|
REMOVE MUTI-COMP PENIS PROS
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.42 |
| Max. Negotiated Rate |
$1,191.81 |
| Rate for Payer: Aetna Commercial |
$1,191.81
|
| Rate for Payer: Ambetter Exchange |
$692.44
|
| Rate for Payer: Anthem Medicaid |
$525.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.93
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,057.93
|
| Rate for Payer: Healthspan PPO |
$1,153.97
|
| Rate for Payer: Humana Medicaid |
$525.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$995.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$535.93
|
| Rate for Payer: Molina Healthcare Passport |
$525.42
|
| Rate for Payer: Multiplan PHCS |
$1,072.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.17
|
| Rate for Payer: UHCCP Medicaid |
$625.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.44
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.40 |
| Max. Negotiated Rate |
$1,716.48 |
| Rate for Payer: Aetna Commercial |
$1,376.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.64
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,484.04
|
| Rate for Payer: First Health Commercial |
$1,698.60
|
| Rate for Payer: Humana Commercial |
$1,519.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.72
|
| Rate for Payer: PHCS Commercial |
$1,716.48
|
| Rate for Payer: United Healthcare All Payer |
$1,573.44
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$614.89 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,376.76
|
| Rate for Payer: Anthem Medicaid |
$614.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,484.04
|
| Rate for Payer: First Health Commercial |
$1,698.60
|
| Rate for Payer: Humana Commercial |
$1,519.80
|
| Rate for Payer: Humana KY Medicaid |
$614.89
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.72
|
| Rate for Payer: PHCS Commercial |
$1,716.48
|
| Rate for Payer: United Healthcare All Payer |
$1,573.44
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
45000207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem Medicaid |
$120.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Humana KY Medicaid |
$120.71
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
45000207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
REMOVE NASAL FOREIGN BODY
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Ambetter Exchange |
$111.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.02
|
| Rate for Payer: Anthem Medicaid |
$42.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.94
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Healthspan PPO |
$251.84
|
| Rate for Payer: Humana Medicaid |
$42.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.45
|
| Rate for Payer: Molina Healthcare Passport |
$42.60
|
| Rate for Payer: Multiplan PHCS |
$489.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.11
|
| Rate for Payer: UHCCP Medicaid |
$67.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.62
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
REMOVE NASAL FOREIGN BODY(P
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761P1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Ambetter Exchange |
$111.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.02
|
| Rate for Payer: Anthem Medicaid |
$42.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.94
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Healthspan PPO |
$251.84
|
| Rate for Payer: Humana Medicaid |
$42.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.45
|
| Rate for Payer: Molina Healthcare Passport |
$42.60
|
| Rate for Payer: Multiplan PHCS |
$279.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.11
|
| Rate for Payer: UHCCP Medicaid |
$67.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.62
|
|
|
REMOVE NASAL FOREIGN BODY(T
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761T1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem Medicaid |
$120.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Humana KY Medicaid |
$120.71
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
REMOVE NASAL FOREIGN BODY(T
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761T1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
REMOVE NERVE LESION
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| 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 |
$1,804.32
|
| 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 |
$2,165.18
|
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REMOVE NERVE LESION
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| 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 |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REMOVE NERVE LESION
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,136.53 |
| Rate for Payer: Aetna Commercial |
$1,136.53
|
| Rate for Payer: Ambetter Exchange |
$692.45
|
| Rate for Payer: Anthem Medicaid |
$452.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.94
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,037.15
|
| Rate for Payer: Healthspan PPO |
$887.37
|
| Rate for Payer: Humana Medicaid |
$452.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.23
|
| Rate for Payer: Molina Healthcare Passport |
$452.19
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.18
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.45
|
|
|
REMOVE NERVE LESION(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
761P2369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,136.53 |
| Rate for Payer: Aetna Commercial |
$1,136.53
|
| Rate for Payer: Ambetter Exchange |
$692.45
|
| Rate for Payer: Anthem Medicaid |
$452.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.94
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,037.15
|
| Rate for Payer: Healthspan PPO |
$887.37
|
| Rate for Payer: Humana Medicaid |
$452.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.23
|
| Rate for Payer: Molina Healthcare Passport |
$452.19
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.18
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.45
|
|
|
REMOVE PALATE/LESION
|
Professional
|
Both
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$5,518.20 |
| Rate for Payer: Aetna Commercial |
$1,365.47
|
| Rate for Payer: Ambetter Exchange |
$929.50
|
| Rate for Payer: Anthem Medicaid |
$367.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.40
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$1,330.11
|
| Rate for Payer: Healthspan PPO |
$1,151.52
|
| Rate for Payer: Humana Medicaid |
$367.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,263.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$929.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.13
|
| Rate for Payer: Molina Healthcare Passport |
$367.77
|
| Rate for Payer: Multiplan PHCS |
$5,518.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,208.35
|
| Rate for Payer: UHCCP Medicaid |
$3,218.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.50
|
|
|
REMOVE PALATE/LESION
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,162.85 |
| Max. Negotiated Rate |
$8,829.12 |
| Rate for Payer: Aetna Commercial |
$7,081.69
|
| Rate for Payer: Anthem Medicaid |
$3,162.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$7,633.51
|
| Rate for Payer: First Health Commercial |
$8,737.15
|
| Rate for Payer: Humana Commercial |
$7,817.45
|
| Rate for Payer: Humana KY Medicaid |
$3,162.85
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,195.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,226.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,093.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,001.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,345.93
|
| Rate for Payer: PHCS Commercial |
$8,829.12
|
| Rate for Payer: United Healthcare All Payer |
$8,093.36
|
|
|
REMOVE PALATE/LESION
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,759.10 |
| Max. Negotiated Rate |
$8,829.12 |
| Rate for Payer: Aetna Commercial |
$7,081.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.66
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$7,633.51
|
| Rate for Payer: First Health Commercial |
$8,737.15
|
| Rate for Payer: Humana Commercial |
$7,817.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,759.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,093.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,001.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,345.93
|
| Rate for Payer: PHCS Commercial |
$8,829.12
|
| Rate for Payer: United Healthcare All Payer |
$8,093.36
|
|
|
REMOVE PALATE/LESION(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761P1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$1,365.47 |
| Rate for Payer: Aetna Commercial |
$1,365.47
|
| Rate for Payer: Ambetter Exchange |
$929.50
|
| Rate for Payer: Anthem Medicaid |
$367.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,330.11
|
| Rate for Payer: Healthspan PPO |
$1,151.52
|
| Rate for Payer: Humana Medicaid |
$367.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,263.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$929.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.13
|
| Rate for Payer: Molina Healthcare Passport |
$367.77
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,208.35
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.50
|
|
|
REMOVE PALATE/LESION(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761T1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,389.07 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem Medicaid |
$2,389.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Humana KY Medicaid |
$2,389.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.43
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
REMOVE PALATE/LESION(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761T1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,084.10 |
| Max. Negotiated Rate |
$6,669.12 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.43
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
REMOVE PELVIS LYMPH NODES
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.20 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna Commercial |
$1,269.61
|
| Rate for Payer: Ambetter Exchange |
$763.20
|
| Rate for Payer: Anthem Medicaid |
$810.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$763.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$915.84
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,155.08
|
| Rate for Payer: Healthspan PPO |
$1,015.17
|
| Rate for Payer: Humana Medicaid |
$810.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,039.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$763.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.35
|
| Rate for Payer: Molina Healthcare Passport |
$810.15
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$992.16
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$763.20
|
|
|
REMOVE PELVIS LYMPH NODES
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
REMOVE PELVIS LYMPH NODES
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
REMOVE PELVIS LYMPH NODES(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
761P1610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.20 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna Commercial |
$1,269.61
|
| Rate for Payer: Ambetter Exchange |
$763.20
|
| Rate for Payer: Anthem Medicaid |
$810.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$763.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$915.84
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,155.08
|
| Rate for Payer: Healthspan PPO |
$1,015.17
|
| Rate for Payer: Humana Medicaid |
$810.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,039.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$763.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.35
|
| Rate for Payer: Molina Healthcare Passport |
$810.15
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$992.16
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$763.20
|
|
