Payer: Ohio Health Group HMO |
$567.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$657.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$521.64
|
| Rate for Payer: PHCS Commercial |
$725.76
|
| Rate for Payer: United Healthcare All Payer |
$665.28
|
|
|
BIOPSY EXTERNAL EAR(T
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
761T2404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$725.76 |
| Rate for Payer: Aetna Commercial |
$582.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.68
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$627.48
|
| Rate for Payer: First Health Commercial |
$718.20
|
| Rate for Payer: Humana Commercial |
$642.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.28
|
| Rate for Payer: Ohio Health Group HMO |
$567.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$657.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$521.64
|
| Rate for Payer: PHCS Commercial |
$725.76
|
| Rate for Payer: United Healthcare All Payer |
$665.28
|
|
|
BIOPSY FINGER JOINT LINING
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
76100664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.18 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna Commercial |
$464.54
|
| Rate for Payer: Ambetter Exchange |
$328.60
|
| Rate for Payer: Anthem Medicaid |
$233.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$394.32
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$518.91
|
| Rate for Payer: Healthspan PPO |
$420.78
|
| Rate for Payer: Humana Medicaid |
$233.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$405.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.84
|
| Rate for Payer: Molina Healthcare Passport |
$233.18
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.18
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.60
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
76100664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.53 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
76100664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
76100665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BIOPSY FINGER JOINT LINING
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
76100665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BIOPSY FINGER JOINT LINING
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
76100665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna Commercial |
$444.52
|
| Rate for Payer: Ambetter Exchange |
$312.03
|
| Rate for Payer: Anthem Medicaid |
$190.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.44
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$493.79
|
| Rate for Payer: Healthspan PPO |
$402.64
|
| Rate for Payer: Humana Medicaid |
$190.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.32
|
| Rate for Payer: Molina Healthcare Passport |
$190.51
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.64
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.03
|
|
|
BIOPSY FINGER JOINT LINING(P
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 26110
|
| Hospital Charge Code |
761P0665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$493.79 |
| Rate for Payer: Aetna Commercial |
$444.52
|
| Rate for Payer: Ambetter Exchange |
$312.03
|
| Rate for Payer: Anthem Medicaid |
$190.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.44
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$493.79
|
| Rate for Payer: Healthspan PPO |
$402.64
|
| Rate for Payer: Humana Medicaid |
$190.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.32
|
| Rate for Payer: Molina Healthcare Passport |
$190.51
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.64
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.03
|
|
|
BIOPSY FINGER JOINT LINING(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26105
|
| Hospital Charge Code |
761P0664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.18 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna Commercial |
$464.54
|
| Rate for Payer: Ambetter Exchange |
$328.60
|
| Rate for Payer: Anthem Medicaid |
$233.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$394.32
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$518.91
|
| Rate for Payer: Healthspan PPO |
$420.78
|
| Rate for Payer: Humana Medicaid |
$233.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$405.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.84
|
| Rate for Payer: Molina Healthcare Passport |
$233.18
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.18
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.60
|
|
|
BIOPSY FLOOR OF MOUTH
|
Facility
|
OP
|
$2,345.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.45 |
| Max. Negotiated Rate |
$2,251.20 |
| Rate for Payer: Aetna Commercial |
$1,805.65
|
| Rate for Payer: Anthem Medicaid |
$806.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.10
|
| 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 |
$1,172.50
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cigna Commercial |
$1,946.35
|
| Rate for Payer: First Health Commercial |
$2,227.75
|
| Rate for Payer: Humana Commercial |
$1,993.25
|
| Rate for Payer: Humana KY Medicaid |
$806.45
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$814.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,922.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,730.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$822.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,063.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,758.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.05
|
| Rate for Payer: PHCS Commercial |
$2,251.20
|
| Rate for Payer: United Healthcare All Payer |
$2,063.60
|
|
|
BIOPSY FLOOR OF MOUTH
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$2,251.20 |
| Rate for Payer: Aetna Commercial |
$1,805.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.10
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cigna Commercial |
$1,946.35
|
| Rate for Payer: First Health Commercial |
$2,227.75
|
| Rate for Payer: Humana Commercial |
$1,993.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,922.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,730.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,063.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,758.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.05
|
| Rate for Payer: PHCS Commercial |
$2,251.20
|
| Rate for Payer: United Healthcare All Payer |
$2,063.60
|
|
|
BIOPSY FLOOR OF MOUTH
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
76101653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$127.76
|
| Rate for Payer: Ambetter Exchange |
$86.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.83
|
| Rate for Payer: Anthem Medicaid |
$54.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.21
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Healthspan PPO |
$165.97
|
| Rate for Payer: Humana Medicaid |
$54.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.42
|
| Rate for Payer: Molina Healthcare Passport |
$54.33
|
| Rate for Payer: Multiplan PHCS |
$1,407.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.81
|
| Rate for Payer: UHCCP Medicaid |
$62.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.01
|
|
|
BIOPSY FLOOR OF MOUTH(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761P1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$127.76
|
| Rate for Payer: Ambetter Exchange |
$86.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.83
|
| Rate for Payer: Anthem Medicaid |
$54.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.21
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Healthspan PPO |
$165.97
|
| Rate for Payer: Humana Medicaid |
$54.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.42
|
| Rate for Payer: Molina Healthcare Passport |
$54.33
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.81
|
| Rate for Payer: UHCCP Medicaid |
$62.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.01
|
|
|
BIOPSY FLOOR OF MOUTH(T
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761T1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$737.67 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,651.65
|
| Rate for Payer: Anthem Medicaid |
$737.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.10
|
| 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 |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna Commercial |
$1,780.35
|
| Rate for Payer: First Health Commercial |
$2,037.75
|
| Rate for Payer: Humana Commercial |
$1,823.25
|
| Rate for Payer: Humana KY Medicaid |
$737.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$745.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.05
|
| Rate for Payer: PHCS Commercial |
$2,059.20
|
| Rate for Payer: United Healthcare All Payer |
$1,887.60
|
|
|
BIOPSY FLOOR OF MOUTH(T
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 41108
|
| Hospital Charge Code |
761T1653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$2,059.20 |
| Rate for Payer: Aetna Commercial |
$1,651.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.10
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cigna Commercial |
$1,780.35
|
| Rate for Payer: First Health Commercial |
$2,037.75
|
| Rate for Payer: Humana Commercial |
$1,823.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.05
|
| Rate for Payer: PHCS Commercial |
$2,059.20
|
| Rate for Payer: United Healthcare All Payer |
$1,887.60
|
|
|
BIOPSY FOREARM SOFT TISSUES
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 25065
|
| Hospital Charge Code |
76100571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$231.08
|
| Rate for Payer: Ambetter Exchange |
$148.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.47
|
| Rate for Payer: Anthem Medicaid |
$92.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$148.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$148.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$250.10
|
| Rate for Payer: Healthspan PPO |
$307.24
|
| Rate for Payer: Humana Medicaid |
$92.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$148.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.28
|
| Rate for Payer: Molina Healthcare Passport |
$92.43
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.62
|
| Rate for Payer: UHCCP Medicaid |
$93.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$148.17
|
|
