|
BIOPSY OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761T2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.08 |
| Max. Negotiated Rate |
$703.68 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Anthem Medicaid |
$252.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$571.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$366.50
|
| Rate for Payer: Cash Price |
$366.50
|
| Rate for Payer: Cigna Commercial |
$608.39
|
| Rate for Payer: First Health Commercial |
$696.35
|
| Rate for Payer: Humana Commercial |
$623.05
|
| Rate for Payer: Humana KY Medicaid |
$252.08
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$254.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$601.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$540.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$645.04
|
| Rate for Payer: Ohio Health Group HMO |
$549.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$586.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.77
|
| Rate for Payer: PHCS Commercial |
$703.68
|
| Rate for Payer: United Healthcare All Payer |
$645.04
|
|
|
BIOPSY OF CERVIX W/SCOPE(T
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
HCPCS 57455
|
| Hospital Charge Code |
761T2195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.90 |
| Max. Negotiated Rate |
$703.68 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$571.74
|
| Rate for Payer: Cash Price |
$366.50
|
| Rate for Payer: Cigna Commercial |
$608.39
|
| Rate for Payer: First Health Commercial |
$696.35
|
| Rate for Payer: Humana Commercial |
$623.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$601.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$540.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$645.04
|
| Rate for Payer: Ohio Health Group HMO |
$549.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$586.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.77
|
| Rate for Payer: PHCS Commercial |
$703.68
|
| Rate for Payer: United Healthcare All Payer |
$645.04
|
|
|
BIOPSY OF LIP
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
BIOPSY OF LIP
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
BIOPSY OF LIP
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
76101625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$448.80 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Ambetter Exchange |
$65.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.27
|
| Rate for Payer: Anthem Medicaid |
$57.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.38
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$168.57
|
| Rate for Payer: Healthspan PPO |
$151.32
|
| Rate for Payer: Humana Medicaid |
$57.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.50
|
| Rate for Payer: Molina Healthcare Passport |
$57.35
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.92
|
| Rate for Payer: UHCCP Medicaid |
$66.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.32
|
|
|
BIOPSY OF LIP(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761P1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$168.57 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Ambetter Exchange |
$65.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.27
|
| Rate for Payer: Anthem Medicaid |
$57.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.38
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$168.57
|
| Rate for Payer: Healthspan PPO |
$151.32
|
| Rate for Payer: Humana Medicaid |
$57.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.50
|
| Rate for Payer: Molina Healthcare Passport |
$57.35
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.92
|
| Rate for Payer: UHCCP Medicaid |
$66.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.32
|
|
|
BIOPSY OF LIP(T
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761T1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.05 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem Medicaid |
$197.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Humana KY Medicaid |
$197.05
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$199.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
BIOPSY OF LIP(T
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
761T1625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
BIOPSY OF NAIL UNIT
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.29 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
BIOPSY OF NAIL UNIT
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
BIOPSY OF NAIL UNIT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
76100100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$925.20 |
| Rate for Payer: Aetna Commercial |
$126.27
|
| Rate for Payer: Ambetter Exchange |
$57.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.44
|
| Rate for Payer: Anthem Medicaid |
$67.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.80
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$170.80
|
| Rate for Payer: Healthspan PPO |
$148.47
|
| Rate for Payer: Humana Medicaid |
$67.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.27
|
| Rate for Payer: Molina Healthcare Passport |
$67.91
|
| Rate for Payer: Multiplan PHCS |
$925.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.53
|
| Rate for Payer: UHCCP Medicaid |
$52.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.33
|
|
|
BIOPSY OF NAIL UNIT (P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761P0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$170.80 |
| Rate for Payer: Aetna Commercial |
$126.27
|
| Rate for Payer: Ambetter Exchange |
$57.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.44
|
| Rate for Payer: Anthem Medicaid |
$67.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.80
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$170.80
|
| Rate for Payer: Healthspan PPO |
$148.47
|
| Rate for Payer: Humana Medicaid |
$67.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.27
|
| Rate for Payer: Molina Healthcare Passport |
$67.91
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.53
|
| Rate for Payer: UHCCP Medicaid |
$52.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.33
|
|
|
BIOPSY OF NAIL UNIT (T
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761T0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.10 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.13
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
|
BIOPSY OF NAIL UNIT (T
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 11755
|
| Hospital Charge Code |
761T0100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.16 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem Medicaid |
$439.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Humana KY Medicaid |
$439.16
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$443.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.13
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
|
BIOPSY OF PALATE
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.09 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Aetna Commercial |
$1,755.60
|
| Rate for Payer: Anthem Medicaid |
$784.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,778.40
|
| 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 |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,892.40
|
| Rate for Payer: First Health Commercial |
$2,166.00
|
| Rate for Payer: Humana Commercial |
$1,938.00
|
| Rate for Payer: Humana KY Medicaid |
$784.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$792.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,869.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,682.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$799.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,006.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,983.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.20
|
| Rate for Payer: PHCS Commercial |
$2,188.80
|
| Rate for Payer: United Healthcare All Payer |
$2,006.40
|
|
|
BIOPSY OF PALATE
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$155.62
|
| Rate for Payer: Ambetter Exchange |
$103.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.99
|
| Rate for Payer: Anthem Medicaid |
$60.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.91
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Healthspan PPO |
$172.76
|
| Rate for Payer: Humana Medicaid |
$60.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.31
|
| Rate for Payer: Molina Healthcare Passport |
$60.11
|
| Rate for Payer: Multiplan PHCS |
$1,368.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.24
|
| Rate for Payer: UHCCP Medicaid |
$69.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.26
|
|
|
BIOPSY OF PALATE
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
76101668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.00 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Aetna Commercial |
$1,755.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,892.40
|
| Rate for Payer: First Health Commercial |
$2,166.00
|
| Rate for Payer: Humana Commercial |
$1,938.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,869.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,682.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$684.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,006.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,983.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.20
|
| Rate for Payer: PHCS Commercial |
$2,188.80
|
| Rate for Payer: United Healthcare All Payer |
$2,006.40
|
|
|
BIOPSY OF PALATE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761P1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$155.62
|
| Rate for Payer: Ambetter Exchange |
$103.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.99
|
| Rate for Payer: Anthem Medicaid |
$60.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.91
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Healthspan PPO |
$172.76
|
| Rate for Payer: Humana Medicaid |
$60.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.31
|
| Rate for Payer: Molina Healthcare Passport |
$60.11
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.24
|
| Rate for Payer: UHCCP Medicaid |
$69.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.26
|
|
|
BIOPSY OF PALATE(T
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761T1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.92 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| 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 |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.20
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
BIOPSY OF PALATE(T
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
761T1668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.20
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
BIOPSY OF PENIS
|
Professional
|
Both
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$2,213.25 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Ambetter Exchange |
$114.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.74
|
| Rate for Payer: Anthem Medicaid |
$74.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.33
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$268.73
|
| Rate for Payer: Healthspan PPO |
$279.98
|
| Rate for Payer: Humana Medicaid |
$74.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.39
|
| Rate for Payer: Molina Healthcare Passport |
$74.89
|
| Rate for Payer: Multiplan PHCS |
$2,213.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.77
|
| Rate for Payer: UHCCP Medicaid |
$63.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.44
|
|
|
BIOPSY OF PENIS
|
Facility
|
OP
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,268.56 |
| Max. Negotiated Rate |
$3,541.20 |
| Rate for Payer: Aetna Commercial |
$2,840.34
|
| Rate for Payer: Anthem Medicaid |
$1,268.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.22
|
| 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 |
$1,844.38
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$3,061.66
|
| Rate for Payer: First Health Commercial |
$3,504.31
|
| Rate for Payer: Humana Commercial |
$3,135.44
|
| Rate for Payer: Humana KY Medicaid |
$1,268.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,951.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,209.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,545.24
|
| Rate for Payer: PHCS Commercial |
$3,541.20
|
| Rate for Payer: United Healthcare All Payer |
$3,246.10
|
|
|
BIOPSY OF PENIS
|
Facility
|
IP
|
$3,688.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
76102129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,106.62 |
| Max. Negotiated Rate |
$3,541.20 |
| Rate for Payer: Aetna Commercial |
$2,840.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,877.22
|
| Rate for Payer: Cash Price |
$1,844.38
|
| Rate for Payer: Cigna Commercial |
$3,061.66
|
| Rate for Payer: First Health Commercial |
$3,504.31
|
| Rate for Payer: Humana Commercial |
$3,135.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,246.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,951.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,209.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,545.24
|
| Rate for Payer: PHCS Commercial |
$3,541.20
|
| Rate for Payer: United Healthcare All Payer |
$3,246.10
|
|
|
BIOPSY OF PENIS (P
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761P2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$279.98 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Ambetter Exchange |
$114.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.74
|
| Rate for Payer: Anthem Medicaid |
$74.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.33
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$268.73
|
| Rate for Payer: Healthspan PPO |
$279.98
|
| Rate for Payer: Humana Medicaid |
$74.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.39
|
| Rate for Payer: Molina Healthcare Passport |
$74.89
|
| Rate for Payer: Multiplan PHCS |
$237.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.77
|
| Rate for Payer: UHCCP Medicaid |
$63.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.44
|
|
|
BIOPSY OF PENIS; (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 54100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
