|
EXCISE ORAL MUCOSA FOR GRAF(P
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 40818
|
| Hospital Charge Code |
761P1639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.53 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna Commercial |
$378.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.50
|
| Rate for Payer: Anthem Medicaid |
$131.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,010.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$381.86
|
| Rate for Payer: Healthspan PPO |
$401.85
|
| Rate for Payer: Humana Medicaid |
$131.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.16
|
| Rate for Payer: Molina Healthcare Passport |
$131.53
|
| Rate for Payer: Multiplan PHCS |
$606.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$707.00
|
| Rate for Payer: UHCCP Medicaid |
$158.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.85
|
|
|
EXCISE ORAL MUCOSA FOR GRAFT
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 40818
|
| Hospital Charge Code |
76101639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.53 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna Commercial |
$378.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.50
|
| Rate for Payer: Anthem Medicaid |
$131.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,010.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$381.86
|
| Rate for Payer: Healthspan PPO |
$401.85
|
| Rate for Payer: Humana Medicaid |
$131.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.16
|
| Rate for Payer: Molina Healthcare Passport |
$131.53
|
| Rate for Payer: Multiplan PHCS |
$606.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$707.00
|
| Rate for Payer: UHCCP Medicaid |
$158.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.85
|
|
|
EXCISE ORAL MUCOSA FOR GRAFT
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
HCPCS 40818
|
| Hospital Charge Code |
76101639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$969.60 |
| Rate for Payer: Aetna Commercial |
$777.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$787.80
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$838.30
|
| Rate for Payer: First Health Commercial |
$959.50
|
| Rate for Payer: Humana Commercial |
$858.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$828.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$745.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$888.80
|
| Rate for Payer: Ohio Health Group HMO |
$757.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.10
|
| Rate for Payer: PHCS Commercial |
$969.60
|
| Rate for Payer: United Healthcare All Payer |
$888.80
|
|
|
EXCISE ORAL MUCOSA FOR GRAFT
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
HCPCS 40818
|
| Hospital Charge Code |
76101639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$969.60 |
| Rate for Payer: Aetna Commercial |
$777.70
|
| Rate for Payer: Anthem Medicaid |
$347.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$787.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$838.30
|
| Rate for Payer: First Health Commercial |
$959.50
|
| Rate for Payer: Humana Commercial |
$858.50
|
| Rate for Payer: Humana KY Medicaid |
$347.34
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$350.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$828.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$745.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$354.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$888.80
|
| Rate for Payer: Ohio Health Group HMO |
$757.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.10
|
| Rate for Payer: PHCS Commercial |
$969.60
|
| Rate for Payer: United Healthcare All Payer |
$888.80
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 40814
|
| Hospital Charge Code |
76101637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$430.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.87
|
| Rate for Payer: Anthem Medicaid |
$147.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$500.77
|
| Rate for Payer: Healthspan PPO |
$440.82
|
| Rate for Payer: Humana Medicaid |
$147.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.99
|
| Rate for Payer: Molina Healthcare Passport |
$147.05
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$198.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.52
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 40814
|
| Hospital Charge Code |
76101637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
EXCISE/REPAIR MOUTH LESION
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 40814
|
| Hospital Charge Code |
76101637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
EXCISE/REPAIR MOUTH LESION(P
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 40814
|
| Hospital Charge Code |
761P1637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$430.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.87
|
| Rate for Payer: Anthem Medicaid |
$147.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$500.77
|
| Rate for Payer: Healthspan PPO |
$440.82
|
| Rate for Payer: Humana Medicaid |
$147.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.99
|
| Rate for Payer: Molina Healthcare Passport |
$147.05
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$198.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.52
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.05 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem Medicaid |
$1,817.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Humana KY Medicaid |
$1,817.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.35
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.05 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.35
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Professional
|
Both
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.30 |
| Max. Negotiated Rate |
$5,285.00 |
| Rate for Payer: Aetna Commercial |
$3,212.19
|
| Rate for Payer: Anthem Medicaid |
$884.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,285.00
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$3,004.47
|
| Rate for Payer: Healthspan PPO |
$2,708.90
|
| Rate for Payer: Humana Medicaid |
$884.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,820.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$901.99
|
| Rate for Payer: Molina Healthcare Passport |
$884.30
|
| Rate for Payer: Multiplan PHCS |
$3,171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,699.50
|
| Rate for Payer: UHCCP Medicaid |
$1,849.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$893.14
|
|
|
EXCISE SACRAL SPINE TUMOR(P
|
Professional
|
Both
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
761P1984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.30 |
| Max. Negotiated Rate |
$5,285.00 |
| Rate for Payer: Aetna Commercial |
$3,212.19
|
| Rate for Payer: Anthem Medicaid |
$884.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,285.00
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$3,004.47
|
| Rate for Payer: Healthspan PPO |
$2,708.90
|
| Rate for Payer: Humana Medicaid |
$884.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,820.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$901.99
|
| Rate for Payer: Molina Healthcare Passport |
$884.30
|
| Rate for Payer: Multiplan PHCS |
$3,171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,699.50
|
| Rate for Payer: UHCCP Medicaid |
$1,849.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$893.14
|
|
|
EXCISE TENDON FOREARM/WRIST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 25109
|
| Hospital Charge Code |
76102669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$801.58 |
| Rate for Payer: Aetna Commercial |
$753.15
|
| Rate for Payer: Anthem Medicaid |
$355.42
|
| 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 |
$801.58
|
| Rate for Payer: Healthspan PPO |
$682.20
|
| Rate for Payer: Humana Medicaid |
$355.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.53
|
| Rate for Payer: Molina Healthcare Passport |
$355.42
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$257.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.97
|
|
|
EXCISE WRIST TENDON SHEATH
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.47 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$548.70
|
| Rate for Payer: Anthem Medicaid |
$286.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$650.18
|
| Rate for Payer: Healthspan PPO |
$497.00
|
| Rate for Payer: Humana Medicaid |
$286.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.20
|
| Rate for Payer: Molina Healthcare Passport |
$286.47
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.33
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
EXCISE WRIST TENDON SHEATH(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
761P0585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.47 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$548.70
|
| Rate for Payer: Anthem Medicaid |
$286.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$650.18
|
| Rate for Payer: Healthspan PPO |
$497.00
|
| Rate for Payer: Humana Medicaid |
$286.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.20
|
| Rate for Payer: Molina Healthcare Passport |
$286.47
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.33
|
|
|
EXCISIE MOUTH LESION
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXCISIE MOUTH LESION
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXCISIE MOUTH LESION
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$279.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.46
|
| Rate for Payer: Anthem Medicaid |
$89.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$365.31
|
| Rate for Payer: Healthspan PPO |
$326.13
|
| Rate for Payer: Humana Medicaid |
$89.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$248.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.63
|
| Rate for Payer: Molina Healthcare Passport |
$89.83
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$118.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.73
|
|
|
EXCISIE MOUTH LESION(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
761P1636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$279.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.46
|
| Rate for Payer: Anthem Medicaid |
$89.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$365.31
|
| Rate for Payer: Healthspan PPO |
$326.13
|
| Rate for Payer: Humana Medicaid |
$89.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$248.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.63
|
| Rate for Payer: Molina Healthcare Passport |
$89.83
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$118.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.73
|
|
|
EXCISION ABDOMINAL WALL TUMO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
761P0427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$596.96
|
| Rate for Payer: Anthem Medicaid |
$288.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.81
|
| Rate for Payer: Healthspan PPO |
$540.72
|
| Rate for Payer: Humana Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$664.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.11
|
| Rate for Payer: Molina Healthcare Passport |
$288.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.22
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$596.96
|
| Rate for Payer: Anthem Medicaid |
$288.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.81
|
| Rate for Payer: Healthspan PPO |
$540.72
|
| Rate for Payer: Humana Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$664.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.11
|
| Rate for Payer: Molina Healthcare Passport |
$288.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.22
|
|
