|
RESECTION OF SCROTUM
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.28 |
| Max. Negotiated Rate |
$784.35 |
| Rate for Payer: Aetna Commercial |
$784.35
|
| Rate for Payer: Ambetter Exchange |
$467.75
|
| Rate for Payer: Anthem Medicaid |
$354.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$561.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$467.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.75
|
| 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 |
$608.08
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.75
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 55150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
RESECTION OF SCROTUM
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
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
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| 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
|
|
|
RESECTION OF SCROTUM
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 55150
|
| Hospital Charge Code |
76102147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
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 |
$784.35 |
| Rate for Payer: Aetna Commercial |
$784.35
|
| Rate for Payer: Ambetter Exchange |
$467.75
|
| Rate for Payer: Anthem Medicaid |
$354.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$561.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$467.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.75
|
| 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 |
$608.08
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.75
|
|
|
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 |
$687.80 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RESECT LEG/ANKLE TUM > 5 CM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27616
|
| Hospital Charge Code |
76100895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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: Ambetter Exchange |
$1,185.94
|
| Rate for Payer: Anthem Medicaid |
$932.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,185.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,423.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,185.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.94
|
| 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 |
$1,541.72
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$941.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,185.94
|
|
|
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: Ambetter Exchange |
$1,185.94
|
| Rate for Payer: Anthem Medicaid |
$932.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,185.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,423.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,185.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.94
|
| 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 |
$1,541.72
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$941.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,185.94
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Facility
|
IP
|
$9,864.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,959.20 |
| Max. Negotiated Rate |
$9,469.44 |
| Rate for Payer: Aetna Commercial |
$7,595.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.92
|
| Rate for Payer: Cash Price |
$4,932.00
|
| Rate for Payer: Cigna Commercial |
$8,187.12
|
| Rate for Payer: First Health Commercial |
$9,370.80
|
| Rate for Payer: Humana Commercial |
$8,384.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,088.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,279.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,959.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,680.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,581.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.16
|
| Rate for Payer: PHCS Commercial |
$9,469.44
|
| Rate for Payer: United Healthcare All Payer |
$8,680.32
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Professional
|
Both
|
$9,864.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.43 |
| Max. Negotiated Rate |
$5,918.40 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: Ambetter Exchange |
$904.94
|
| Rate for Payer: Anthem Medicaid |
$513.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$904.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$904.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,085.93
|
| Rate for Payer: Cash Price |
$4,932.00
|
| Rate for Payer: Cash Price |
$4,932.00
|
| Rate for Payer: Cigna Commercial |
$923.56
|
| Rate for Payer: Healthspan PPO |
$770.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$904.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.70
|
| Rate for Payer: Molina Healthcare Passport |
$513.43
|
| Rate for Payer: Multiplan PHCS |
$5,918.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,176.42
|
| Rate for Payer: UHCCP Medicaid |
$3,452.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$904.94
|
|
|
RESECT NECK THORAX TUMOR<5CM
|
Facility
|
OP
|
$9,864.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
76100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$9,469.44 |
| Rate for Payer: Aetna Commercial |
$7,595.28
|
| Rate for Payer: Anthem Medicaid |
$3,392.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.92
|
| 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 |
$4,932.00
|
| Rate for Payer: Cash Price |
$4,932.00
|
| Rate for Payer: Cigna Commercial |
$8,187.12
|
| Rate for Payer: First Health Commercial |
$9,370.80
|
| Rate for Payer: Humana Commercial |
$8,384.40
|
| Rate for Payer: Humana KY Medicaid |
$3,392.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,426.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,088.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,279.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,460.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,680.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,581.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.16
|
| Rate for Payer: PHCS Commercial |
$9,469.44
|
| Rate for Payer: United Healthcare All Payer |
$8,680.32
|
|
|
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 |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: Ambetter Exchange |
$904.94
|
| Rate for Payer: Anthem Medicaid |
$513.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$904.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$904.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,085.93
|
| 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 |
$770.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$904.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.94
|
| 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 |
$1,176.42
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$904.94
|
|
|
RESECT NECK THORAX TUMOR<5C(T
|
Facility
|
OP
|
$7,414.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
761T0397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,549.67 |
| Max. Negotiated Rate |
$7,117.44 |
| Rate for Payer: Aetna Commercial |
$5,708.78
|
| Rate for Payer: Anthem Medicaid |
$2,549.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.92
|
| 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 |
$3,707.00
|
| Rate for Payer: Cash Price |
$3,707.00
|
| Rate for Payer: Cigna Commercial |
$6,153.62
|
| Rate for Payer: First Health Commercial |
$7,043.30
|
| Rate for Payer: Humana Commercial |
$6,301.90
|
| Rate for Payer: Humana KY Medicaid |
$2,549.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,524.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,931.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,450.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,115.66
|
| Rate for Payer: PHCS Commercial |
$7,117.44
|
| Rate for Payer: United Healthcare All Payer |
$6,524.32
|
|
|
RESECT NECK THORAX TUMOR<5C(T
|
Facility
|
IP
|
$7,414.00
|
|
|
Service Code
|
HCPCS 21557
|
| Hospital Charge Code |
761T0397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,224.20 |
| Max. Negotiated Rate |
$7,117.44 |
| Rate for Payer: Aetna Commercial |
$5,708.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.92
|
| Rate for Payer: Cash Price |
$3,707.00
|
| Rate for Payer: Cigna Commercial |
$6,153.62
|
| Rate for Payer: First Health Commercial |
$7,043.30
|
| Rate for Payer: Humana Commercial |
$6,301.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,079.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,471.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,524.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,560.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,931.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,450.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,115.66
|
| Rate for Payer: PHCS Commercial |
$7,117.44
|
| Rate for Payer: United Healthcare All Payer |
$6,524.32
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Professional
|
Both
|
$11,524.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$6,914.40 |
| Rate for Payer: Aetna Commercial |
$2,136.07
|
| Rate for Payer: Ambetter Exchange |
$1,272.09
|
| Rate for Payer: Anthem Medicaid |
$1,006.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,272.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,272.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,526.51
|
| Rate for Payer: Cash Price |
$5,762.00
|
| Rate for Payer: Cash Price |
$5,762.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,272.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,026.32
|
| Rate for Payer: Molina Healthcare Passport |
$1,006.20
|
| Rate for Payer: Multiplan PHCS |
$6,914.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,653.72
|
| Rate for Payer: UHCCP Medicaid |
$4,033.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,016.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,272.09
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Facility
|
IP
|
$11,524.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,457.20 |
| Max. Negotiated Rate |
$11,063.04 |
| Rate for Payer: Aetna Commercial |
$8,873.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,988.72
|
| Rate for Payer: Cash Price |
$5,762.00
|
| Rate for Payer: Cigna Commercial |
$9,564.92
|
| Rate for Payer: First Health Commercial |
$10,947.80
|
| Rate for Payer: Humana Commercial |
$9,795.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,449.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,504.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,457.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,141.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,643.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,025.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,951.56
|
| Rate for Payer: PHCS Commercial |
$11,063.04
|
| Rate for Payer: United Healthcare All Payer |
$10,141.12
|
|
|
RESECT NECK TUMOR 5 CM/>
|
Facility
|
OP
|
$11,524.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
76100398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$11,063.04 |
| Rate for Payer: Aetna Commercial |
$8,873.48
|
| Rate for Payer: Anthem Medicaid |
$3,963.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,988.72
|
| 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 |
$5,762.00
|
| Rate for Payer: Cash Price |
$5,762.00
|
| Rate for Payer: Cigna Commercial |
$9,564.92
|
| Rate for Payer: First Health Commercial |
$10,947.80
|
| Rate for Payer: Humana Commercial |
$9,795.40
|
| Rate for Payer: Humana KY Medicaid |
$3,963.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,003.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,449.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,504.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,042.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,141.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,643.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,025.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,951.56
|
| Rate for Payer: PHCS Commercial |
$11,063.04
|
| Rate for Payer: United Healthcare All Payer |
$10,141.12
|
|
|
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 |
$2,431.43 |
| Rate for Payer: Aetna Commercial |
$2,136.07
|
| Rate for Payer: Ambetter Exchange |
$1,272.09
|
| Rate for Payer: Anthem Medicaid |
$1,006.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,272.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,272.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,526.51
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,272.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.09
|
| 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 |
$1,653.72
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,016.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,272.09
|
|
|
RESECT NECK TUMOR 5 CM/>(T
|
Facility
|
IP
|
$8,524.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
761T0398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,557.20 |
| Max. Negotiated Rate |
$8,183.04 |
| Rate for Payer: Aetna Commercial |
$6,563.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.72
|
| Rate for Payer: Cash Price |
$4,262.00
|
| Rate for Payer: Cigna Commercial |
$7,074.92
|
| Rate for Payer: First Health Commercial |
$8,097.80
|
| Rate for Payer: Humana Commercial |
$7,245.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,415.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,881.56
|
| Rate for Payer: PHCS Commercial |
$8,183.04
|
| Rate for Payer: United Healthcare All Payer |
$7,501.12
|
|
|
RESECT NECK TUMOR 5 CM/>(T
|
Facility
|
OP
|
$8,524.00
|
|
|
Service Code
|
HCPCS 21558
|
| Hospital Charge Code |
761T0398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$8,183.04 |
| Rate for Payer: Aetna Commercial |
$6,563.48
|
| Rate for Payer: Anthem Medicaid |
$2,931.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.72
|
| 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 |
$4,262.00
|
| Rate for Payer: Cash Price |
$4,262.00
|
| Rate for Payer: Cigna Commercial |
$7,074.92
|
| Rate for Payer: First Health Commercial |
$8,097.80
|
| Rate for Payer: Humana Commercial |
$7,245.40
|
| Rate for Payer: Humana KY Medicaid |
$2,931.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,415.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,881.56
|
| Rate for Payer: PHCS Commercial |
$8,183.04
|
| Rate for Payer: United Healthcare All Payer |
$7,501.12
|
|
|
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 |
$612.00 |
| 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 |
$1,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.60
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
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 |
$701.56 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem Medicaid |
$701.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| 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 |
$1,020.00
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$1,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.60
|
| 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: Ambetter Exchange |
$1,370.52
|
| Rate for Payer: Anthem Medicaid |
$1,020.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,370.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,370.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,644.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,370.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.52
|
| 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 |
$1,781.68
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,370.52
|
|
