|
EXCI LES MNSCS/CPSL (GANGLION)
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$740.76
|
| Rate for Payer: Anthem Medicaid |
$247.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$793.25
|
| Rate for Payer: Healthspan PPO |
$670.97
|
| Rate for Payer: Humana Medicaid |
$247.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.29
|
| Rate for Payer: Molina Healthcare Passport |
$247.34
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.81
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
761P0822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$740.76
|
| Rate for Payer: Anthem Medicaid |
$247.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$793.25
|
| Rate for Payer: Healthspan PPO |
$670.97
|
| Rate for Payer: Humana Medicaid |
$247.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.29
|
| Rate for Payer: Molina Healthcare Passport |
$247.34
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.81
|
|
|
EXC INTRACARDIAC TUMOR
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
EXC INTRACARDIAC TUMOR
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem Medicaid |
$1,925.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Humana KY Medicaid |
$1,925.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
EXC INTRACARDIAC TUMOR
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,562.79 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$2,649.93
|
| Rate for Payer: Anthem Medicaid |
$1,562.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,600.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$2,486.81
|
| Rate for Payer: Healthspan PPO |
$2,605.40
|
| Rate for Payer: Humana Medicaid |
$1,562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,179.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,594.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,562.79
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,920.00
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,578.42
|
|
|
EXC INTRACARDIAC TUMOR(P
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
761P1240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,562.79 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$2,649.93
|
| Rate for Payer: Anthem Medicaid |
$1,562.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,600.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$2,486.81
|
| Rate for Payer: Healthspan PPO |
$2,605.40
|
| Rate for Payer: Humana Medicaid |
$1,562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,179.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,594.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,562.79
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,920.00
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,578.42
|
|
|
EXC I PRESSURE ULCER
|
Professional
|
Both
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.71 |
| Max. Negotiated Rate |
$9,203.70 |
| Rate for Payer: Aetna Commercial |
$1,287.73
|
| Rate for Payer: Anthem Medicaid |
$520.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,203.70
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$1,254.18
|
| Rate for Payer: Healthspan PPO |
$1,029.66
|
| Rate for Payer: Humana Medicaid |
$520.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,117.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$531.12
|
| Rate for Payer: Molina Healthcare Passport |
$520.71
|
| Rate for Payer: Multiplan PHCS |
$5,522.22
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,442.59
|
| Rate for Payer: UHCCP Medicaid |
$3,221.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.92
|
|
|
EXC I PRESSURE ULCER
|
Facility
|
OP
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,196.48 |
| Max. Negotiated Rate |
$8,835.55 |
| Rate for Payer: Aetna Commercial |
$7,086.85
|
| Rate for Payer: Anthem Medicaid |
$3,165.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,178.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$7,639.07
|
| Rate for Payer: First Health Commercial |
$8,743.52
|
| Rate for Payer: Humana Commercial |
$7,823.14
|
| Rate for Payer: Humana KY Medicaid |
$3,165.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,228.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.15
|
| Rate for Payer: PHCS Commercial |
$8,835.55
|
| Rate for Payer: United Healthcare All Payer |
$8,099.26
|
|
|
EXC I PRESSURE ULCER
|
Facility
|
IP
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,196.48 |
| Max. Negotiated Rate |
$8,835.55 |
| Rate for Payer: Aetna Commercial |
$7,086.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,178.89
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$7,639.07
|
| Rate for Payer: First Health Commercial |
$8,743.52
|
| Rate for Payer: Humana Commercial |
$7,823.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.15
|
| Rate for Payer: PHCS Commercial |
$8,835.55
|
| Rate for Payer: United Healthcare All Payer |
$8,099.26
|
|
|
EXC I PRESSURE ULCER(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761P0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.71 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,287.73
|
| Rate for Payer: Anthem Medicaid |
$520.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,254.18
|
| Rate for Payer: Healthspan PPO |
$1,029.66
|
| Rate for Payer: Humana Medicaid |
$520.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,117.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$531.12
|
| Rate for Payer: Molina Healthcare Passport |
$520.71
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.92
|
|
|
EXC I PRESSURE ULCER(T
|
Facility
|
OP
|
$7,603.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761T0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.48 |
| Max. Negotiated Rate |
$7,299.55 |
| Rate for Payer: Aetna Commercial |
$5,854.85
|
| Rate for Payer: Anthem Medicaid |
$2,614.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,930.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cigna Commercial |
$6,311.07
|
| Rate for Payer: First Health Commercial |
$7,223.52
|
| Rate for Payer: Humana Commercial |
$6,463.14
|
| Rate for Payer: Humana KY Medicaid |
$2,614.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,641.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,235.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,611.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,667.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,691.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,702.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,357.15
|
| Rate for Payer: PHCS Commercial |
$7,299.55
|
| Rate for Payer: United Healthcare All Payer |
$6,691.26
|
|
|
EXC I PRESSURE ULCER(T
|
Facility
|
IP
|
$7,603.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761T0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.48 |
| Max. Negotiated Rate |
$7,299.55 |
| Rate for Payer: Aetna Commercial |
$5,854.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,930.89
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cigna Commercial |
$6,311.07
|
| Rate for Payer: First Health Commercial |
$7,223.52
|
| Rate for Payer: Humana Commercial |
$6,463.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,235.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,611.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,281.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,691.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,702.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,357.15
|
| Rate for Payer: PHCS Commercial |
$7,299.55
|
| Rate for Payer: United Healthcare All Payer |
$6,691.26
|
|
|
EXCIS BX CERVICAL LYMPH
|
Facility
|
IP
|
$6,941.40
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$902.38 |
| Max. Negotiated Rate |
$6,663.74 |
| Rate for Payer: Aetna Commercial |
$5,344.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.29
|
| Rate for Payer: Cash Price |
$3,470.70
|
| Rate for Payer: Cigna Commercial |
$5,761.36
|
| Rate for Payer: First Health Commercial |
$6,594.33
|
| Rate for Payer: Humana Commercial |
$5,900.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,691.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,122.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$902.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,151.83
|
| Rate for Payer: PHCS Commercial |
$6,663.74
|
| Rate for Payer: United Healthcare All Payer |
$6,108.43
|
|
|
EXCIS BX CERVICAL LYMPH
|
Facility
|
OP
|
$6,941.40
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$902.38 |
| Max. Negotiated Rate |
$6,663.74 |
| Rate for Payer: Aetna Commercial |
$5,344.88
|
| Rate for Payer: Anthem Medicaid |
$2,387.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$3,470.70
|
| Rate for Payer: Cash Price |
$3,470.70
|
| Rate for Payer: Cigna Commercial |
$5,761.36
|
| Rate for Payer: First Health Commercial |
$6,594.33
|
| Rate for Payer: Humana Commercial |
$5,900.19
|
| Rate for Payer: Humana KY Medicaid |
$2,387.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,691.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,122.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$902.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,151.83
|
| Rate for Payer: PHCS Commercial |
$6,663.74
|
| Rate for Payer: United Healthcare All Payer |
$6,108.43
|
|
|
EXCIS BX CERVICAL LYMPH
|
Professional
|
Both
|
$6,941.40
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$6,941.40 |
| Rate for Payer: Aetna Commercial |
$671.35
|
| Rate for Payer: Anthem Medicaid |
$236.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,941.40
|
| Rate for Payer: Cash Price |
$3,470.70
|
| Rate for Payer: Cash Price |
$3,470.70
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: Healthspan PPO |
$536.81
|
| Rate for Payer: Humana Medicaid |
$236.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$241.14
|
| Rate for Payer: Molina Healthcare Passport |
$236.41
|
| Rate for Payer: Multiplan PHCS |
$4,164.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,858.98
|
| Rate for Payer: UHCCP Medicaid |
$2,429.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.77
|
|
|
EXCIS BX CERVICAL LYMPH(P
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761P1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$671.35
|
| Rate for Payer: Anthem Medicaid |
$236.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$702.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: Healthspan PPO |
$536.81
|
| Rate for Payer: Humana Medicaid |
$236.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$241.14
|
| Rate for Payer: Molina Healthcare Passport |
$236.41
|
| Rate for Payer: Multiplan PHCS |
$421.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$491.40
|
| Rate for Payer: UHCCP Medicaid |
$245.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.77
|
|
|
EXCIS BX CERVICAL LYMPH(T
|
Facility
|
OP
|
$6,239.40
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761T1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.12 |
| Max. Negotiated Rate |
$5,989.82 |
| Rate for Payer: Aetna Commercial |
$4,804.34
|
| Rate for Payer: Anthem Medicaid |
$2,145.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,866.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$3,119.70
|
| Rate for Payer: Cash Price |
$3,119.70
|
| Rate for Payer: Cigna Commercial |
$5,178.70
|
| Rate for Payer: First Health Commercial |
$5,927.43
|
| Rate for Payer: Humana Commercial |
$5,303.49
|
| Rate for Payer: Humana KY Medicaid |
$2,145.73
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,167.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,116.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,604.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,188.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,490.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,679.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,247.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,934.21
|
| Rate for Payer: PHCS Commercial |
$5,989.82
|
| Rate for Payer: United Healthcare All Payer |
$5,490.67
|
|
|
EXCIS BX CERVICAL LYMPH(T
|
Facility
|
IP
|
$6,239.40
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761T1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.12 |
| Max. Negotiated Rate |
$5,989.82 |
| Rate for Payer: Aetna Commercial |
$4,804.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,866.73
|
| Rate for Payer: Cash Price |
$3,119.70
|
| Rate for Payer: Cigna Commercial |
$5,178.70
|
| Rate for Payer: First Health Commercial |
$5,927.43
|
| Rate for Payer: Humana Commercial |
$5,303.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,116.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,604.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,871.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,490.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,679.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,247.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,934.21
|
| Rate for Payer: PHCS Commercial |
$5,989.82
|
| Rate for Payer: United Healthcare All Payer |
$5,490.67
|
|
|
EXCISE EXCESSIVE SKIN ARM
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 15836
|
| Hospital Charge Code |
76102711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,067.25 |
| Rate for Payer: Aetna Commercial |
$1,067.25
|
| Rate for Payer: Anthem Medicaid |
$441.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,007.39
|
| Rate for Payer: Healthspan PPO |
$853.36
|
| Rate for Payer: Humana Medicaid |
$441.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.23
|
| Rate for Payer: Molina Healthcare Passport |
$441.40
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.50
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$445.81
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Facility
|
IP
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.73 |
| Max. Negotiated Rate |
$5,588.16 |
| Rate for Payer: Aetna Commercial |
$4,482.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,540.38
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$4,831.43
|
| Rate for Payer: First Health Commercial |
$5,529.95
|
| Rate for Payer: Humana Commercial |
$4,947.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,295.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,746.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,122.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,365.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,164.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,804.51
|
| Rate for Payer: PHCS Commercial |
$5,588.16
|
| Rate for Payer: United Healthcare All Payer |
$5,122.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Facility
|
OP
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.73 |
| Max. Negotiated Rate |
$5,588.16 |
| Rate for Payer: Aetna Commercial |
$4,482.17
|
| Rate for Payer: Anthem Medicaid |
$2,001.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,540.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$4,831.43
|
| Rate for Payer: First Health Commercial |
$5,529.95
|
| Rate for Payer: Humana Commercial |
$4,947.85
|
| Rate for Payer: Humana KY Medicaid |
$2,001.84
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,022.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,295.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,042.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,122.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,365.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,164.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,804.51
|
| Rate for Payer: PHCS Commercial |
$5,588.16
|
| Rate for Payer: United Healthcare All Payer |
$5,122.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Professional
|
Both
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.59 |
| Max. Negotiated Rate |
$5,821.00 |
| Rate for Payer: Aetna Commercial |
$1,280.96
|
| Rate for Payer: Anthem Medicaid |
$539.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,821.00
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$1,190.93
|
| Rate for Payer: Healthspan PPO |
$1,024.24
|
| Rate for Payer: Humana Medicaid |
$539.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.38
|
| Rate for Payer: Molina Healthcare Passport |
$539.59
|
| Rate for Payer: Multiplan PHCS |
$3,492.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,074.70
|
| Rate for Payer: UHCCP Medicaid |
$2,037.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.99
|
|
|
EXCISE EXCESSIVE SKIN BUTTC(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761P0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.59 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,280.96
|
| Rate for Payer: Anthem Medicaid |
$539.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,190.93
|
| Rate for Payer: Healthspan PPO |
$1,024.24
|
| Rate for Payer: Humana Medicaid |
$539.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.38
|
| Rate for Payer: Molina Healthcare Passport |
$539.59
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.99
|
|
