|
EXCISE EXCESSIVE SKIN BUTTC(T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761T0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| 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 |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTC(T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761T0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Facility
|
OP
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.78 |
| Max. Negotiated Rate |
$4,229.76 |
| Rate for Payer: Aetna Commercial |
$3,392.62
|
| Rate for Payer: Anthem Medicaid |
$1,515.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.68
|
| 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 |
$2,203.00
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$3,656.98
|
| Rate for Payer: First Health Commercial |
$4,185.70
|
| Rate for Payer: Humana Commercial |
$3,745.10
|
| Rate for Payer: Humana KY Medicaid |
$1,515.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,530.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,545.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.86
|
| Rate for Payer: PHCS Commercial |
$4,229.76
|
| Rate for Payer: United Healthcare All Payer |
$3,877.28
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Facility
|
IP
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.78 |
| Max. Negotiated Rate |
$4,229.76 |
| Rate for Payer: Aetna Commercial |
$3,392.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.68
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$3,656.98
|
| Rate for Payer: First Health Commercial |
$4,185.70
|
| Rate for Payer: Humana Commercial |
$3,745.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.86
|
| Rate for Payer: PHCS Commercial |
$4,229.76
|
| Rate for Payer: United Healthcare All Payer |
$3,877.28
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Professional
|
Both
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.36 |
| Max. Negotiated Rate |
$4,406.00 |
| Rate for Payer: Aetna Commercial |
$1,214.53
|
| Rate for Payer: Anthem Medicaid |
$520.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,406.00
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$1,153.37
|
| Rate for Payer: Healthspan PPO |
$971.12
|
| Rate for Payer: Humana Medicaid |
$520.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Molina Healthcare Passport |
$520.36
|
| Rate for Payer: Multiplan PHCS |
$2,643.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,084.20
|
| Rate for Payer: UHCCP Medicaid |
$1,542.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.56
|
|
|
EXCISE EXCESSIVE SKIN HIP(P
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761P0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.75 |
| Max. Negotiated Rate |
$1,214.53 |
| Rate for Payer: Aetna Commercial |
$1,214.53
|
| Rate for Payer: Anthem Medicaid |
$520.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,085.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$1,153.37
|
| Rate for Payer: Healthspan PPO |
$971.12
|
| Rate for Payer: Humana Medicaid |
$520.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Molina Healthcare Passport |
$520.36
|
| Rate for Payer: Multiplan PHCS |
$651.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$759.50
|
| Rate for Payer: UHCCP Medicaid |
$379.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.56
|
|
|
EXCISE EXCESSIVE SKIN HIP(T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761T0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN HIP(T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761T0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| 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 |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN TISSUE
|
Professional
|
Both
|
$12,357.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.57 |
| Max. Negotiated Rate |
$12,357.00 |
| Rate for Payer: Aetna Commercial |
$1,291.06
|
| Rate for Payer: Anthem Medicaid |
$576.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$12,357.00
|
| Rate for Payer: Cash Price |
$6,178.50
|
| Rate for Payer: Cash Price |
$6,178.50
|
| Rate for Payer: Cigna Commercial |
$1,226.94
|
| Rate for Payer: Healthspan PPO |
$1,032.32
|
| Rate for Payer: Humana Medicaid |
$576.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,155.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.10
|
| Rate for Payer: Molina Healthcare Passport |
$576.57
|
| Rate for Payer: Multiplan PHCS |
$7,414.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,649.90
|
| Rate for Payer: UHCCP Medicaid |
$4,324.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.34
|
|
|
EXCISE EXCESSIVE SKIN TISSUE
|
Facility
|
IP
|
$12,357.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,606.41 |
| Max. Negotiated Rate |
$11,862.72 |
| Rate for Payer: Aetna Commercial |
$9,514.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,638.46
|
| Rate for Payer: Cash Price |
$6,178.50
|
| Rate for Payer: Cigna Commercial |
$10,256.31
|
| Rate for Payer: First Health Commercial |
$11,739.15
|
| Rate for Payer: Humana Commercial |
$10,503.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,132.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,119.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,707.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,874.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,606.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,830.67
|
| Rate for Payer: PHCS Commercial |
$11,862.72
|
| Rate for Payer: United Healthcare All Payer |
$10,874.16
|
|
|
EXCISE EXCESSIVE SKIN TISSUE
|
Facility
|
OP
|
$12,357.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,606.41 |
| Max. Negotiated Rate |
$11,862.72 |
| Rate for Payer: Aetna Commercial |
$9,514.89
|
| Rate for Payer: Anthem Medicaid |
$4,249.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,638.46
|
| 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 |
$6,178.50
|
| Rate for Payer: Cash Price |
$6,178.50
|
| Rate for Payer: Cigna Commercial |
$10,256.31
|
| Rate for Payer: First Health Commercial |
$11,739.15
|
| Rate for Payer: Humana Commercial |
$10,503.45
|
| Rate for Payer: Humana KY Medicaid |
$4,249.57
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,292.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,132.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,119.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,334.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,874.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,471.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,606.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,830.67
|
| Rate for Payer: PHCS Commercial |
$11,862.72
|
| Rate for Payer: United Healthcare All Payer |
$10,874.16
|
|
|
EXCISE EXCESSIVE SKIN TISSUE(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
761P0220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.57 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,291.06
|
| Rate for Payer: Anthem Medicaid |
$576.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,226.94
|
| Rate for Payer: Healthspan PPO |
$1,032.32
|
| Rate for Payer: Humana Medicaid |
$576.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,155.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.10
|
| Rate for Payer: Molina Healthcare Passport |
$576.57
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.34
|
|
|
EXCISE EXCESSIVE SKIN TISSUE(T
|
Facility
|
IP
|
$10,157.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
761T0220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,320.41 |
| Max. Negotiated Rate |
$9,750.72 |
| Rate for Payer: Aetna Commercial |
$7,820.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,922.46
|
| Rate for Payer: Cash Price |
$5,078.50
|
| Rate for Payer: Cigna Commercial |
$8,430.31
|
| Rate for Payer: First Health Commercial |
$9,649.15
|
| Rate for Payer: Humana Commercial |
$8,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,328.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,495.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,047.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,938.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,617.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,031.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,148.67
|
| Rate for Payer: PHCS Commercial |
$9,750.72
|
| Rate for Payer: United Healthcare All Payer |
$8,938.16
|
|
|
EXCISE EXCESSIVE SKIN TISSUE(T
|
Facility
|
OP
|
$10,157.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
761T0220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,320.41 |
| Max. Negotiated Rate |
$9,750.72 |
| Rate for Payer: Aetna Commercial |
$7,820.89
|
| Rate for Payer: Anthem Medicaid |
$3,492.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,922.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$5,078.50
|
| Rate for Payer: Cash Price |
$5,078.50
|
| Rate for Payer: Cigna Commercial |
$8,430.31
|
| Rate for Payer: First Health Commercial |
$9,649.15
|
| Rate for Payer: Humana Commercial |
$8,633.45
|
| Rate for Payer: Humana KY Medicaid |
$3,492.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,528.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,328.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,495.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,563.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,938.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,617.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,031.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,148.67
|
| Rate for Payer: PHCS Commercial |
$9,750.72
|
| Rate for Payer: United Healthcare All Payer |
$8,938.16
|
|
|
EXCISE EXCESS SKIN & TISSUE
|
Facility
|
IP
|
$8,201.83
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$7,873.76 |
| Rate for Payer: Aetna Commercial |
$6,315.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.43
|
| Rate for Payer: Cash Price |
$4,100.92
|
| Rate for Payer: Cigna Commercial |
$6,807.52
|
| Rate for Payer: First Health Commercial |
$7,791.74
|
| Rate for Payer: Humana Commercial |
$6,971.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.57
|
| Rate for Payer: PHCS Commercial |
$7,873.76
|
| Rate for Payer: United Healthcare All Payer |
$7,217.61
|
|
|
EXCISE EXCESS SKIN & TISSUE
|
Facility
|
OP
|
$8,201.83
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$7,873.76 |
| Rate for Payer: Aetna Commercial |
$6,315.41
|
| Rate for Payer: Anthem Medicaid |
$2,820.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.43
|
| 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 |
$4,100.92
|
| Rate for Payer: Cash Price |
$4,100.92
|
| Rate for Payer: Cigna Commercial |
$6,807.52
|
| Rate for Payer: First Health Commercial |
$7,791.74
|
| Rate for Payer: Humana Commercial |
$6,971.56
|
| Rate for Payer: Humana KY Medicaid |
$2,820.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.57
|
| Rate for Payer: PHCS Commercial |
$7,873.76
|
| Rate for Payer: United Healthcare All Payer |
$7,217.61
|
|
|
EXCISE EXCESS SKIN & TISSUE
|
Professional
|
Both
|
$8,201.83
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$8,201.83 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem Medicaid |
$338.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,201.83
|
| Rate for Payer: Cash Price |
$4,100.92
|
| Rate for Payer: Cash Price |
$4,100.92
|
| Rate for Payer: Cigna Commercial |
$967.73
|
| Rate for Payer: Healthspan PPO |
$963.92
|
| Rate for Payer: Humana Medicaid |
$338.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$907.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.14
|
| Rate for Payer: Molina Healthcare Passport |
$338.37
|
| Rate for Payer: Multiplan PHCS |
$4,921.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,741.28
|
| Rate for Payer: UHCCP Medicaid |
$2,870.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.75
|
|
|
EXCISE EXCESS SKIN & TISSUE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
761P0223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem Medicaid |
$338.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$967.73
|
| Rate for Payer: Healthspan PPO |
$963.92
|
| Rate for Payer: Humana Medicaid |
$338.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$907.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.14
|
| Rate for Payer: Molina Healthcare Passport |
$338.37
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.75
|
|
|
EXCISE EXCESS SKIN & TISSUE(T
|
Facility
|
OP
|
$6,201.83
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
761T0223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.24 |
| Max. Negotiated Rate |
$5,953.76 |
| Rate for Payer: Aetna Commercial |
$4,775.41
|
| Rate for Payer: Anthem Medicaid |
$2,132.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,837.43
|
| 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 |
$3,100.92
|
| Rate for Payer: Cash Price |
$3,100.92
|
| Rate for Payer: Cigna Commercial |
$5,147.52
|
| Rate for Payer: First Health Commercial |
$5,891.74
|
| Rate for Payer: Humana Commercial |
$5,271.56
|
| Rate for Payer: Humana KY Medicaid |
$2,132.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,154.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,085.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,576.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,175.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,457.61
|
| Rate for Payer: Ohio Health Group HMO |
$4,651.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,922.57
|
| Rate for Payer: PHCS Commercial |
$5,953.76
|
| Rate for Payer: United Healthcare All Payer |
$5,457.61
|
|
|
EXCISE EXCESS SKIN & TISSUE(T
|
Facility
|
IP
|
$6,201.83
|
|
|
Service Code
|
HCPCS 15839
|
| Hospital Charge Code |
761T0223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.24 |
| Max. Negotiated Rate |
$5,953.76 |
| Rate for Payer: Aetna Commercial |
$4,775.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,837.43
|
| Rate for Payer: Cash Price |
$3,100.92
|
| Rate for Payer: Cigna Commercial |
$5,147.52
|
| Rate for Payer: First Health Commercial |
$5,891.74
|
| Rate for Payer: Humana Commercial |
$5,271.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,085.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,576.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,860.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,457.61
|
| Rate for Payer: Ohio Health Group HMO |
$4,651.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,922.57
|
| Rate for Payer: PHCS Commercial |
$5,953.76
|
| Rate for Payer: United Healthcare All Payer |
$5,457.61
|
|
|
EXCISE FOOT TENDON SHEATH
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28086
|
| Hospital Charge Code |
76102720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$543.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$181.86
|
| Rate for Payer: Anthem Medicaid |
$227.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$616.99
|
| Rate for Payer: Healthspan PPO |
$670.00
|
| Rate for Payer: Humana Medicaid |
$227.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$446.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.04
|
| Rate for Payer: Molina Healthcare Passport |
$227.49
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$190.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.76
|
|
|
EXCISE LWR JAW CYST W/REPAI(P
|
Professional
|
Both
|
$3,235.00
|
|
|
Service Code
|
HCPCS 21047
|
| Hospital Charge Code |
761P0370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$833.04 |
| Max. Negotiated Rate |
$3,235.00 |
| Rate for Payer: Aetna Commercial |
$1,907.63
|
| Rate for Payer: Anthem Medicaid |
$833.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,235.00
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cigna Commercial |
$2,110.05
|
| Rate for Payer: Healthspan PPO |
$1,727.91
|
| Rate for Payer: Humana Medicaid |
$833.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,621.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$849.70
|
| Rate for Payer: Molina Healthcare Passport |
$833.04
|
| Rate for Payer: Multiplan PHCS |
$1,941.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,264.50
|
| Rate for Payer: UHCCP Medicaid |
$1,132.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$841.37
|
|
|
EXCISE LWR JAW CYST W/REPAIR
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
HCPCS 21047
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.55 |
| Max. Negotiated Rate |
$3,105.60 |
| Rate for Payer: Aetna Commercial |
$2,490.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,523.30
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cigna Commercial |
$2,685.05
|
| Rate for Payer: First Health Commercial |
$3,073.25
|
| Rate for Payer: Humana Commercial |
$2,749.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,652.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,387.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,846.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,426.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.85
|
| Rate for Payer: PHCS Commercial |
$3,105.60
|
| Rate for Payer: United Healthcare All Payer |
$2,846.80
|
|
|
EXCISE LWR JAW CYST W/REPAIR
|
Professional
|
Both
|
$3,235.00
|
|
|
Service Code
|
HCPCS 21047
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$833.04 |
| Max. Negotiated Rate |
$3,235.00 |
| Rate for Payer: Aetna Commercial |
$1,907.63
|
| Rate for Payer: Anthem Medicaid |
$833.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,235.00
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cigna Commercial |
$2,110.05
|
| Rate for Payer: Healthspan PPO |
$1,727.91
|
| Rate for Payer: Humana Medicaid |
$833.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,621.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$849.70
|
| Rate for Payer: Molina Healthcare Passport |
$833.04
|
| Rate for Payer: Multiplan PHCS |
$1,941.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,264.50
|
| Rate for Payer: UHCCP Medicaid |
$1,132.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$841.37
|
|
|
EXCISE LWR JAW CYST W/REPAIR
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
HCPCS 21047
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.55 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,490.95
|
| Rate for Payer: Anthem Medicaid |
$1,112.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,523.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cash Price |
$1,617.50
|
| Rate for Payer: Cigna Commercial |
$2,685.05
|
| Rate for Payer: First Health Commercial |
$3,073.25
|
| Rate for Payer: Humana Commercial |
$2,749.75
|
| Rate for Payer: Humana KY Medicaid |
$1,112.52
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,652.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,387.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,846.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,426.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.85
|
| Rate for Payer: PHCS Commercial |
$3,105.60
|
| Rate for Payer: United Healthcare All Payer |
$2,846.80
|
|
