|
REMOVE ELTRD/THORACOTOMY
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.90
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
REMOVE ELTRD/THORACOTOMY
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.90
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
REMOVE ELTRD/THORACOTOMY(P
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
761P1268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,282.01 |
| Rate for Payer: Aetna Commercial |
$2,282.01
|
| Rate for Payer: Anthem Medicaid |
$909.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,590.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,161.15
|
| Rate for Payer: Healthspan PPO |
$2,243.66
|
| Rate for Payer: Humana Medicaid |
$909.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,923.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$927.55
|
| Rate for Payer: Molina Healthcare Passport |
$909.36
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,113.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.45
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVE EPIDIDYMIS LESION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.49 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$523.05
|
| Rate for Payer: Anthem Medicaid |
$288.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$466.04
|
| Rate for Payer: Healthspan PPO |
$506.45
|
| Rate for Payer: Humana Medicaid |
$288.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.26
|
| Rate for Payer: Molina Healthcare Passport |
$288.49
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.37
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVE EPIDIDYMIS LESION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
761P2141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.49 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$523.05
|
| Rate for Payer: Anthem Medicaid |
$288.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$466.04
|
| Rate for Payer: Healthspan PPO |
$506.45
|
| Rate for Payer: Humana Medicaid |
$288.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.26
|
| Rate for Payer: Molina Healthcare Passport |
$288.49
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.37
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.23 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.23
|
| Rate for Payer: Anthem Medicaid |
$177.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$457.11
|
| Rate for Payer: Healthspan PPO |
$555.09
|
| Rate for Payer: Humana Medicaid |
$177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.09
|
| Rate for Payer: Molina Healthcare Passport |
$177.54
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$177.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.32
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem Medicaid |
$316.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Humana KY Medicaid |
$316.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$319.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$322.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
REMOVE EXTERNAL EAR PARTIAL(P
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
761P2406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.23 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.23
|
| Rate for Payer: Anthem Medicaid |
$177.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$457.11
|
| Rate for Payer: Healthspan PPO |
$555.09
|
| Rate for Payer: Humana Medicaid |
$177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.09
|
| Rate for Payer: Molina Healthcare Passport |
$177.54
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$177.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.32
|
|
|
REMOVE EYELID LESION
|
Professional
|
Both
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.46 |
| Max. Negotiated Rate |
$3,130.66 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.33
|
| Rate for Payer: Anthem Medicaid |
$76.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,130.66
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Healthspan PPO |
$316.90
|
| Rate for Payer: Humana Medicaid |
$76.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.99
|
| Rate for Payer: Molina Healthcare Passport |
$76.46
|
| Rate for Payer: Multiplan PHCS |
$1,878.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,191.46
|
| Rate for Payer: UHCCP Medicaid |
$117.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.22
|
|
|
REMOVE EYELID LESION
|
Facility
|
IP
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.99 |
| Max. Negotiated Rate |
$3,005.43 |
| Rate for Payer: Aetna Commercial |
$2,410.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.91
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$2,598.45
|
| Rate for Payer: First Health Commercial |
$2,974.13
|
| Rate for Payer: Humana Commercial |
$2,661.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,567.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,348.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$970.50
|
| Rate for Payer: PHCS Commercial |
$3,005.43
|
| Rate for Payer: United Healthcare All Payer |
$2,754.98
|
|
|
REMOVE EYELID LESION
|
Facility
|
OP
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.99 |
| Max. Negotiated Rate |
$3,005.43 |
| Rate for Payer: Aetna Commercial |
$2,410.61
|
| Rate for Payer: Anthem Medicaid |
$1,076.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$875.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,225.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,181.94
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$2,598.45
|
| Rate for Payer: First Health Commercial |
$2,974.13
|
| Rate for Payer: Humana Commercial |
$2,661.06
|
| Rate for Payer: Humana KY Medicaid |
$1,076.63
|
| Rate for Payer: Humana Medicare Advantage |
$875.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,567.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,348.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$970.50
|
| Rate for Payer: PHCS Commercial |
$3,005.43
|
| Rate for Payer: United Healthcare All Payer |
$2,754.98
|
|
|
REMOVE EYELID LESION(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761P2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.46 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.33
|
| Rate for Payer: Anthem Medicaid |
$76.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Healthspan PPO |
$316.90
|
| Rate for Payer: Humana Medicaid |
$76.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.99
|
| Rate for Payer: Molina Healthcare Passport |
$76.46
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$117.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.22
|
|
|
REMOVE EYELID LESION(T
|
Facility
|
OP
|
$2,455.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761T2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.24 |
| Max. Negotiated Rate |
$2,357.43 |
| Rate for Payer: Aetna Commercial |
$1,890.86
|
| Rate for Payer: Anthem Medicaid |
$844.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$875.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,915.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,225.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,181.94
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cigna Commercial |
$2,038.20
|
| Rate for Payer: First Health Commercial |
$2,332.88
|
| Rate for Payer: Humana Commercial |
$2,087.31
|
| Rate for Payer: Humana KY Medicaid |
$844.50
|
| Rate for Payer: Humana Medicare Advantage |
$875.51
|
| Rate for Payer: Kentucky WC Medicaid |
$853.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,013.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,812.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$861.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,160.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,841.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$491.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.25
|
| Rate for Payer: PHCS Commercial |
$2,357.43
|
| Rate for Payer: United Healthcare All Payer |
$2,160.98
|
|
|
REMOVE EYELID LESION(T
|
Facility
|
IP
|
$2,455.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761T2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.24 |
| Max. Negotiated Rate |
$2,357.43 |
| Rate for Payer: Aetna Commercial |
$1,890.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,915.41
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cigna Commercial |
$2,038.20
|
| Rate for Payer: First Health Commercial |
$2,332.88
|
| Rate for Payer: Humana Commercial |
$2,087.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,013.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,812.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$736.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,160.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,841.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$491.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.25
|
| Rate for Payer: PHCS Commercial |
$2,357.43
|
| Rate for Payer: United Healthcare All Payer |
$2,160.98
|
|
|
REMOVE FEMUR LESION
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE FEMUR LESION
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE FEMUR LESION
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Anthem Medicaid |
$440.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$966.71
|
| Rate for Payer: Healthspan PPO |
$796.78
|
| Rate for Payer: Humana Medicaid |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.17
|
| Rate for Payer: Molina Healthcare Passport |
$440.36
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.76
|
|
|
REMOVE FEMUR LESION/BURSA
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.55 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$651.45
|
| Rate for Payer: Anthem Medicaid |
$269.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$714.09
|
| Rate for Payer: Healthspan PPO |
$590.08
|
| Rate for Payer: Humana Medicaid |
$269.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$558.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$274.94
|
| Rate for Payer: Molina Healthcare Passport |
$269.55
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.25
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE FEMUR LESION/BURSA(P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
761P0771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.55 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$651.45
|
| Rate for Payer: Anthem Medicaid |
$269.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$714.09
|
| Rate for Payer: Healthspan PPO |
$590.08
|
| Rate for Payer: Humana Medicaid |
$269.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$558.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$274.94
|
| Rate for Payer: Molina Healthcare Passport |
$269.55
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.25
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem Medicaid |
$349.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Humana KY Medicaid |
$349.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$352.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$356.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$314.65
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
