|
BIOPSY NASOPHARYNX
|
Professional
|
Both
|
$4,841.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
76101701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$2,904.80 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Ambetter Exchange |
$132.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.57
|
| Rate for Payer: Anthem Medicaid |
$86.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.77
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cash Price |
$2,420.66
|
| Rate for Payer: Cigna Commercial |
$197.77
|
| Rate for Payer: Healthspan PPO |
$260.37
|
| Rate for Payer: Humana Medicaid |
$86.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.06
|
| Rate for Payer: Molina Healthcare Passport |
$86.33
|
| Rate for Payer: Multiplan PHCS |
$2,904.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.00
|
| Rate for Payer: UHCCP Medicaid |
$97.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.31
|
|
|
BIOPSY NASOPHARYNX(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761P1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$260.37 |
| Rate for Payer: Aetna Commercial |
$193.14
|
| Rate for Payer: Ambetter Exchange |
$132.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.57
|
| Rate for Payer: Anthem Medicaid |
$86.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.77
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$197.77
|
| Rate for Payer: Healthspan PPO |
$260.37
|
| Rate for Payer: Humana Medicaid |
$86.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.06
|
| Rate for Payer: Molina Healthcare Passport |
$86.33
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.00
|
| Rate for Payer: UHCCP Medicaid |
$97.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.31
|
|
|
BIOPSY NASOPHARYNX(T
|
Facility
|
OP
|
$4,441.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761T1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,527.37 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$3,419.82
|
| Rate for Payer: Anthem Medicaid |
$1,527.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,464.24
|
| 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 |
$2,220.66
|
| Rate for Payer: Cash Price |
$2,220.66
|
| Rate for Payer: Cigna Commercial |
$3,686.30
|
| Rate for Payer: First Health Commercial |
$4,219.26
|
| Rate for Payer: Humana Commercial |
$3,775.13
|
| Rate for Payer: Humana KY Medicaid |
$1,527.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,542.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,641.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,277.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,558.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,908.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,331.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,553.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,863.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,064.52
|
| Rate for Payer: PHCS Commercial |
$4,263.68
|
| Rate for Payer: United Healthcare All Payer |
$3,908.37
|
|
|
BIOPSY NASOPHARYNX(T
|
Facility
|
IP
|
$4,441.33
|
|
|
Service Code
|
HCPCS 42806
|
| Hospital Charge Code |
761T1701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,332.40 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$3,419.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,464.24
|
| Rate for Payer: Cash Price |
$2,220.66
|
| Rate for Payer: Cigna Commercial |
$3,686.30
|
| Rate for Payer: First Health Commercial |
$4,219.26
|
| Rate for Payer: Humana Commercial |
$3,775.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,641.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,277.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,908.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,331.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,553.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,863.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,064.52
|
| Rate for Payer: PHCS Commercial |
$4,263.68
|
| Rate for Payer: United Healthcare All Payer |
$3,908.37
|
|
|
BIOPSY NERVE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BIOPSY NERVE
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$314.38 |
| Rate for Payer: Aetna Commercial |
$314.38
|
| Rate for Payer: Ambetter Exchange |
$188.32
|
| Rate for Payer: Anthem Medicaid |
$161.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.98
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$285.75
|
| Rate for Payer: Healthspan PPO |
$245.46
|
| Rate for Payer: Humana Medicaid |
$161.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.87
|
| Rate for Payer: Molina Healthcare Passport |
$161.64
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.82
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.32
|
|
|
BIOPSY NERVE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
76102371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BIOPSY NERVE(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64795
|
| Hospital Charge Code |
761P2371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$314.38 |
| Rate for Payer: Aetna Commercial |
$314.38
|
| Rate for Payer: Ambetter Exchange |
$188.32
|
| Rate for Payer: Anthem Medicaid |
$161.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.98
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$285.75
|
| Rate for Payer: Healthspan PPO |
$245.46
|
| Rate for Payer: Humana Medicaid |
$161.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.87
|
| Rate for Payer: Molina Healthcare Passport |
$161.64
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.82
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.32
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Ambetter Exchange |
$65.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.39
|
| Rate for Payer: Anthem Medicaid |
$57.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.25
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cigna Commercial |
$190.52
|
| Rate for Payer: Healthspan PPO |
$156.31
|
| Rate for Payer: Humana Medicaid |
$57.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.74
|
| Rate for Payer: Molina Healthcare Passport |
$57.59
|
| Rate for Payer: Multiplan PHCS |
$1,627.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.77
|
| Rate for Payer: UHCCP Medicaid |
$42.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.21
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
IP
|
$2,712.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$2,603.52 |
| Rate for Payer: Aetna Commercial |
$2,088.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,115.36
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cigna Commercial |
$2,250.96
|
| Rate for Payer: First Health Commercial |
$2,576.40
|
| Rate for Payer: Humana Commercial |
$2,305.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,223.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,001.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,386.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,034.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,359.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,871.28
|
| Rate for Payer: PHCS Commercial |
$2,603.52
|
| Rate for Payer: United Healthcare All Payer |
$2,386.56
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761T0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$738.60 |
| Max. Negotiated Rate |
$2,363.52 |
| Rate for Payer: Aetna Commercial |
$1,895.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,920.36
|
| Rate for Payer: Cash Price |
$1,231.00
|
| Rate for Payer: Cigna Commercial |
$2,043.46
|
| Rate for Payer: First Health Commercial |
$2,338.90
|
| Rate for Payer: Humana Commercial |
$2,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,166.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,846.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,141.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.78
|
| Rate for Payer: PHCS Commercial |
$2,363.52
|
| Rate for Payer: United Healthcare All Payer |
$2,166.56
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761T0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.68 |
| Max. Negotiated Rate |
$2,363.52 |
| Rate for Payer: Aetna Commercial |
$1,895.74
|
| Rate for Payer: Anthem Medicaid |
$846.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,920.36
|
| 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 |
$1,231.00
|
| Rate for Payer: Cash Price |
$1,231.00
|
| Rate for Payer: Cigna Commercial |
$2,043.46
|
| Rate for Payer: First Health Commercial |
$2,338.90
|
| Rate for Payer: Humana Commercial |
$2,092.70
|
| Rate for Payer: Humana KY Medicaid |
$846.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$855.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$863.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,166.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,846.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,141.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.78
|
| Rate for Payer: PHCS Commercial |
$2,363.52
|
| Rate for Payer: United Healthcare All Payer |
$2,166.56
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
76100284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$932.66 |
| Max. Negotiated Rate |
$2,603.52 |
| Rate for Payer: Aetna Commercial |
$2,088.24
|
| Rate for Payer: Anthem Medicaid |
$932.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,115.36
|
| 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 |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cigna Commercial |
$2,250.96
|
| Rate for Payer: First Health Commercial |
$2,576.40
|
| Rate for Payer: Humana Commercial |
$2,305.20
|
| Rate for Payer: Humana KY Medicaid |
$932.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$942.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,223.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,001.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$951.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,386.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,034.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,359.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,871.28
|
| Rate for Payer: PHCS Commercial |
$2,603.52
|
| Rate for Payer: United Healthcare All Payer |
$2,386.56
|
|
|
BIOPSY OF BREAST; PERCUTANEOUS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
761P0284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$190.52 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Ambetter Exchange |
$65.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.39
|
| Rate for Payer: Anthem Medicaid |
$57.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.25
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$190.52
|
| Rate for Payer: Healthspan PPO |
$156.31
|
| Rate for Payer: Humana Medicaid |
$57.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.74
|
| Rate for Payer: Molina Healthcare Passport |
$57.59
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.77
|
| Rate for Payer: UHCCP Medicaid |
$42.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.21
|
|
|
BIOPSY OF CERVIX
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.30 |
| Max. Negotiated Rate |
$2,420.16 |
| Rate for Payer: Aetna Commercial |
$1,941.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,966.38
|
| Rate for Payer: Cash Price |
$1,260.50
|
| Rate for Payer: Cigna Commercial |
$2,092.43
|
| Rate for Payer: First Health Commercial |
$2,394.95
|
| Rate for Payer: Humana Commercial |
$2,142.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,067.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,860.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,218.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,193.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.49
|
| Rate for Payer: PHCS Commercial |
$2,420.16
|
| Rate for Payer: United Healthcare All Payer |
$2,218.48
|
|
|
BIOPSY OF CERVIX
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$804.55 |
| Max. Negotiated Rate |
$2,420.16 |
| Rate for Payer: Aetna Commercial |
$1,941.17
|
| Rate for Payer: Anthem Medicaid |
$866.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,966.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$1,260.50
|
| Rate for Payer: Cash Price |
$1,260.50
|
| Rate for Payer: Cigna Commercial |
$2,092.43
|
| Rate for Payer: First Health Commercial |
$2,394.95
|
| Rate for Payer: Humana Commercial |
$2,142.85
|
| Rate for Payer: Humana KY Medicaid |
$866.97
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$875.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,067.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,860.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$884.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,218.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,193.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.49
|
| Rate for Payer: PHCS Commercial |
$2,420.16
|
| Rate for Payer: United Healthcare All Payer |
$2,218.48
|
|
|
BIOPSY OF CERVIX
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
76102198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$1,512.60 |
| Rate for Payer: Aetna Commercial |
$112.60
|
| Rate for Payer: Ambetter Exchange |
$71.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.67
|
| Rate for Payer: Anthem Medicaid |
$46.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.37
|
| Rate for Payer: Cash Price |
$1,260.50
|
| Rate for Payer: Cash Price |
$1,260.50
|
| Rate for Payer: Cigna Commercial |
$208.20
|
| Rate for Payer: Healthspan PPO |
$186.25
|
| Rate for Payer: Humana Medicaid |
$46.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.60
|
| Rate for Payer: Molina Healthcare Passport |
$46.67
|
| Rate for Payer: Multiplan PHCS |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.48
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.14
|
|
|
BIOPSY OF CERVIX(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761P2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$112.60
|
| Rate for Payer: Ambetter Exchange |
$71.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.67
|
| Rate for Payer: Anthem Medicaid |
$46.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.37
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$208.20
|
| Rate for Payer: Healthspan PPO |
$186.25
|
| Rate for Payer: Humana Medicaid |
$46.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.60
|
| Rate for Payer: Molina Healthcare Passport |
$46.67
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.48
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.14
|
|
|
BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,126.37
|
|
|
Service Code
|
CPT 57500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.55 |
| Max. Negotiated Rate |
$1,126.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
|
|
BIOPSY OF CERVIX(T
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761T2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$2,031.36 |
| Rate for Payer: Aetna Commercial |
$1,629.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,650.48
|
| Rate for Payer: Cash Price |
$1,058.00
|
| Rate for Payer: Cigna Commercial |
$1,756.28
|
| Rate for Payer: First Health Commercial |
$2,010.20
|
| Rate for Payer: Humana Commercial |
$1,798.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,561.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.04
|
| Rate for Payer: PHCS Commercial |
$2,031.36
|
| Rate for Payer: United Healthcare All Payer |
$1,862.08
|
|
|
BIOPSY OF CERVIX(T
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
761T2198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$727.69 |
| Max. Negotiated Rate |
$2,031.36 |
| Rate for Payer: Aetna Commercial |
$1,629.32
|
| Rate for Payer: Anthem Medicaid |
$727.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,650.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$1,058.00
|
| Rate for Payer: Cash Price |
$1,058.00
|
| Rate for Payer: Cigna Commercial |
$1,756.28
|
| Rate for Payer: First Health Commercial |
$2,010.20
|
| Rate for Payer: Humana Commercial |
$1,798.60
|
| Rate for Payer: Humana KY Medicaid |
$727.69
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$735.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,561.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,840.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.04
|
| Rate for Payer: PHCS Commercial |
$2,031.36
|
| Rate for Payer: United Healthcare All Payer |
$1,862.08
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,001.28 |
| Rate for Payer: Aetna Commercial |
$803.11
|
| Rate for Payer: Anthem Medicaid |
$358.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$813.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cigna Commercial |
$865.69
|
| Rate for Payer: First Health Commercial |
$990.85
|
| Rate for Payer: Humana Commercial |
$886.55
|
| Rate for Payer: Humana KY Medicaid |
$358.69
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$855.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$917.84
|
| Rate for Payer: Ohio Health Group HMO |
$782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$719.67
|
| Rate for Payer: PHCS Commercial |
$1,001.28
|
| Rate for Payer: United Healthcare All Payer |
$917.84
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$625.80 |
| Rate for Payer: Aetna Commercial |
$171.58
|
| Rate for Payer: Ambetter Exchange |
$103.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.83
|
| Rate for Payer: Anthem Medicaid |
$110.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.12
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cigna Commercial |
$216.30
|
| Rate for Payer: Healthspan PPO |
$209.14
|
| Rate for Payer: Humana Medicaid |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.71
|
| Rate for Payer: Molina Healthcare Passport |
$110.50
|
| Rate for Payer: Multiplan PHCS |
$625.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.46
|
| Rate for Payer: UHCCP Medicaid |
$79.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.43
|
|
|
BIOPSY OF CERVIX W/SCOPE
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
76102195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$1,001.28 |
| Rate for Payer: Aetna Commercial |
$803.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$813.54
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cigna Commercial |
$865.69
|
| Rate for Payer: First Health Commercial |
$990.85
|
| Rate for Payer: Humana Commercial |
$886.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$855.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$917.84
|
| Rate for Payer: Ohio Health Group HMO |
$782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$719.67
|
| Rate for Payer: PHCS Commercial |
$1,001.28
|
| Rate for Payer: United Healthcare All Payer |
$917.84
|
|
|
BIOPSY OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761P2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$171.58
|
| Rate for Payer: Ambetter Exchange |
$103.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.83
|
| Rate for Payer: Anthem Medicaid |
$110.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.12
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$216.30
|
| Rate for Payer: Healthspan PPO |
$209.14
|
| Rate for Payer: Humana Medicaid |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.71
|
| Rate for Payer: Molina Healthcare Passport |
$110.50
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.46
|
| Rate for Payer: UHCCP Medicaid |
$79.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.43
|
|
