|
RESECTION OF SCROTUM
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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: 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 |
$360.00
|
| 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
|
|
|
RESECTION OF SCROTUM(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
761P2147
|
|
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
|
|
|
RESECT LEG/ANKLE TUM > 5 CM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27616
|
| Hospital Charge Code |
76100895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RESECT LEG/ANKLE TUM > 5 CM
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27616
|
| Hospital Charge Code |
76100895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,255.55 |
| Rate for Payer: Aetna Commercial |
$1,982.84
|
| Rate for Payer: Anthem Medicaid |
$932.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,255.55
|
| Rate for Payer: Healthspan PPO |
$1,415.04
|
| Rate for Payer: Humana Medicaid |
$932.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,631.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.96
|
| Rate for Payer: Molina Healthcare Passport |
$932.31
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$941.63
|
|
|
RESECT LEG/ANKLE TUM > 5 CM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27616
|
| Hospital Charge Code |
76100895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RESECT LEG/ANKLE TUM > 5 CM(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27616
|
| Hospital Charge Code |
761P0895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,255.55 |
| Rate for Payer: Aetna Commercial |
$1,982.84
|
| Rate for Payer: Anthem Medicaid |
$932.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,255.55
|
| Rate for Payer: Healthspan PPO |
$1,415.04
|
| Rate for Payer: Humana Medicaid |
$932.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,631.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.96
|
| Rate for Payer: Molina Healthcare Passport |
$932.31
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$941.63
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Facility
|
IP
|
$9,863.72
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,282.28 |
| Max. Negotiated Rate |
$9,469.17 |
| Rate for Payer: Aetna Commercial |
$7,595.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.70
|
| Rate for Payer: Cash Price |
$4,931.86
|
| Rate for Payer: Cigna Commercial |
$8,186.89
|
| Rate for Payer: First Health Commercial |
$9,370.53
|
| Rate for Payer: Humana Commercial |
$8,384.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,088.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,959.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,680.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,397.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,972.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.75
|
| Rate for Payer: PHCS Commercial |
$9,469.17
|
| Rate for Payer: United Healthcare All Payer |
$8,680.07
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Professional
|
Both
|
$9,863.72
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.43 |
| Max. Negotiated Rate |
$9,863.72 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: Anthem Medicaid |
$513.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,863.72
|
| Rate for Payer: Cash Price |
$4,931.86
|
| Rate for Payer: Cash Price |
$4,931.86
|
| Rate for Payer: Cigna Commercial |
$923.56
|
| Rate for Payer: Healthspan PPO |
$770.68
|
| Rate for Payer: Humana Medicaid |
$513.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,124.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.70
|
| Rate for Payer: Molina Healthcare Passport |
$513.43
|
| Rate for Payer: Multiplan PHCS |
$5,918.23
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,904.60
|
| Rate for Payer: UHCCP Medicaid |
$3,452.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.56
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Facility
|
OP
|
$9,863.72
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,282.28 |
| Max. Negotiated Rate |
$9,469.17 |
| Rate for Payer: Aetna Commercial |
$7,595.06
|
| Rate for Payer: Anthem Medicaid |
$3,392.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.70
|
| 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 |
$4,931.86
|
| Rate for Payer: Cash Price |
$4,931.86
|
| Rate for Payer: Cigna Commercial |
$8,186.89
|
| Rate for Payer: First Health Commercial |
$9,370.53
|
| Rate for Payer: Humana Commercial |
$8,384.16
|
| Rate for Payer: Humana KY Medicaid |
$3,392.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,426.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,088.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,460.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,680.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,397.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,972.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.75
|
| Rate for Payer: PHCS Commercial |
$9,469.17
|
| Rate for Payer: United Healthcare All Payer |
$8,680.07
|
|
|
RESECT NECK THORAX TUMOR<5C(P
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
761P0397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.43 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: Anthem Medicaid |
$513.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$923.56
|
| Rate for Payer: Healthspan PPO |
$770.68
|
| Rate for Payer: Humana Medicaid |
$513.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,124.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.70
|
| Rate for Payer: Molina Healthcare Passport |
$513.43
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.56
|
|
|
RESECT NECK THORAX TUMOR<5C(T
|
Facility
|
OP
|
$7,413.72
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
761T0397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$963.78 |
| Max. Negotiated Rate |
$7,117.17 |
| Rate for Payer: Aetna Commercial |
$5,708.56
|
| Rate for Payer: Anthem Medicaid |
$2,549.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.70
|
| 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 |
$3,706.86
|
| Rate for Payer: Cash Price |
$3,706.86
|
| Rate for Payer: Cigna Commercial |
$6,153.39
|
| Rate for Payer: First Health Commercial |
$7,043.03
|
| Rate for Payer: Humana Commercial |
$6,301.66
|
| Rate for Payer: Humana KY Medicaid |
$2,549.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,524.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.25
|
| Rate for Payer: PHCS Commercial |
$7,117.17
|
| Rate for Payer: United Healthcare All Payer |
$6,524.07
|
|
|
RESECT NECK THORAX TUMOR<5C(T
|
Facility
|
IP
|
$7,413.72
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
761T0397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$963.78 |
| Max. Negotiated Rate |
$7,117.17 |
| Rate for Payer: Aetna Commercial |
$5,708.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.70
|
| Rate for Payer: Cash Price |
$3,706.86
|
| Rate for Payer: Cigna Commercial |
$6,153.39
|
| Rate for Payer: First Health Commercial |
$7,043.03
|
| Rate for Payer: Humana Commercial |
$6,301.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,524.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.25
|
| Rate for Payer: PHCS Commercial |
$7,117.17
|
| Rate for Payer: United Healthcare All Payer |
$6,524.07
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Professional
|
Both
|
$11,523.59
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$11,523.59 |
| Rate for Payer: Aetna Commercial |
$2,136.07
|
| Rate for Payer: Anthem Medicaid |
$1,006.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,523.59
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cigna Commercial |
$2,431.43
|
| Rate for Payer: Healthspan PPO |
$1,523.73
|
| Rate for Payer: Humana Medicaid |
$1,006.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,746.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,026.32
|
| Rate for Payer: Molina Healthcare Passport |
$1,006.20
|
| Rate for Payer: Multiplan PHCS |
$6,914.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,066.51
|
| Rate for Payer: UHCCP Medicaid |
$4,033.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,016.26
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Facility
|
IP
|
$11,523.59
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,498.07 |
| Max. Negotiated Rate |
$11,062.65 |
| Rate for Payer: Aetna Commercial |
$8,873.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,988.40
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cigna Commercial |
$9,564.58
|
| Rate for Payer: First Health Commercial |
$10,947.41
|
| Rate for Payer: Humana Commercial |
$9,795.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,449.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,504.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,457.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,140.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,572.31
|
| Rate for Payer: PHCS Commercial |
$11,062.65
|
| Rate for Payer: United Healthcare All Payer |
$10,140.76
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Facility
|
OP
|
$11,523.59
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,498.07 |
| Max. Negotiated Rate |
$11,062.65 |
| Rate for Payer: Aetna Commercial |
$8,873.16
|
| Rate for Payer: Anthem Medicaid |
$3,962.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,988.40
|
| 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 |
$5,761.80
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cigna Commercial |
$9,564.58
|
| Rate for Payer: First Health Commercial |
$10,947.41
|
| Rate for Payer: Humana Commercial |
$9,795.05
|
| Rate for Payer: Humana KY Medicaid |
$3,962.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,003.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,449.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,504.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,042.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,140.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,304.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,572.31
|
| Rate for Payer: PHCS Commercial |
$11,062.65
|
| Rate for Payer: United Healthcare All Payer |
$10,140.76
|
|
|
RESECT NECK TUMOR 5 CM/>(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
761P0398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,136.07
|
| Rate for Payer: Anthem Medicaid |
$1,006.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,431.43
|
| Rate for Payer: Healthspan PPO |
$1,523.73
|
| Rate for Payer: Humana Medicaid |
$1,006.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,746.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,026.32
|
| Rate for Payer: Molina Healthcare Passport |
$1,006.20
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,016.26
|
|
|
RESECT NECK TUMOR 5 CM/>(T
|
Facility
|
OP
|
$8,523.59
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
761T0398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,108.07 |
| Max. Negotiated Rate |
$8,182.65 |
| Rate for Payer: Aetna Commercial |
$6,563.16
|
| Rate for Payer: Anthem Medicaid |
$2,931.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.40
|
| 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 |
$4,261.80
|
| Rate for Payer: Cash Price |
$4,261.80
|
| Rate for Payer: Cigna Commercial |
$7,074.58
|
| Rate for Payer: First Health Commercial |
$8,097.41
|
| Rate for Payer: Humana Commercial |
$7,245.05
|
| Rate for Payer: Humana KY Medicaid |
$2,931.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,500.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,392.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.31
|
| Rate for Payer: PHCS Commercial |
$8,182.65
|
| Rate for Payer: United Healthcare All Payer |
$7,500.76
|
|
|
RESECT NECK TUMOR 5 CM/>(T
|
Facility
|
IP
|
$8,523.59
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
761T0398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,108.07 |
| Max. Negotiated Rate |
$8,182.65 |
| Rate for Payer: Aetna Commercial |
$6,563.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.40
|
| Rate for Payer: Cash Price |
$4,261.80
|
| Rate for Payer: Cigna Commercial |
$7,074.58
|
| Rate for Payer: First Health Commercial |
$8,097.41
|
| Rate for Payer: Humana Commercial |
$7,245.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,500.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,392.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.31
|
| Rate for Payer: PHCS Commercial |
$8,182.65
|
| Rate for Payer: United Healthcare All Payer |
$7,500.76
|
|
|
RESECT SHOULDER TUMOR 5 CM/>
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 23078
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem Medicaid |
$701.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| 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 |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Humana KY Medicaid |
$701.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$708.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.40
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
RESECT SHOULDER TUMOR 5 CM/>
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 23078
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$2,470.88 |
| Rate for Payer: Aetna Commercial |
$2,178.38
|
| Rate for Payer: Anthem Medicaid |
$1,020.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,040.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,470.88
|
| Rate for Payer: Healthspan PPO |
$1,553.89
|
| Rate for Payer: Humana Medicaid |
$1,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,779.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,040.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,020.16
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,428.00
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.36
|
|
|
RESECT SHOULDER TUMOR 5 CM/>
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 23078
|
| Hospital Charge Code |
76100441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.40
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
RESECT SHOULDER TUMOR 5 CM/(P
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 23078
|
| Hospital Charge Code |
761P0441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$2,470.88 |
| Rate for Payer: Aetna Commercial |
$2,178.38
|
| Rate for Payer: Anthem Medicaid |
$1,020.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,040.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,470.88
|
| Rate for Payer: Healthspan PPO |
$1,553.89
|
| Rate for Payer: Humana Medicaid |
$1,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,779.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,040.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,020.16
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,428.00
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.36
|
|
|
RESECT THIGH/KNEE TUM < 5 CM
|
Professional
|
Both
|
$3,950.00
|
|
|
Service Code
|
HCPCS 27329
|
| Hospital Charge Code |
76100815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.04 |
| Max. Negotiated Rate |
$3,950.00 |
| Rate for Payer: Aetna Commercial |
$1,531.36
|
| Rate for Payer: Anthem Medicaid |
$710.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,950.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$1,634.19
|
| Rate for Payer: Healthspan PPO |
$1,387.08
|
| Rate for Payer: Humana Medicaid |
$710.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,303.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$724.24
|
| Rate for Payer: Molina Healthcare Passport |
$710.04
|
| Rate for Payer: Multiplan PHCS |
$2,370.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,765.00
|
| Rate for Payer: UHCCP Medicaid |
$1,382.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$717.14
|
|
|
RESECT THIGH/KNEE TUM < 5 CM
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS 27329
|
| Hospital Charge Code |
76100815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RESECT THIGH/KNEE TUM < 5 CM
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS 27329
|
| Hospital Charge Code |
76100815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| 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 |
$1,975.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
