|
RESECT BACK TUM 5 CM/>(P
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761P0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$2,532.94 |
| Rate for Payer: Aetna Commercial |
$2,229.11
|
| Rate for Payer: Anthem Medicaid |
$1,046.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,180.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cigna Commercial |
$2,532.94
|
| Rate for Payer: Healthspan PPO |
$1,590.55
|
| Rate for Payer: Humana Medicaid |
$1,046.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,824.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,067.59
|
| Rate for Payer: Molina Healthcare Passport |
$1,046.66
|
| Rate for Payer: Multiplan PHCS |
$1,308.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,526.00
|
| Rate for Payer: UHCCP Medicaid |
$763.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,057.13
|
|
|
RESECT BACK TUM < 5 CM(T
|
Facility
|
OP
|
$5,941.68
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761T0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$5,704.01 |
| Rate for Payer: Aetna Commercial |
$4,575.09
|
| Rate for Payer: Anthem Medicaid |
$2,043.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,634.51
|
| 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 |
$2,970.84
|
| Rate for Payer: Cash Price |
$2,970.84
|
| Rate for Payer: Cigna Commercial |
$4,931.59
|
| Rate for Payer: First Health Commercial |
$5,644.60
|
| Rate for Payer: Humana Commercial |
$5,050.43
|
| Rate for Payer: Humana KY Medicaid |
$2,043.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,064.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,872.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,384.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,084.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,228.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,456.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,841.92
|
| Rate for Payer: PHCS Commercial |
$5,704.01
|
| Rate for Payer: United Healthcare All Payer |
$5,228.68
|
|
|
RESECT BACK TUM < 5 CM(T
|
Facility
|
IP
|
$5,941.68
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761T0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$5,704.01 |
| Rate for Payer: Aetna Commercial |
$4,575.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,634.51
|
| Rate for Payer: Cash Price |
$2,970.84
|
| Rate for Payer: Cigna Commercial |
$4,931.59
|
| Rate for Payer: First Health Commercial |
$5,644.60
|
| Rate for Payer: Humana Commercial |
$5,050.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,872.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,384.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,228.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,456.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,841.92
|
| Rate for Payer: PHCS Commercial |
$5,704.01
|
| Rate for Payer: United Healthcare All Payer |
$5,228.68
|
|
|
RESECT BACK TUM 5 CM/>(T
|
Facility
|
IP
|
$7,660.54
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761T0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$995.87 |
| Max. Negotiated Rate |
$7,354.12 |
| Rate for Payer: Aetna Commercial |
$5,898.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.22
|
| Rate for Payer: Cash Price |
$3,830.27
|
| Rate for Payer: Cigna Commercial |
$6,358.25
|
| Rate for Payer: First Health Commercial |
$7,277.51
|
| Rate for Payer: Humana Commercial |
$6,511.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,374.77
|
| Rate for Payer: PHCS Commercial |
$7,354.12
|
| Rate for Payer: United Healthcare All Payer |
$6,741.28
|
|
|
RESECT BACK TUM 5 CM/>(T
|
Facility
|
OP
|
$7,660.54
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761T0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$995.87 |
| Max. Negotiated Rate |
$7,354.12 |
| Rate for Payer: Aetna Commercial |
$5,898.62
|
| Rate for Payer: Anthem Medicaid |
$2,634.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.22
|
| 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 |
$3,830.27
|
| Rate for Payer: Cash Price |
$3,830.27
|
| Rate for Payer: Cigna Commercial |
$6,358.25
|
| Rate for Payer: First Health Commercial |
$7,277.51
|
| Rate for Payer: Humana Commercial |
$6,511.46
|
| Rate for Payer: Humana KY Medicaid |
$2,634.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,661.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,687.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,374.77
|
| Rate for Payer: PHCS Commercial |
$7,354.12
|
| Rate for Payer: United Healthcare All Payer |
$6,741.28
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.95 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem Medicaid |
$1,002.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Humana KY Medicaid |
$1,002.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.65
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
RESECT/DEBRIDE PANCREAS
|
Professional
|
Both
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.25 |
| Max. Negotiated Rate |
$4,118.57 |
| Rate for Payer: Aetna Commercial |
$4,118.57
|
| Rate for Payer: Anthem Medicaid |
$1,969.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,915.00
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$3,824.84
|
| Rate for Payer: Healthspan PPO |
$3,473.27
|
| Rate for Payer: Humana Medicaid |
$1,969.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,648.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,009.04
|
| Rate for Payer: Molina Healthcare Passport |
$1,969.65
|
| Rate for Payer: Multiplan PHCS |
$1,749.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,040.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,989.35
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
IP
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.95 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.65
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.65 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.55
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.65 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem Medicaid |
$345.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Humana KY Medicaid |
$345.62
|
| Rate for Payer: Kentucky WC Medicaid |
$349.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.55
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,212.46 |
| Rate for Payer: Aetna Commercial |
$1,177.18
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,212.46
|
| Rate for Payer: Healthspan PPO |
$941.26
|
| Rate for Payer: Humana Medicaid |
$602.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$614.56
|
| Rate for Payer: Molina Healthcare Passport |
$602.51
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$608.54
|
|
|
RESECT DIAPHRAGM SIMPLE(P
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
761P1623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,212.46 |
| Rate for Payer: Aetna Commercial |
$1,177.18
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,212.46
|
| Rate for Payer: Healthspan PPO |
$941.26
|
| Rate for Payer: Humana Medicaid |
$602.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$614.56
|
| Rate for Payer: Molina Healthcare Passport |
$602.51
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$608.54
|
|
|
RESECT FACE TUM = 2 CM
|
Facility
|
IP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.56 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.72
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
RESECT FACE TUM = 2 CM
|
Professional
|
Both
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.32 |
| Max. Negotiated Rate |
$7,112.00 |
| Rate for Payer: Aetna Commercial |
$1,604.18
|
| Rate for Payer: Anthem Medicaid |
$756.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,112.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$1,828.61
|
| Rate for Payer: Healthspan PPO |
$1,144.70
|
| Rate for Payer: Humana Medicaid |
$756.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,328.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.45
|
| Rate for Payer: Molina Healthcare Passport |
$756.32
|
| Rate for Payer: Multiplan PHCS |
$4,267.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,978.40
|
| Rate for Payer: UHCCP Medicaid |
$2,489.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.88
|
|
|
RESECT FACE TUM = 2 CM
|
Facility
|
OP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.56 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem Medicaid |
$2,445.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| 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 |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Humana KY Medicaid |
$2,445.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.72
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
RESECT FACE TUM = 2 CM(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761P0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,828.61 |
| Rate for Payer: Aetna Commercial |
$1,604.18
|
| Rate for Payer: Anthem Medicaid |
$756.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,828.61
|
| Rate for Payer: Healthspan PPO |
$1,144.70
|
| Rate for Payer: Humana Medicaid |
$756.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,328.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.45
|
| Rate for Payer: Molina Healthcare Passport |
$756.32
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.88
|
|
|
RESECT FACE TUM = 2 CM(T
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761T0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.56 |
| Max. Negotiated Rate |
$5,387.52 |
| Rate for Payer: Aetna Commercial |
$4,321.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.36
|
| Rate for Payer: Cash Price |
$2,806.00
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: First Health Commercial |
$5,331.40
|
| Rate for Payer: Humana Commercial |
$4,770.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,938.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.72
|
| Rate for Payer: PHCS Commercial |
$5,387.52
|
| Rate for Payer: United Healthcare All Payer |
$4,938.56
|
|
|
RESECT FACE TUM = 2 CM(T
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761T0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.56 |
| Max. Negotiated Rate |
$5,387.52 |
| Rate for Payer: Aetna Commercial |
$4,321.24
|
| Rate for Payer: Anthem Medicaid |
$1,929.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.36
|
| 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 |
$2,806.00
|
| Rate for Payer: Cash Price |
$2,806.00
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: First Health Commercial |
$5,331.40
|
| Rate for Payer: Humana Commercial |
$4,770.20
|
| Rate for Payer: Humana KY Medicaid |
$1,929.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,938.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.72
|
| Rate for Payer: PHCS Commercial |
$5,387.52
|
| Rate for Payer: United Healthcare All Payer |
$4,938.56
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.21 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,446.60
|
| Rate for Payer: Anthem Medicaid |
$700.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,665.57
|
| Rate for Payer: Healthspan PPO |
$1,030.88
|
| Rate for Payer: Humana Medicaid |
$700.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$714.21
|
| Rate for Payer: Molina Healthcare Passport |
$700.21
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$707.21
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| 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 |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
761P0971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.21 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,446.60
|
| Rate for Payer: Anthem Medicaid |
$700.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,665.57
|
| Rate for Payer: Healthspan PPO |
$1,030.88
|
| Rate for Payer: Humana Medicaid |
$700.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$714.21
|
| Rate for Payer: Molina Healthcare Passport |
$700.21
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$707.21
|
|
|
RESECT FORARM/WRIST TUM 3CM>
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 25078
|
| Hospital Charge Code |
76100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$502.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RESECT FORARM/WRIST TUM 3CM>
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 25078
|
| Hospital Charge Code |
76100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem Medicaid |
$576.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| 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 |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Humana KY Medicaid |
$576.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$587.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RESECT FORARM/WRIST TUM 3CM>
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 25078
|
| Hospital Charge Code |
76100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$586.25 |
| Max. Negotiated Rate |
$1,986.25 |
| Rate for Payer: Aetna Commercial |
$1,749.84
|
| Rate for Payer: Anthem Medicaid |
$820.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,675.00
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,986.25
|
| Rate for Payer: Healthspan PPO |
$1,249.02
|
| Rate for Payer: Humana Medicaid |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,433.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.40
|
| Rate for Payer: Molina Healthcare Passport |
$820.00
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,172.50
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$828.20
|
|
