|
RESECT FORARM/WRIST TUM 3CM(P
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 25078
|
| Hospital Charge Code |
761P0577
|
|
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
|
|
|
RESECT FOREARM/WRIST TUM<3CM
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
76100576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| 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 |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
RESECT FOREARM/WRIST TUM<3CM
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
76100576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
RESECT FOREARM/WRIST TUM<3CM
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
76100576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.46 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,087.92
|
| Rate for Payer: Anthem Medicaid |
$539.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,389.36
|
| Rate for Payer: Healthspan PPO |
$985.42
|
| Rate for Payer: Humana Medicaid |
$539.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.25
|
| Rate for Payer: Molina Healthcare Passport |
$539.46
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.85
|
|
|
RESECT FOREARM/WRIST TUM<3C(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
761P0576
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.46 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,087.92
|
| Rate for Payer: Anthem Medicaid |
$539.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,389.36
|
| Rate for Payer: Healthspan PPO |
$985.42
|
| Rate for Payer: Humana Medicaid |
$539.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.25
|
| Rate for Payer: Molina Healthcare Passport |
$539.46
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.85
|
|
|
RESECT INFERIOR TURBINATE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
76101123
|
|
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
|
|
|
RESECT INFERIOR TURBINATE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
76101123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| 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 |
$2,784.17
|
| 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 |
$3,341.00
|
| 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
|
|
|
RESECT INFERIOR TURBINATE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
76101123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.99 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$591.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.99
|
| Rate for Payer: Anthem Medicaid |
$186.05
|
| 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 |
$565.86
|
| Rate for Payer: Healthspan PPO |
$499.16
|
| Rate for Payer: Humana Medicaid |
$186.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$543.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.77
|
| Rate for Payer: Molina Healthcare Passport |
$186.05
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$190.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.91
|
|
|
RESECT INFERIOR TURBINATE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
761P1123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.99 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$591.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.99
|
| Rate for Payer: Anthem Medicaid |
$186.05
|
| 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 |
$565.86
|
| Rate for Payer: Healthspan PPO |
$499.16
|
| Rate for Payer: Humana Medicaid |
$186.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$543.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.77
|
| Rate for Payer: Molina Healthcare Passport |
$186.05
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$190.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.91
|
|
|
RESECTION OF LIP ONE FOURTH +
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 40530
|
| Hospital Charge Code |
76101627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
RESECTION OF LIP ONE FOURTH +
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 40530
|
| Hospital Charge Code |
76101627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
RESECTION OF LIP ONE FOURTH +
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 40530
|
| Hospital Charge Code |
76101627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.41 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$586.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$300.41
|
| Rate for Payer: Anthem Medicaid |
$305.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$581.76
|
| Rate for Payer: Healthspan PPO |
$639.58
|
| Rate for Payer: Humana Medicaid |
$305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.71
|
| Rate for Payer: Molina Healthcare Passport |
$305.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$315.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.66
|
|
|
RESECTION OF LIP ONE FOURTH (P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 40530
|
| Hospital Charge Code |
761P1627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.41 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$586.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$300.41
|
| Rate for Payer: Anthem Medicaid |
$305.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$581.76
|
| Rate for Payer: Healthspan PPO |
$639.58
|
| Rate for Payer: Humana Medicaid |
$305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.71
|
| Rate for Payer: Molina Healthcare Passport |
$305.60
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$315.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.66
|
|
|
RESECTION OF MEDIASTINAL CYS(P
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 39200
|
| Hospital Charge Code |
761P1617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.50 |
| Max. Negotiated Rate |
$1,425.48 |
| Rate for Payer: Aetna Commercial |
$1,375.62
|
| Rate for Payer: Anthem Medicaid |
$726.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$1,425.48
|
| Rate for Payer: Healthspan PPO |
$1,099.93
|
| Rate for Payer: Humana Medicaid |
$726.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,182.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$740.99
|
| Rate for Payer: Molina Healthcare Passport |
$726.46
|
| Rate for Payer: Multiplan PHCS |
$654.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$763.00
|
| Rate for Payer: UHCCP Medicaid |
$381.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$733.72
|
|
|
RESECTION OF MEDIASTINAL CYST
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 39200
|
| Hospital Charge Code |
76101617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$1,046.40 |
| Rate for Payer: Aetna Commercial |
$839.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.20
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$904.70
|
| Rate for Payer: First Health Commercial |
$1,035.50
|
| Rate for Payer: Humana Commercial |
$926.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$804.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.20
|
| Rate for Payer: Ohio Health Group HMO |
$817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.90
|
| Rate for Payer: PHCS Commercial |
$1,046.40
|
| Rate for Payer: United Healthcare All Payer |
$959.20
|
|
|
RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 39200
|
| Hospital Charge Code |
76101617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.50 |
| Max. Negotiated Rate |
$1,425.48 |
| Rate for Payer: Aetna Commercial |
$1,375.62
|
| Rate for Payer: Anthem Medicaid |
$726.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$1,425.48
|
| Rate for Payer: Healthspan PPO |
$1,099.93
|
| Rate for Payer: Humana Medicaid |
$726.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,182.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$740.99
|
| Rate for Payer: Molina Healthcare Passport |
$726.46
|
| Rate for Payer: Multiplan PHCS |
$654.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$763.00
|
| Rate for Payer: UHCCP Medicaid |
$381.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$733.72
|
|
|
RESECTION OF MEDIASTINAL CYST
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 39200
|
| Hospital Charge Code |
76101617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$1,046.40 |
| Rate for Payer: Aetna Commercial |
$839.30
|
| Rate for Payer: Anthem Medicaid |
$374.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.20
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$904.70
|
| Rate for Payer: First Health Commercial |
$1,035.50
|
| Rate for Payer: Humana Commercial |
$926.50
|
| Rate for Payer: Humana KY Medicaid |
$374.85
|
| Rate for Payer: Kentucky WC Medicaid |
$378.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$804.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.20
|
| Rate for Payer: Ohio Health Group HMO |
$817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.90
|
| Rate for Payer: PHCS Commercial |
$1,046.40
|
| Rate for Payer: United Healthcare All Payer |
$959.20
|
|
|
RESECTION OF MEDIASTINAL TUMOR
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 39220
|
| Hospital Charge Code |
76101618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RESECTION OF MEDIASTINAL TUMOR
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 39220
|
| Hospital Charge Code |
76101618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RESECTION OF MEDIASTINAL TUMOR
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 39220
|
| Hospital Charge Code |
761P1618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$1,817.05 |
| Rate for Payer: Aetna Commercial |
$1,766.34
|
| Rate for Payer: Anthem Medicaid |
$943.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,817.05
|
| Rate for Payer: Healthspan PPO |
$1,412.35
|
| Rate for Payer: Humana Medicaid |
$943.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,524.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$962.55
|
| Rate for Payer: Molina Healthcare Passport |
$943.68
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$953.12
|
|
|
RESECTION OF MEDIASTINAL TUMOR
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 39220
|
| Hospital Charge Code |
76101618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$1,817.05 |
| Rate for Payer: Aetna Commercial |
$1,766.34
|
| Rate for Payer: Anthem Medicaid |
$943.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,817.05
|
| Rate for Payer: Healthspan PPO |
$1,412.35
|
| Rate for Payer: Humana Medicaid |
$943.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,524.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$962.55
|
| Rate for Payer: Molina Healthcare Passport |
$943.68
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$953.12
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 55150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
RESECTION OF SCROTUM
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.28 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$784.35
|
| Rate for Payer: Anthem Medicaid |
$354.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$691.74
|
| Rate for Payer: Healthspan PPO |
$759.45
|
| Rate for Payer: Humana Medicaid |
$354.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$361.37
|
| Rate for Payer: Molina Healthcare Passport |
$354.28
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.82
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
