|
BIOPSY OF PENIS (T
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761T2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,132.72 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| 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 |
$1,646.88
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
BIOPSY OF PENIS (T
|
Facility
|
IP
|
$3,293.75
|
|
|
Service Code
|
HCPCS 54100
|
| Hospital Charge Code |
761T2129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
BIOPSY OF PROSTATE
|
Professional
|
Both
|
$3,432.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$2,059.20 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Ambetter Exchange |
$122.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.41
|
| Rate for Payer: Anthem Medicaid |
$89.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.51
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$368.18
|
| Rate for Payer: Healthspan PPO |
$351.83
|
| Rate for Payer: Humana Medicaid |
$89.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.75
|
| Rate for Payer: Molina Healthcare Passport |
$89.95
|
| Rate for Payer: Multiplan PHCS |
$2,059.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.72
|
| Rate for Payer: UHCCP Medicaid |
$68.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.09
|
|
|
BIOPSY OF PROSTATE
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,029.60 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,985.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.08
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
BIOPSY OF PROSTATE
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
76102152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,180.26 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,985.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.08
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
BIOPSY OF PROSTATE(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761P2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$222.08
|
| Rate for Payer: Ambetter Exchange |
$122.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.41
|
| Rate for Payer: Anthem Medicaid |
$89.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.51
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$368.18
|
| Rate for Payer: Healthspan PPO |
$351.83
|
| Rate for Payer: Humana Medicaid |
$89.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.75
|
| Rate for Payer: Molina Healthcare Passport |
$89.95
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.72
|
| Rate for Payer: UHCCP Medicaid |
$68.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.09
|
|
|
BIOPSY OF PROSTATE(T
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761T2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$845.10 |
| Max. Negotiated Rate |
$2,704.32 |
| Rate for Payer: Aetna Commercial |
$2,169.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna Commercial |
$2,338.11
|
| Rate for Payer: First Health Commercial |
$2,676.15
|
| Rate for Payer: Humana Commercial |
$2,394.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,943.73
|
| Rate for Payer: PHCS Commercial |
$2,704.32
|
| Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
|
BIOPSY OF PROSTATE(T
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
HCPCS 55700
|
| Hospital Charge Code |
761T2152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$968.77 |
| Max. Negotiated Rate |
$2,704.32 |
| Rate for Payer: Aetna Commercial |
$2,169.09
|
| Rate for Payer: Anthem Medicaid |
$968.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna Commercial |
$2,338.11
|
| Rate for Payer: First Health Commercial |
$2,676.15
|
| Rate for Payer: Humana Commercial |
$2,394.45
|
| Rate for Payer: Humana KY Medicaid |
$968.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$978.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$988.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,943.73
|
| Rate for Payer: PHCS Commercial |
$2,704.32
|
| Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.35 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem Medicaid |
$369.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Humana KY Medicaid |
$369.35
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$373.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.06
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
OP
|
$5,036.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$4,834.56 |
| Rate for Payer: Aetna Commercial |
$3,877.72
|
| Rate for Payer: Anthem Medicaid |
$1,731.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,928.08
|
| 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 |
$2,518.00
|
| Rate for Payer: Cash Price |
$2,518.00
|
| Rate for Payer: Cigna Commercial |
$4,179.88
|
| Rate for Payer: First Health Commercial |
$4,784.20
|
| Rate for Payer: Humana Commercial |
$4,280.60
|
| Rate for Payer: Humana KY Medicaid |
$1,731.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,129.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,716.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,431.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,777.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,381.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,474.84
|
| Rate for Payer: PHCS Commercial |
$4,834.56
|
| Rate for Payer: United Healthcare All Payer |
$4,431.68
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
IP
|
$5,036.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,510.80 |
| Max. Negotiated Rate |
$4,834.56 |
| Rate for Payer: Aetna Commercial |
$3,877.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,928.08
|
| Rate for Payer: Cash Price |
$2,518.00
|
| Rate for Payer: Cigna Commercial |
$4,179.88
|
| Rate for Payer: First Health Commercial |
$4,784.20
|
| Rate for Payer: Humana Commercial |
$4,280.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,129.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,716.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,431.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,777.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,381.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,474.84
|
| Rate for Payer: PHCS Commercial |
$4,834.56
|
| Rate for Payer: United Healthcare All Payer |
$4,431.68
|
|
|
BIOPSY OF SALIVARY GLAND
|
Professional
|
Both
|
$5,036.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
76101685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$333.05
|
| Rate for Payer: Ambetter Exchange |
$214.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.22
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$214.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$214.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$2,518.00
|
| Rate for Payer: Cash Price |
$2,518.00
|
| Rate for Payer: Cigna Commercial |
$419.74
|
| Rate for Payer: Healthspan PPO |
$358.51
|
| Rate for Payer: Humana Medicaid |
$141.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$214.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.82
|
| Rate for Payer: Molina Healthcare Passport |
$141.00
|
| Rate for Payer: Multiplan PHCS |
$3,021.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.95
|
| Rate for Payer: UHCCP Medicaid |
$151.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$214.58
|
|
|
BIOPSY OF SALIVARY GLAND
|
Professional
|
Both
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Ambetter Exchange |
$49.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.88
|
| Rate for Payer: Anthem Medicaid |
$46.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.26
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$142.65
|
| Rate for Payer: Healthspan PPO |
$126.43
|
| Rate for Payer: Humana Medicaid |
$46.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.44
|
| Rate for Payer: Molina Healthcare Passport |
$46.51
|
| Rate for Payer: Multiplan PHCS |
$644.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.19
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.38
|
|
|
BIOPSY OF SALIVARY GLAND
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
76101684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.06
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
BIOPSY OF SALIVARY GLAND(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
761P1685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$419.74 |
| Rate for Payer: Aetna Commercial |
$333.05
|
| Rate for Payer: Ambetter Exchange |
$214.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.22
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$214.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$214.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$419.74
|
| Rate for Payer: Healthspan PPO |
$358.51
|
| Rate for Payer: Humana Medicaid |
$141.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$214.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.82
|
| Rate for Payer: Molina Healthcare Passport |
$141.00
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.95
|
| Rate for Payer: UHCCP Medicaid |
$151.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$214.58
|
|
|
BIOPSY OF SALIVARY GLAND(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
761P1684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$142.65 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Ambetter Exchange |
$49.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.88
|
| Rate for Payer: Anthem Medicaid |
$46.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.26
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$142.65
|
| Rate for Payer: Healthspan PPO |
$126.43
|
| Rate for Payer: Humana Medicaid |
$46.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.44
|
| Rate for Payer: Molina Healthcare Passport |
$46.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.19
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.38
|
|
|
BIOPSY OF SALIVARY GLAND(T
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
761T1684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.06
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
BIOPSY OF SALIVARY GLAND(T
|
Facility
|
OP
|
$4,586.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
761T1685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$4,402.56 |
| Rate for Payer: Aetna Commercial |
$3,531.22
|
| Rate for Payer: Anthem Medicaid |
$1,577.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,577.08
|
| 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 |
$2,293.00
|
| Rate for Payer: Cash Price |
$2,293.00
|
| Rate for Payer: Cigna Commercial |
$3,806.38
|
| Rate for Payer: First Health Commercial |
$4,356.70
|
| Rate for Payer: Humana Commercial |
$3,898.10
|
| Rate for Payer: Humana KY Medicaid |
$1,577.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,608.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.34
|
| Rate for Payer: PHCS Commercial |
$4,402.56
|
| Rate for Payer: United Healthcare All Payer |
$4,035.68
|
|
|
BIOPSY OF SALIVARY GLAND(T
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 42400
|
| Hospital Charge Code |
761T1684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.06
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
BIOPSY OF SALIVARY GLAND(T
|
Facility
|
IP
|
$4,586.00
|
|
|
Service Code
|
HCPCS 42405
|
| Hospital Charge Code |
761T1685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,375.80 |
| Max. Negotiated Rate |
$4,402.56 |
| Rate for Payer: Aetna Commercial |
$3,531.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,577.08
|
| Rate for Payer: Cash Price |
$2,293.00
|
| Rate for Payer: Cigna Commercial |
$3,806.38
|
| Rate for Payer: First Health Commercial |
$4,356.70
|
| Rate for Payer: Humana Commercial |
$3,898.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.34
|
| Rate for Payer: PHCS Commercial |
$4,402.56
|
| Rate for Payer: United Healthcare All Payer |
$4,035.68
|
|
|
BIOPSY OF SPLEEN
|
Professional
|
Both
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76102725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,786.65 |
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,245.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,786.65
|
| Rate for Payer: UHCCP Medicaid |
$1,893.33
|
|
|
BIOPSY OF SPLEEN
|
Facility
|
OP
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76102725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$5,193.12 |
| Rate for Payer: Aetna Commercial |
$4,165.31
|
| Rate for Payer: Anthem Medicaid |
$1,860.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cigna Commercial |
$4,489.89
|
| Rate for Payer: First Health Commercial |
$5,139.02
|
| Rate for Payer: Humana Commercial |
$4,598.07
|
| Rate for Payer: Humana KY Medicaid |
$1,860.33
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.55
|
| Rate for Payer: PHCS Commercial |
$5,193.12
|
| Rate for Payer: United Healthcare All Payer |
$4,760.36
|
|
|
BIOPSY OF SPLEEN
|
Facility
|
IP
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76102725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,622.85 |
| Max. Negotiated Rate |
$5,193.12 |
| Rate for Payer: Aetna Commercial |
$4,165.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.41
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cigna Commercial |
$4,489.89
|
| Rate for Payer: First Health Commercial |
$5,139.02
|
| Rate for Payer: Humana Commercial |
$4,598.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.55
|
| Rate for Payer: PHCS Commercial |
$5,193.12
|
| Rate for Payer: United Healthcare All Payer |
$4,760.36
|
|
|
BIOPSY OF SPLEEN (P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761P2725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
|
|
BIOPSY OF SPLEEN (T
|
Facility
|
OP
|
$4,759.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761T2725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$4,569.12 |
| Rate for Payer: Aetna Commercial |
$3,664.82
|
| Rate for Payer: Anthem Medicaid |
$1,636.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$2,379.75
|
| Rate for Payer: Cash Price |
$2,379.75
|
| Rate for Payer: Cigna Commercial |
$3,950.39
|
| Rate for Payer: First Health Commercial |
$4,521.52
|
| Rate for Payer: Humana Commercial |
$4,045.57
|
| Rate for Payer: Humana KY Medicaid |
$1,636.79
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,902.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,569.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,807.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,140.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.05
|
| Rate for Payer: PHCS Commercial |
$4,569.12
|
| Rate for Payer: United Healthcare All Payer |
$4,188.36
|
|
