|
BIOPSY LYMPH NODE
|
Facility
|
IP
|
$6,130.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
76101593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,839.00 |
| Max. Negotiated Rate |
$5,884.80 |
| Rate for Payer: Aetna Commercial |
$4,720.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,781.40
|
| Rate for Payer: Cash Price |
$3,065.00
|
| Rate for Payer: Cigna Commercial |
$5,087.90
|
| Rate for Payer: First Health Commercial |
$5,823.50
|
| Rate for Payer: Humana Commercial |
$5,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,026.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,523.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,839.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,394.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,597.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,333.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,229.70
|
| Rate for Payer: PHCS Commercial |
$5,884.80
|
| Rate for Payer: United Healthcare All Payer |
$5,394.40
|
|
|
BIOPSY LYMPH NODE
|
Facility
|
OP
|
$6,130.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
76101593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,108.11 |
| Max. Negotiated Rate |
$5,884.80 |
| Rate for Payer: Aetna Commercial |
$4,720.10
|
| Rate for Payer: Anthem Medicaid |
$2,108.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,781.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,065.00
|
| Rate for Payer: Cash Price |
$3,065.00
|
| Rate for Payer: Cigna Commercial |
$5,087.90
|
| Rate for Payer: First Health Commercial |
$5,823.50
|
| Rate for Payer: Humana Commercial |
$5,210.50
|
| Rate for Payer: Humana KY Medicaid |
$2,108.11
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,129.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,026.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,523.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,150.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,394.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,597.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,333.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,229.70
|
| Rate for Payer: PHCS Commercial |
$5,884.80
|
| Rate for Payer: United Healthcare All Payer |
$5,394.40
|
|
|
BIOPSY LYMPH NODE
|
Professional
|
Both
|
$6,188.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
76101597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.58 |
| Max. Negotiated Rate |
$3,712.80 |
| Rate for Payer: Aetna Commercial |
$609.78
|
| Rate for Payer: Ambetter Exchange |
$420.54
|
| Rate for Payer: Anthem Medicaid |
$210.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$420.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$504.65
|
| Rate for Payer: Cash Price |
$3,094.00
|
| Rate for Payer: Cash Price |
$3,094.00
|
| Rate for Payer: Cigna Commercial |
$566.09
|
| Rate for Payer: Healthspan PPO |
$487.58
|
| Rate for Payer: Humana Medicaid |
$210.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$420.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.79
|
| Rate for Payer: Molina Healthcare Passport |
$210.58
|
| Rate for Payer: Multiplan PHCS |
$3,712.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.70
|
| Rate for Payer: UHCCP Medicaid |
$2,165.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$420.54
|
|
|
BIOPSY LYMPH NODE
|
Professional
|
Both
|
$6,130.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
76101593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.68 |
| Max. Negotiated Rate |
$3,678.00 |
| Rate for Payer: Aetna Commercial |
$363.27
|
| Rate for Payer: Ambetter Exchange |
$242.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.68
|
| Rate for Payer: Anthem Medicaid |
$133.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$242.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.60
|
| Rate for Payer: Cash Price |
$3,065.00
|
| Rate for Payer: Cash Price |
$3,065.00
|
| Rate for Payer: Cigna Commercial |
$341.47
|
| Rate for Payer: Healthspan PPO |
$361.51
|
| Rate for Payer: Humana Medicaid |
$133.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$242.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.88
|
| Rate for Payer: Molina Healthcare Passport |
$133.22
|
| Rate for Payer: Multiplan PHCS |
$3,678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$314.82
|
| Rate for Payer: UHCCP Medicaid |
$138.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.17
|
|
|
BIOPSY LYMPH NODE(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
761P1597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.58 |
| Max. Negotiated Rate |
$609.78 |
| Rate for Payer: Aetna Commercial |
$609.78
|
| Rate for Payer: Ambetter Exchange |
$420.54
|
| Rate for Payer: Anthem Medicaid |
$210.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$420.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$504.65
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$566.09
|
| Rate for Payer: Healthspan PPO |
$487.58
|
| Rate for Payer: Humana Medicaid |
$210.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$420.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.79
|
| Rate for Payer: Molina Healthcare Passport |
$210.58
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.70
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$420.54
|
|
|
BIOPSY LYMPH NODE(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
761P1593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.68 |
| Max. Negotiated Rate |
$363.27 |
| Rate for Payer: Aetna Commercial |
$363.27
|
| Rate for Payer: Ambetter Exchange |
$242.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.68
|
| Rate for Payer: Anthem Medicaid |
$133.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$242.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.60
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$341.47
|
| Rate for Payer: Healthspan PPO |
$361.51
|
| Rate for Payer: Humana Medicaid |
$133.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$320.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$242.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.88
|
| Rate for Payer: Molina Healthcare Passport |
$133.22
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$314.82
|
| Rate for Payer: UHCCP Medicaid |
$138.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.17
|
|
|
BIOPSY LYMPH NODE(T
|
Facility
|
OP
|
$5,680.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
761T1593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,953.35 |
| Max. Negotiated Rate |
$5,452.80 |
| Rate for Payer: Aetna Commercial |
$4,373.60
|
| Rate for Payer: Anthem Medicaid |
$1,953.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,430.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cigna Commercial |
$4,714.40
|
| Rate for Payer: First Health Commercial |
$5,396.00
|
| Rate for Payer: Humana Commercial |
$4,828.00
|
| Rate for Payer: Humana KY Medicaid |
$1,953.35
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,973.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,657.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,191.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,992.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,998.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,941.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,919.20
|
| Rate for Payer: PHCS Commercial |
$5,452.80
|
| Rate for Payer: United Healthcare All Payer |
$4,998.40
|
|
|
BIOPSY LYMPH NODE(T
|
Facility
|
IP
|
$5,538.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
761T1597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,661.40 |
| Max. Negotiated Rate |
$5,316.48 |
| Rate for Payer: Aetna Commercial |
$4,264.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.64
|
| Rate for Payer: Cash Price |
$2,769.00
|
| Rate for Payer: Cigna Commercial |
$4,596.54
|
| Rate for Payer: First Health Commercial |
$5,261.10
|
| Rate for Payer: Humana Commercial |
$4,707.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.22
|
| Rate for Payer: PHCS Commercial |
$5,316.48
|
| Rate for Payer: United Healthcare All Payer |
$4,873.44
|
|
|
BIOPSY LYMPH NODE(T
|
Facility
|
OP
|
$5,538.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
761T1597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,904.52 |
| Max. Negotiated Rate |
$5,316.48 |
| Rate for Payer: Aetna Commercial |
$4,264.26
|
| Rate for Payer: Anthem Medicaid |
$1,904.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,769.00
|
| Rate for Payer: Cash Price |
$2,769.00
|
| Rate for Payer: Cigna Commercial |
$4,596.54
|
| Rate for Payer: First Health Commercial |
$5,261.10
|
| Rate for Payer: Humana Commercial |
$4,707.30
|
| Rate for Payer: Humana KY Medicaid |
$1,904.52
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,541.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,087.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,942.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.22
|
| Rate for Payer: PHCS Commercial |
$5,316.48
|
| Rate for Payer: United Healthcare All Payer |
$4,873.44
|
|
|
BIOPSY LYMPH NODE(T
|
Facility
|
IP
|
$5,680.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
761T1593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,704.00 |
| Max. Negotiated Rate |
$5,452.80 |
| Rate for Payer: Aetna Commercial |
$4,373.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,430.40
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cigna Commercial |
$4,714.40
|
| Rate for Payer: First Health Commercial |
$5,396.00
|
| Rate for Payer: Humana Commercial |
$4,828.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,657.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,191.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,998.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,941.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,919.20
|
| Rate for Payer: PHCS Commercial |
$5,452.80
|
| Rate for Payer: United Healthcare All Payer |
$4,998.40
|
|
|
BIOPSY MUSCLE
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$833.27 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem Medicaid |
$833.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| 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 |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Humana KY Medicaid |
$833.27
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$841.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,108.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,671.87
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
BIOPSY MUSCLE
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.90 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,108.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,671.87
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
BIOPSY MUSCLE
|
Professional
|
Both
|
$2,423.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$1,453.80 |
| Rate for Payer: Aetna Commercial |
$94.78
|
| Rate for Payer: Ambetter Exchange |
$53.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.91
|
| Rate for Payer: Anthem Medicaid |
$58.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.36
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$101.30
|
| Rate for Payer: Healthspan PPO |
$323.89
|
| Rate for Payer: Humana Medicaid |
$58.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.36
|
| Rate for Payer: Molina Healthcare Passport |
$58.20
|
| Rate for Payer: Multiplan PHCS |
$1,453.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.72
|
| Rate for Payer: UHCCP Medicaid |
$46.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.63
|
|
|
BIOPSY MUSCLE DEEP
|
Facility
|
IP
|
$6,247.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,874.10 |
| Max. Negotiated Rate |
$5,997.12 |
| Rate for Payer: Aetna Commercial |
$4,810.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,872.66
|
| Rate for Payer: Cash Price |
$3,123.50
|
| Rate for Payer: Cigna Commercial |
$5,185.01
|
| Rate for Payer: First Health Commercial |
$5,934.65
|
| Rate for Payer: Humana Commercial |
$5,309.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,122.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,610.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,874.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,497.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,997.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,434.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,310.43
|
| Rate for Payer: PHCS Commercial |
$5,997.12
|
| Rate for Payer: United Healthcare All Payer |
$5,497.36
|
|
|
BIOPSY MUSCLE DEEP
|
Facility
|
OP
|
$6,247.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,148.34 |
| Max. Negotiated Rate |
$5,997.12 |
| Rate for Payer: Aetna Commercial |
$4,810.19
|
| Rate for Payer: Anthem Medicaid |
$2,148.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,872.66
|
| 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 |
$3,123.50
|
| Rate for Payer: Cash Price |
$3,123.50
|
| Rate for Payer: Cigna Commercial |
$5,185.01
|
| Rate for Payer: First Health Commercial |
$5,934.65
|
| Rate for Payer: Humana Commercial |
$5,309.95
|
| Rate for Payer: Humana KY Medicaid |
$2,148.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,170.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,122.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,610.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,191.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,497.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,997.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,434.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,310.43
|
| Rate for Payer: PHCS Commercial |
$5,997.12
|
| Rate for Payer: United Healthcare All Payer |
$5,497.36
|
|
|
BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$6,247.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$3,748.20 |
| Rate for Payer: Aetna Commercial |
$221.23
|
| Rate for Payer: Ambetter Exchange |
$147.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.04
|
| Rate for Payer: Anthem Medicaid |
$127.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.64
|
| Rate for Payer: Cash Price |
$3,123.50
|
| Rate for Payer: Cash Price |
$3,123.50
|
| Rate for Payer: Cigna Commercial |
$234.90
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$127.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.95
|
| Rate for Payer: Molina Healthcare Passport |
$127.40
|
| Rate for Payer: Multiplan PHCS |
$3,748.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$191.36
|
| Rate for Payer: UHCCP Medicaid |
$86.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.20
|
|
|
BIOPSY, MUSCLE; DEEP
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 20205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
BIOPSY MUSCLE DEEP(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761P0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$329.83 |
| Rate for Payer: Aetna Commercial |
$221.23
|
| Rate for Payer: Ambetter Exchange |
$147.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.04
|
| Rate for Payer: Anthem Medicaid |
$127.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.64
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$234.90
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$127.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.95
|
| Rate for Payer: Molina Healthcare Passport |
$127.40
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$191.36
|
| Rate for Payer: UHCCP Medicaid |
$86.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.20
|
|
|
BIOPSY MUSCLE DEEP(T
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761T0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,024.54 |
| Max. Negotiated Rate |
$5,651.52 |
| Rate for Payer: Aetna Commercial |
$4,532.99
|
| Rate for Payer: Anthem Medicaid |
$2,024.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,591.86
|
| 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 |
$2,943.50
|
| Rate for Payer: Cash Price |
$2,943.50
|
| Rate for Payer: Cigna Commercial |
$4,886.21
|
| Rate for Payer: First Health Commercial |
$5,592.65
|
| Rate for Payer: Humana Commercial |
$5,003.95
|
| Rate for Payer: Humana KY Medicaid |
$2,024.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,045.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,827.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,344.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,065.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,180.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,415.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,709.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,121.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,062.03
|
| Rate for Payer: PHCS Commercial |
$5,651.52
|
| Rate for Payer: United Healthcare All Payer |
$5,180.56
|
|
|
BIOPSY MUSCLE DEEP(T
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS 20205
|
| Hospital Charge Code |
761T0326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,766.10 |
| Max. Negotiated Rate |
$5,651.52 |
| Rate for Payer: Aetna Commercial |
$4,532.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,591.86
|
| Rate for Payer: Cash Price |
$2,943.50
|
| Rate for Payer: Cigna Commercial |
$4,886.21
|
| Rate for Payer: First Health Commercial |
$5,592.65
|
| Rate for Payer: Humana Commercial |
$5,003.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,827.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,344.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,766.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,180.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,415.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,709.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,121.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,062.03
|
| Rate for Payer: PHCS Commercial |
$5,651.52
|
| Rate for Payer: United Healthcare All Payer |
$5,180.56
|
|
|
BIOPSY MUSCLE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761P0327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$323.89 |
| Rate for Payer: Aetna Commercial |
$94.78
|
| Rate for Payer: Ambetter Exchange |
$53.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.91
|
| Rate for Payer: Anthem Medicaid |
$58.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.36
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$101.30
|
| Rate for Payer: Healthspan PPO |
$323.89
|
| Rate for Payer: Humana Medicaid |
$58.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.36
|
| Rate for Payer: Molina Healthcare Passport |
$58.20
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.72
|
| Rate for Payer: UHCCP Medicaid |
$46.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.63
|
|
|
BIOPSY MUSCLE(T
|
Facility
|
IP
|
$2,023.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761T0327
|
|
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 MUSCLE(T
|
Facility
|
OP
|
$2,023.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
761T0327
|
|
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 NASOPHARYNX
|
Facility
|
OP
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,664.93 |
| Max. Negotiated Rate |
$4,647.68 |
| Rate for Payer: Aetna Commercial |
$3,727.82
|
| Rate for Payer: Anthem Medicaid |
$1,664.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$4,018.30
|
| Rate for Payer: First Health Commercial |
$4,599.26
|
| Rate for Payer: Humana Commercial |
$4,115.13
|
| Rate for Payer: Humana KY Medicaid |
$1,664.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,969.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,698.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,873.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,211.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,340.52
|
| Rate for Payer: PHCS Commercial |
$4,647.68
|
| Rate for Payer: United Healthcare All Payer |
$4,260.37
|
|
|
BIOPSY NASOPHARYNX
|
Facility
|
IP
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,452.40 |
| Max. Negotiated Rate |
$4,647.68 |
| Rate for Payer: Aetna Commercial |
$3,727.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.24
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$4,018.30
|
| Rate for Payer: First Health Commercial |
$4,599.26
|
| Rate for Payer: Humana Commercial |
$4,115.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,969.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,873.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,211.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,340.52
|
| Rate for Payer: PHCS Commercial |
$4,647.68
|
| Rate for Payer: United Healthcare All Payer |
$4,260.37
|
|
