|
RESECT BACK TUM 5 CM/>
|
Facility
|
OP
|
$9,841.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$9,447.36 |
| Rate for Payer: Aetna Commercial |
$7,577.57
|
| Rate for Payer: Anthem Medicaid |
$3,384.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,675.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$4,920.50
|
| Rate for Payer: Cash Price |
$4,920.50
|
| Rate for Payer: Cigna Commercial |
$8,168.03
|
| Rate for Payer: First Health Commercial |
$9,348.95
|
| Rate for Payer: Humana Commercial |
$8,364.85
|
| Rate for Payer: Humana KY Medicaid |
$3,384.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,418.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,069.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,262.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,452.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,660.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,380.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,561.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,790.29
|
| Rate for Payer: PHCS Commercial |
$9,447.36
|
| Rate for Payer: United Healthcare All Payer |
$8,660.08
|
|
|
RESECT BACK TUM 5 CM/>
|
Facility
|
IP
|
$9,841.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,952.30 |
| Max. Negotiated Rate |
$9,447.36 |
| Rate for Payer: Aetna Commercial |
$7,577.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,675.98
|
| Rate for Payer: Cash Price |
$4,920.50
|
| Rate for Payer: Cigna Commercial |
$8,168.03
|
| Rate for Payer: First Health Commercial |
$9,348.95
|
| Rate for Payer: Humana Commercial |
$8,364.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,069.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,262.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,952.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,660.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,380.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,561.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,790.29
|
| Rate for Payer: PHCS Commercial |
$9,447.36
|
| Rate for Payer: United Healthcare All Payer |
$8,660.08
|
|
|
RESECT BACK TUM 5 CM/>
|
Professional
|
Both
|
$9,841.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,046.66 |
| Max. Negotiated Rate |
$5,904.60 |
| Rate for Payer: Aetna Commercial |
$2,229.11
|
| Rate for Payer: Ambetter Exchange |
$1,343.45
|
| Rate for Payer: Anthem Medicaid |
$1,046.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,343.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,343.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,612.14
|
| Rate for Payer: Cash Price |
$4,920.50
|
| Rate for Payer: Cash Price |
$4,920.50
|
| Rate for Payer: Cigna Commercial |
$2,532.94
|
| Rate for Payer: Healthspan PPO |
$1,590.55
|
| Rate for Payer: Humana Medicaid |
$1,046.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,824.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,343.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,067.59
|
| Rate for Payer: Molina Healthcare Passport |
$1,046.66
|
| Rate for Payer: Multiplan PHCS |
$5,904.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,746.48
|
| Rate for Payer: UHCCP Medicaid |
$3,444.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,057.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,343.45
|
|
|
RESECT BACK TUM < 5 CM(P
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761P0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.71 |
| Max. Negotiated Rate |
$1,846.19 |
| Rate for Payer: Aetna Commercial |
$1,720.35
|
| Rate for Payer: Ambetter Exchange |
$968.15
|
| Rate for Payer: Anthem Medicaid |
$710.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$968.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$968.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,161.78
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,846.19
|
| Rate for Payer: Healthspan PPO |
$1,558.27
|
| Rate for Payer: Humana Medicaid |
$710.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,296.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$968.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$724.92
|
| Rate for Payer: Molina Healthcare Passport |
$710.71
|
| Rate for Payer: Multiplan PHCS |
$1,268.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,258.60
|
| Rate for Payer: UHCCP Medicaid |
$739.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$717.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$968.15
|
|
|
RESECT BACK TUM 5 CM/>(P
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761P0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$2,532.94 |
| Rate for Payer: Aetna Commercial |
$2,229.11
|
| Rate for Payer: Ambetter Exchange |
$1,343.45
|
| Rate for Payer: Anthem Medicaid |
$1,046.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,343.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,343.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,612.14
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cash Price |
$1,090.00
|
| Rate for Payer: Cigna Commercial |
$2,532.94
|
| Rate for Payer: Healthspan PPO |
$1,590.55
|
| Rate for Payer: Humana Medicaid |
$1,046.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,824.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,343.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,067.59
|
| Rate for Payer: Molina Healthcare Passport |
$1,046.66
|
| Rate for Payer: Multiplan PHCS |
$1,308.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,746.48
|
| Rate for Payer: UHCCP Medicaid |
$763.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,057.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,343.45
|
|
|
RESECT BACK TUM < 5 CM(T
|
Facility
|
OP
|
$5,942.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761T0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,043.45 |
| Max. Negotiated Rate |
$5,704.32 |
| Rate for Payer: Aetna Commercial |
$4,575.34
|
| Rate for Payer: Anthem Medicaid |
$2,043.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,634.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,971.00
|
| Rate for Payer: Cash Price |
$2,971.00
|
| Rate for Payer: Cigna Commercial |
$4,931.86
|
| Rate for Payer: First Health Commercial |
$5,644.90
|
| Rate for Payer: Humana Commercial |
$5,050.70
|
| Rate for Payer: Humana KY Medicaid |
$2,043.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,064.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,872.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,385.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,084.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,228.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,456.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,169.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.98
|
| Rate for Payer: PHCS Commercial |
$5,704.32
|
| Rate for Payer: United Healthcare All Payer |
$5,228.96
|
|
|
RESECT BACK TUM < 5 CM(T
|
Facility
|
IP
|
$5,942.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761T0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,782.60 |
| Max. Negotiated Rate |
$5,704.32 |
| Rate for Payer: Aetna Commercial |
$4,575.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,634.76
|
| Rate for Payer: Cash Price |
$2,971.00
|
| Rate for Payer: Cigna Commercial |
$4,931.86
|
| Rate for Payer: First Health Commercial |
$5,644.90
|
| Rate for Payer: Humana Commercial |
$5,050.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,872.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,385.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,782.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,228.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,456.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,169.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,099.98
|
| Rate for Payer: PHCS Commercial |
$5,704.32
|
| Rate for Payer: United Healthcare All Payer |
$5,228.96
|
|
|
RESECT BACK TUM 5 CM/>(T
|
Facility
|
OP
|
$7,661.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761T0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,634.62 |
| Max. Negotiated Rate |
$7,354.56 |
| Rate for Payer: Aetna Commercial |
$5,898.97
|
| Rate for Payer: Anthem Medicaid |
$2,634.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,830.50
|
| Rate for Payer: Cash Price |
$3,830.50
|
| Rate for Payer: Cigna Commercial |
$6,358.63
|
| Rate for Payer: First Health Commercial |
$7,277.95
|
| Rate for Payer: Humana Commercial |
$6,511.85
|
| Rate for Payer: Humana KY Medicaid |
$2,634.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,661.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,282.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,687.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,665.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,286.09
|
| Rate for Payer: PHCS Commercial |
$7,354.56
|
| Rate for Payer: United Healthcare All Payer |
$6,741.68
|
|
|
RESECT BACK TUM 5 CM/>(T
|
Facility
|
IP
|
$7,661.00
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
761T0417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,298.30 |
| Max. Negotiated Rate |
$7,354.56 |
| Rate for Payer: Aetna Commercial |
$5,898.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.58
|
| Rate for Payer: Cash Price |
$3,830.50
|
| Rate for Payer: Cigna Commercial |
$6,358.63
|
| Rate for Payer: First Health Commercial |
$7,277.95
|
| Rate for Payer: Humana Commercial |
$6,511.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,282.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,665.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,286.09
|
| Rate for Payer: PHCS Commercial |
$7,354.56
|
| Rate for Payer: United Healthcare All Payer |
$6,741.68
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem Medicaid |
$1,002.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Humana KY Medicaid |
$1,002.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
RESECT/DEBRIDE PANCREAS
|
Facility
|
IP
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
RESECT/DEBRIDE PANCREAS
|
Professional
|
Both
|
$2,915.00
|
|
|
Service Code
|
HCPCS 48105
|
| Hospital Charge Code |
76102811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.25 |
| Max. Negotiated Rate |
$4,118.57 |
| Rate for Payer: Aetna Commercial |
$4,118.57
|
| Rate for Payer: Ambetter Exchange |
$2,682.43
|
| Rate for Payer: Anthem Medicaid |
$1,969.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,682.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,682.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,218.92
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$3,824.84
|
| Rate for Payer: Healthspan PPO |
$3,473.27
|
| Rate for Payer: Humana Medicaid |
$1,969.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,648.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,682.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,009.04
|
| Rate for Payer: Molina Healthcare Passport |
$1,969.65
|
| Rate for Payer: Multiplan PHCS |
$1,749.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,487.16
|
| Rate for Payer: UHCCP Medicaid |
$1,020.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,989.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,682.43
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.50 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem Medicaid |
$345.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Humana KY Medicaid |
$345.62
|
| Rate for Payer: Kentucky WC Medicaid |
$349.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$693.45
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.50 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$693.45
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
RESECT DIAPHRAGM SIMPLE
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
76101623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,212.46 |
| Rate for Payer: Aetna Commercial |
$1,177.18
|
| Rate for Payer: Ambetter Exchange |
$762.45
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$914.94
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,212.46
|
| Rate for Payer: Healthspan PPO |
$941.26
|
| Rate for Payer: Humana Medicaid |
$602.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$762.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$614.56
|
| Rate for Payer: Molina Healthcare Passport |
$602.51
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$991.18
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$608.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.45
|
|
|
RESECT DIAPHRAGM SIMPLE(P
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 39560
|
| Hospital Charge Code |
761P1623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,212.46 |
| Rate for Payer: Aetna Commercial |
$1,177.18
|
| Rate for Payer: Ambetter Exchange |
$762.45
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$914.94
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,212.46
|
| Rate for Payer: Healthspan PPO |
$941.26
|
| Rate for Payer: Humana Medicaid |
$602.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$762.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$614.56
|
| Rate for Payer: Molina Healthcare Passport |
$602.51
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$991.18
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$608.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.45
|
|
|
RESECT FACE TUM = 2 CM
|
Professional
|
Both
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.32 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$1,604.18
|
| Rate for Payer: Ambetter Exchange |
$951.29
|
| Rate for Payer: Anthem Medicaid |
$756.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$951.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$951.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,141.55
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$1,828.61
|
| Rate for Payer: Healthspan PPO |
$1,144.70
|
| Rate for Payer: Humana Medicaid |
$756.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,328.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$951.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.45
|
| Rate for Payer: Molina Healthcare Passport |
$756.32
|
| Rate for Payer: Multiplan PHCS |
$4,267.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,236.68
|
| Rate for Payer: UHCCP Medicaid |
$2,489.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$951.29
|
|
|
RESECT FACE TUM = 2 CM
|
Facility
|
OP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,445.82 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem Medicaid |
$2,445.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Humana KY Medicaid |
$2,445.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,187.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,907.28
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
RESECT FACE TUM = 2 CM
|
Facility
|
IP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,133.60 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,187.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,907.28
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
RESECT FACE TUM = 2 CM(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761P0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,828.61 |
| Rate for Payer: Aetna Commercial |
$1,604.18
|
| Rate for Payer: Ambetter Exchange |
$951.29
|
| Rate for Payer: Anthem Medicaid |
$756.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$951.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$951.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,141.55
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,828.61
|
| Rate for Payer: Healthspan PPO |
$1,144.70
|
| Rate for Payer: Humana Medicaid |
$756.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,328.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$951.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.45
|
| Rate for Payer: Molina Healthcare Passport |
$756.32
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,236.68
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$951.29
|
|
|
RESECT FACE TUM = 2 CM(T
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761T0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,683.60 |
| Max. Negotiated Rate |
$5,387.52 |
| Rate for Payer: Aetna Commercial |
$4,321.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.36
|
| Rate for Payer: Cash Price |
$2,806.00
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: First Health Commercial |
$5,331.40
|
| Rate for Payer: Humana Commercial |
$4,770.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,938.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,882.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,872.28
|
| Rate for Payer: PHCS Commercial |
$5,387.52
|
| Rate for Payer: United Healthcare All Payer |
$4,938.56
|
|
|
RESECT FACE TUM = 2 CM(T
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 21016
|
| Hospital Charge Code |
761T0367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,929.97 |
| Max. Negotiated Rate |
$5,387.52 |
| Rate for Payer: Aetna Commercial |
$4,321.24
|
| Rate for Payer: Anthem Medicaid |
$1,929.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,806.00
|
| Rate for Payer: Cash Price |
$2,806.00
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: First Health Commercial |
$5,331.40
|
| Rate for Payer: Humana Commercial |
$4,770.20
|
| Rate for Payer: Humana KY Medicaid |
$1,929.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,938.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,882.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,872.28
|
| Rate for Payer: PHCS Commercial |
$5,387.52
|
| Rate for Payer: United Healthcare All Payer |
$4,938.56
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RESECT FOOT/TOE TUMOR 3 CM/>
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 28047
|
| Hospital Charge Code |
76100971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.21 |
| Max. Negotiated Rate |
$1,665.57 |
| Rate for Payer: Aetna Commercial |
$1,446.60
|
| Rate for Payer: Ambetter Exchange |
$988.77
|
| Rate for Payer: Anthem Medicaid |
$700.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$988.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$988.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,186.52
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,665.57
|
| Rate for Payer: Healthspan PPO |
$1,030.88
|
| Rate for Payer: Humana Medicaid |
$700.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$988.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$714.21
|
| Rate for Payer: Molina Healthcare Passport |
$700.21
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,285.40
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$707.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$988.77
|
|
