|
BIOPSY; OROPHARYNX
|
Facility
|
OP
|
$1,916.14
|
|
|
Service Code
|
CPT 42800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
|
|
BIOPSY OROPHARYNX(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761P1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.11 |
| Max. Negotiated Rate |
$208.37 |
| Rate for Payer: Aetna Commercial |
$160.42
|
| Rate for Payer: Ambetter Exchange |
$110.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.03
|
| Rate for Payer: Anthem Medicaid |
$61.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.56
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$208.37
|
| Rate for Payer: Healthspan PPO |
$182.67
|
| Rate for Payer: Humana Medicaid |
$61.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.33
|
| Rate for Payer: Molina Healthcare Passport |
$61.11
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$143.61
|
| Rate for Payer: UHCCP Medicaid |
$70.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.47
|
|
|
BIOPSY OROPHARYNX(T
|
Facility
|
IP
|
$3,252.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761T1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.60 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Aetna Commercial |
$2,504.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.56
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,699.16
|
| Rate for Payer: First Health Commercial |
$3,089.40
|
| Rate for Payer: Humana Commercial |
$2,764.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,829.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.88
|
| Rate for Payer: PHCS Commercial |
$3,121.92
|
| Rate for Payer: United Healthcare All Payer |
$2,861.76
|
|
|
BIOPSY OROPHARYNX(T
|
Facility
|
OP
|
$3,252.00
|
|
|
Service Code
|
HCPCS 42800
|
| Hospital Charge Code |
761T1699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,118.36 |
| Max. Negotiated Rate |
$3,121.92 |
| Rate for Payer: Aetna Commercial |
$2,504.04
|
| Rate for Payer: Anthem Medicaid |
$1,118.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.56
|
| 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 |
$1,626.00
|
| Rate for Payer: Cash Price |
$1,626.00
|
| Rate for Payer: Cigna Commercial |
$2,699.16
|
| Rate for Payer: First Health Commercial |
$3,089.40
|
| Rate for Payer: Humana Commercial |
$2,764.20
|
| Rate for Payer: Humana KY Medicaid |
$1,118.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,829.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.88
|
| Rate for Payer: PHCS Commercial |
$3,121.92
|
| Rate for Payer: United Healthcare All Payer |
$2,861.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Facility
|
OP
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.13 |
| Max. Negotiated Rate |
$3,433.92 |
| Rate for Payer: Aetna Commercial |
$2,754.29
|
| Rate for Payer: Anthem Medicaid |
$1,230.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.06
|
| 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 |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$2,968.91
|
| Rate for Payer: First Health Commercial |
$3,398.15
|
| Rate for Payer: Humana Commercial |
$3,040.45
|
| Rate for Payer: Humana KY Medicaid |
$1,230.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,242.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.13
|
| Rate for Payer: PHCS Commercial |
$3,433.92
|
| Rate for Payer: United Healthcare All Payer |
$3,147.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Professional
|
Both
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$2,146.20 |
| Rate for Payer: Aetna Commercial |
$226.21
|
| Rate for Payer: Ambetter Exchange |
$146.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.60
|
| Rate for Payer: Anthem Medicaid |
$84.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.26
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Healthspan PPO |
$316.88
|
| Rate for Payer: Humana Medicaid |
$84.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.39
|
| Rate for Payer: Molina Healthcare Passport |
$84.70
|
| Rate for Payer: Multiplan PHCS |
$2,146.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.87
|
| Rate for Payer: UHCCP Medicaid |
$83.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.05
|
|
|
BIOPSY - SOFT TISSUE OF NECK
|
Facility
|
IP
|
$3,577.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
76100392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$3,433.92 |
| Rate for Payer: Aetna Commercial |
$2,754.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.06
|
| Rate for Payer: Cash Price |
$1,788.50
|
| Rate for Payer: Cigna Commercial |
$2,968.91
|
| Rate for Payer: First Health Commercial |
$3,398.15
|
| Rate for Payer: Humana Commercial |
$3,040.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.13
|
| Rate for Payer: PHCS Commercial |
$3,433.92
|
| Rate for Payer: United Healthcare All Payer |
$3,147.76
|
|
|
BIOPSY - SOFT TISSUE OF NECK(P
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761P0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$316.88 |
| Rate for Payer: Aetna Commercial |
$226.21
|
| Rate for Payer: Ambetter Exchange |
$146.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.60
|
| Rate for Payer: Anthem Medicaid |
$84.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.26
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Healthspan PPO |
$316.88
|
| Rate for Payer: Humana Medicaid |
$84.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.39
|
| Rate for Payer: Molina Healthcare Passport |
$84.70
|
| Rate for Payer: Multiplan PHCS |
$189.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.87
|
| Rate for Payer: UHCCP Medicaid |
$83.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.05
|
|
|
BIOPSY - SOFT TISSUE OF NECK(T
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761T0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.30 |
| Max. Negotiated Rate |
$3,130.56 |
| Rate for Payer: Aetna Commercial |
$2,510.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.58
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cigna Commercial |
$2,706.63
|
| Rate for Payer: First Health Commercial |
$3,097.95
|
| Rate for Payer: Humana Commercial |
$2,771.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.09
|
| Rate for Payer: PHCS Commercial |
$3,130.56
|
| Rate for Payer: United Healthcare All Payer |
$2,869.68
|
|
|
BIOPSY - SOFT TISSUE OF NECK(T
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
761T0392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,121.46 |
| Max. Negotiated Rate |
$3,130.56 |
| Rate for Payer: Aetna Commercial |
$2,510.97
|
| Rate for Payer: Anthem Medicaid |
$1,121.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.58
|
| 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 |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cigna Commercial |
$2,706.63
|
| Rate for Payer: First Health Commercial |
$3,097.95
|
| Rate for Payer: Humana Commercial |
$2,771.85
|
| Rate for Payer: Humana KY Medicaid |
$1,121.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,143.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.09
|
| Rate for Payer: PHCS Commercial |
$3,130.56
|
| Rate for Payer: United Healthcare All Payer |
$2,869.68
|
|
|
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 27323
|
|
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
|
|
|
BIOPSY - SOFT TISSUE - THIGH
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
BIOPSY - SOFT TISSUE - THIGH
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
BIOPSY - SOFT TISSUE - THIGH
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
76100812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$330.15 |
| Rate for Payer: Aetna Commercial |
$254.23
|
| Rate for Payer: Ambetter Exchange |
$165.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.77
|
| Rate for Payer: Anthem Medicaid |
$105.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.49
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$271.35
|
| Rate for Payer: Healthspan PPO |
$330.15
|
| Rate for Payer: Humana Medicaid |
$105.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.03
|
| Rate for Payer: Molina Healthcare Passport |
$105.91
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$215.03
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.41
|
|
|
BIOPSY - SOFT TISSUE - THIGH(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
761P0812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$330.15 |
| Rate for Payer: Aetna Commercial |
$254.23
|
| Rate for Payer: Ambetter Exchange |
$165.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.77
|
| Rate for Payer: Anthem Medicaid |
$105.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.49
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$271.35
|
| Rate for Payer: Healthspan PPO |
$330.15
|
| Rate for Payer: Humana Medicaid |
$105.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.03
|
| Rate for Payer: Molina Healthcare Passport |
$105.91
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$215.03
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.41
|
|
|
BIOPSY VESTIBULE
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,334.40 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem Medicaid |
$478.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Humana KY Medicaid |
$478.02
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$482.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$487.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,209.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.10
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
BIOPSY VESTIBULE
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,334.40 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,209.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.10
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
BIOPSY VESTIBULE
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$834.00 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Ambetter Exchange |
$83.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.15
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.78
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$221.51
|
| Rate for Payer: Healthspan PPO |
$204.47
|
| Rate for Payer: Humana Medicaid |
$49.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.01
|
| Rate for Payer: Molina Healthcare Passport |
$49.03
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.17
|
| Rate for Payer: UHCCP Medicaid |
$87.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.98
|
|
|
BIOPSY VESTIBULE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761P1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$221.51 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Ambetter Exchange |
$83.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.15
|
| Rate for Payer: Anthem Medicaid |
$49.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.78
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$221.51
|
| Rate for Payer: Healthspan PPO |
$204.47
|
| Rate for Payer: Humana Medicaid |
$49.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.01
|
| Rate for Payer: Molina Healthcare Passport |
$49.03
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.17
|
| Rate for Payer: UHCCP Medicaid |
$87.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.98
|
|
|
BIOPSY VESTIBULE(T
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761T1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
BIOPSY VESTIBULE(T
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761T1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.64 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
BIO-STUR TAK 2.4 TO 3.7ANCHOR
|
Facility
|
IP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
BIO-STUR TAK 2.4 TO 3.7ANCHOR
|
Facility
|
OP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem Medicaid |
$1,055.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Humana KY Medicaid |
$1,055.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,066.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
BIO SURGE KIT/W 5CC ALLOSYNC
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
BIO SURGE KIT/W 5CC ALLOSYNC
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
