|
EXCISION AURAL POLYP
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| 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 |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXCISION AURAL POLYP
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$178.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$54.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$180.53
|
| Rate for Payer: Healthspan PPO |
$249.68
|
| Rate for Payer: Humana Medicaid |
$54.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.26
|
| Rate for Payer: Molina Healthcare Passport |
$54.18
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.72
|
|
|
EXCISION AURAL POLYP
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXCISION AURAL POLYP(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
761P2424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$178.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$54.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$180.53
|
| Rate for Payer: Healthspan PPO |
$249.68
|
| Rate for Payer: Humana Medicaid |
$54.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.26
|
| Rate for Payer: Molina Healthcare Passport |
$54.18
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.72
|
|
|
EXCISION BARTHOLIN GLAND/CYS(P
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761P2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$448.76
|
| Rate for Payer: Anthem Medicaid |
$195.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$436.93
|
| Rate for Payer: Healthspan PPO |
$434.51
|
| Rate for Payer: Humana Medicaid |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.90
|
| Rate for Payer: Molina Healthcare Passport |
$195.98
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$535.50
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.94
|
|
|
EXCISION BARTHOLIN GLAND/CYS(T
|
Facility
|
OP
|
$6,999.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761T2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.87 |
| Max. Negotiated Rate |
$6,719.04 |
| Rate for Payer: Aetna Commercial |
$5,389.23
|
| Rate for Payer: Anthem Medicaid |
$2,406.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,459.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$5,809.17
|
| Rate for Payer: First Health Commercial |
$6,649.05
|
| Rate for Payer: Humana Commercial |
$5,949.15
|
| Rate for Payer: Humana KY Medicaid |
$2,406.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,431.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,739.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,165.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,455.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,159.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,249.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.69
|
| Rate for Payer: PHCS Commercial |
$6,719.04
|
| Rate for Payer: United Healthcare All Payer |
$6,159.12
|
|
|
EXCISION BARTHOLIN GLAND/CYS(T
|
Facility
|
IP
|
$6,999.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761T2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.87 |
| Max. Negotiated Rate |
$6,719.04 |
| Rate for Payer: Aetna Commercial |
$5,389.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,459.22
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$5,809.17
|
| Rate for Payer: First Health Commercial |
$6,649.05
|
| Rate for Payer: Humana Commercial |
$5,949.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,739.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,165.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,159.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,249.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.69
|
| Rate for Payer: PHCS Commercial |
$6,719.04
|
| Rate for Payer: United Healthcare All Payer |
$6,159.12
|
|
|
EXCISION BARTHOLIN GLAND/CYST
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
EXCISION BARTHOLIN GLAND/CYST
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
EXCISION BARTHOLIN GLAND/CYST
|
Professional
|
Both
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$7,764.00 |
| Rate for Payer: Aetna Commercial |
$448.76
|
| Rate for Payer: Anthem Medicaid |
$195.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,764.00
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$436.93
|
| Rate for Payer: Healthspan PPO |
$434.51
|
| Rate for Payer: Humana Medicaid |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.90
|
| Rate for Payer: Molina Healthcare Passport |
$195.98
|
| Rate for Payer: Multiplan PHCS |
$4,658.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,434.80
|
| Rate for Payer: UHCCP Medicaid |
$2,717.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.94
|
|
|
EXCISION BENIGN
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$113.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.65
|
| Rate for Payer: Anthem Medicaid |
$37.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$156.41
|
| Rate for Payer: Healthspan PPO |
$127.88
|
| Rate for Payer: Humana Medicaid |
$37.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.59
|
| Rate for Payer: Molina Healthcare Passport |
$37.83
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$48.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.21
|
|
|
EXCISION BENIGN
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
EXCISION BENIGN
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXCISION BENIGN
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
EXCISION BENIGN
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXCISION - BENIGN LESION
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.37
|
| Rate for Payer: Anthem Medicaid |
$59.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,055.00
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$216.66
|
| Rate for Payer: Healthspan PPO |
$178.06
|
| Rate for Payer: Humana Medicaid |
$59.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$159.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.30
|
| Rate for Payer: Molina Healthcare Passport |
$59.12
|
| Rate for Payer: Multiplan PHCS |
$1,233.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,438.50
|
| Rate for Payer: UHCCP Medicaid |
$70.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.71
|
|
|
EXCISION - BENIGN LESION
|
Facility
|
OP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.15 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Aetna Commercial |
$1,582.35
|
| Rate for Payer: Anthem Medicaid |
$706.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,602.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$1,705.65
|
| Rate for Payer: First Health Commercial |
$1,952.25
|
| Rate for Payer: Humana Commercial |
$1,746.75
|
| Rate for Payer: Humana KY Medicaid |
$706.71
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$713.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,516.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,808.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.05
|
| Rate for Payer: PHCS Commercial |
$1,972.80
|
| Rate for Payer: United Healthcare All Payer |
$1,808.40
|
|
|
EXCISION - BENIGN LESION
|
Facility
|
IP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.15 |
| Max. Negotiated Rate |
$1,972.80 |
| Rate for Payer: Aetna Commercial |
$1,582.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,027.50
|
| Rate for Payer: Cigna Commercial |
$1,705.65
|
| Rate for Payer: First Health Commercial |
$1,952.25
|
| Rate for Payer: Humana Commercial |
$1,746.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,516.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,808.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.05
|
| Rate for Payer: PHCS Commercial |
$1,972.80
|
| Rate for Payer: United Healthcare All Payer |
$1,808.40
|
|
|
EXCISION BENIGN LESION
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.06 |
| Max. Negotiated Rate |
$4,571.52 |
| Rate for Payer: Aetna Commercial |
$3,666.74
|
| Rate for Payer: Anthem Medicaid |
$1,637.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,714.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cigna Commercial |
$3,952.46
|
| Rate for Payer: First Health Commercial |
$4,523.90
|
| Rate for Payer: Humana Commercial |
$4,047.70
|
| Rate for Payer: Humana KY Medicaid |
$1,637.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,514.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,670.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.22
|
| Rate for Payer: PHCS Commercial |
$4,571.52
|
| Rate for Payer: United Healthcare All Payer |
$4,190.56
|
|
|
EXCISION BENIGN LESION
|
Facility
|
IP
|
$2,775.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.75 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Aetna Commercial |
$2,136.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,164.50
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$2,303.25
|
| Rate for Payer: First Health Commercial |
$2,636.25
|
| Rate for Payer: Humana Commercial |
$2,358.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,275.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,047.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$832.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,442.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,081.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$860.25
|
| Rate for Payer: PHCS Commercial |
$2,664.00
|
| Rate for Payer: United Healthcare All Payer |
$2,442.00
|
|
|
EXCISION BENIGN LESION
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.06 |
| Max. Negotiated Rate |
$4,571.52 |
| Rate for Payer: Aetna Commercial |
$3,666.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,714.36
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cigna Commercial |
$3,952.46
|
| Rate for Payer: First Health Commercial |
$4,523.90
|
| Rate for Payer: Humana Commercial |
$4,047.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,514.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.22
|
| Rate for Payer: PHCS Commercial |
$4,571.52
|
| Rate for Payer: United Healthcare All Payer |
$4,190.56
|
|
|
EXCISION BENIGN LESION
|
Professional
|
Both
|
$4,762.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$4,762.00 |
| Rate for Payer: Aetna Commercial |
$331.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.49
|
| Rate for Payer: Anthem Medicaid |
$137.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,762.00
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cash Price |
$2,381.00
|
| Rate for Payer: Cigna Commercial |
$378.50
|
| Rate for Payer: Healthspan PPO |
$325.61
|
| Rate for Payer: Humana Medicaid |
$137.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$297.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.72
|
| Rate for Payer: Molina Healthcare Passport |
$137.96
|
| Rate for Payer: Multiplan PHCS |
$2,857.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,333.40
|
| Rate for Payer: UHCCP Medicaid |
$132.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.34
|
|
|
EXCISION BENIGN LESION
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$2,775.00 |
| Rate for Payer: Aetna Commercial |
$154.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.96
|
| Rate for Payer: Anthem Medicaid |
$54.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,775.00
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$199.93
|
| Rate for Payer: Healthspan PPO |
$166.73
|
| Rate for Payer: Humana Medicaid |
$54.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.74
|
| Rate for Payer: Molina Healthcare Passport |
$54.65
|
| Rate for Payer: Multiplan PHCS |
$1,665.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,942.50
|
| Rate for Payer: UHCCP Medicaid |
$60.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.20
|
|
|
EXCISION BENIGN LESION
|
Facility
|
OP
|
$2,775.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.75 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Aetna Commercial |
$2,136.75
|
| Rate for Payer: Anthem Medicaid |
$954.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,164.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$2,303.25
|
| Rate for Payer: First Health Commercial |
$2,636.25
|
| Rate for Payer: Humana Commercial |
$2,358.75
|
| Rate for Payer: Humana KY Medicaid |
$954.32
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$964.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,275.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,047.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$973.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,442.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,081.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$860.25
|
| Rate for Payer: PHCS Commercial |
$2,664.00
|
| Rate for Payer: United Healthcare All Payer |
$2,442.00
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$1,393.92 |
| Rate for Payer: Aetna Commercial |
$1,118.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,132.56
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,205.16
|
| Rate for Payer: First Health Commercial |
$1,379.40
|
| Rate for Payer: Humana Commercial |
$1,234.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,190.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,071.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,277.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$450.12
|
| Rate for Payer: PHCS Commercial |
$1,393.92
|
| Rate for Payer: United Healthcare All Payer |
$1,277.76
|
|
