|
EXCISION FACE OVER 4.0 CM
|
Professional
|
Both
|
$5,645.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$5,645.00 |
| Rate for Payer: Aetna Commercial |
$579.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$212.59
|
| Rate for Payer: Anthem Medicaid |
$302.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,645.00
|
| Rate for Payer: Cash Price |
$2,822.50
|
| Rate for Payer: Cash Price |
$2,822.50
|
| Rate for Payer: Cigna Commercial |
$551.54
|
| Rate for Payer: Healthspan PPO |
$574.30
|
| Rate for Payer: Humana Medicaid |
$302.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.15
|
| Rate for Payer: Molina Healthcare Passport |
$302.11
|
| Rate for Payer: Multiplan PHCS |
$3,387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,951.50
|
| Rate for Payer: UHCCP Medicaid |
$223.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.13
|
|
|
EXCISION FACE OVER 4.0 CM(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761P0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$579.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$212.59
|
| Rate for Payer: Anthem Medicaid |
$302.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$551.54
|
| Rate for Payer: Healthspan PPO |
$574.30
|
| Rate for Payer: Humana Medicaid |
$302.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.15
|
| Rate for Payer: Molina Healthcare Passport |
$302.11
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$223.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.13
|
|
|
EXCISION FACE OVER 4.0 CM(T
|
Facility
|
IP
|
$4,445.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761T0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.85 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$3,422.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.10
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: Cigna Commercial |
$3,689.35
|
| Rate for Payer: First Health Commercial |
$4,222.75
|
| Rate for Payer: Humana Commercial |
$3,778.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$889.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.95
|
| Rate for Payer: PHCS Commercial |
$4,267.20
|
| Rate for Payer: United Healthcare All Payer |
$3,911.60
|
|
|
EXCISION FACE OVER 4.0 CM(T
|
Facility
|
OP
|
$4,445.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761T0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.85 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$3,422.65
|
| Rate for Payer: Anthem Medicaid |
$1,528.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.10
|
| 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 |
$2,222.50
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: Cigna Commercial |
$3,689.35
|
| Rate for Payer: First Health Commercial |
$4,222.75
|
| Rate for Payer: Humana Commercial |
$3,778.25
|
| Rate for Payer: Humana KY Medicaid |
$1,528.64
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$889.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.95
|
| Rate for Payer: PHCS Commercial |
$4,267.20
|
| Rate for Payer: United Healthcare All Payer |
$3,911.60
|
|
|
EXCISION GRAFT ABDOMEN
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem Medicaid |
$1,607.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Humana KY Medicaid |
$1,607.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.25
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
EXCISION GRAFT ABDOMEN
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.25
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
EXCISION GRAFT ABDOMEN
|
Professional
|
Both
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.85 |
| Max. Negotiated Rate |
$4,675.00 |
| Rate for Payer: Aetna Commercial |
$3,399.95
|
| Rate for Payer: Anthem Medicaid |
$746.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,675.00
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,252.03
|
| Rate for Payer: Healthspan PPO |
$3,342.80
|
| Rate for Payer: Humana Medicaid |
$746.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,642.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$761.79
|
| Rate for Payer: Molina Healthcare Passport |
$746.85
|
| Rate for Payer: Multiplan PHCS |
$2,805.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,272.50
|
| Rate for Payer: UHCCP Medicaid |
$1,636.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$754.32
|
|
|
EXCISION GRAFT NECK
|
Professional
|
Both
|
$502.07
|
|
|
Service Code
|
HCPCS 35901
|
| Hospital Charge Code |
76102730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.72 |
| Max. Negotiated Rate |
$868.23 |
| Rate for Payer: Aetna Commercial |
$868.23
|
| Rate for Payer: Anthem Medicaid |
$440.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$502.07
|
| Rate for Payer: Cash Price |
$251.04
|
| Rate for Payer: Cash Price |
$251.04
|
| Rate for Payer: Cigna Commercial |
$850.34
|
| Rate for Payer: Healthspan PPO |
$853.64
|
| Rate for Payer: Humana Medicaid |
$440.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.62
|
| Rate for Payer: Molina Healthcare Passport |
$440.80
|
| Rate for Payer: Multiplan PHCS |
$301.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$351.45
|
| Rate for Payer: UHCCP Medicaid |
$175.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$445.21
|
|
|
EXCISION H/P/P/U COMPLEX RPR
|
Professional
|
Both
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.47 |
| Max. Negotiated Rate |
$8,283.00 |
| Rate for Payer: Aetna Commercial |
$477.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.47
|
| Rate for Payer: Anthem Medicaid |
$202.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,283.00
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$444.02
|
| Rate for Payer: Healthspan PPO |
$531.49
|
| Rate for Payer: Humana Medicaid |
$202.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.70
|
| Rate for Payer: Molina Healthcare Passport |
$202.65
|
| Rate for Payer: Multiplan PHCS |
$4,969.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,798.10
|
| Rate for Payer: UHCCP Medicaid |
$189.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.68
|
|
|
EXCISION H/P/P/U COMPLEX RPR
|
Facility
|
IP
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,076.79 |
| Max. Negotiated Rate |
$7,951.68 |
| Rate for Payer: Aetna Commercial |
$6,377.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.74
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$6,874.89
|
| Rate for Payer: First Health Commercial |
$7,868.85
|
| Rate for Payer: Humana Commercial |
$7,040.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.73
|
| Rate for Payer: PHCS Commercial |
$7,951.68
|
| Rate for Payer: United Healthcare All Payer |
$7,289.04
|
|
|
EXCISION H/P/P/U COMPLEX RPR
|
Facility
|
OP
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,076.79 |
| Max. Negotiated Rate |
$7,951.68 |
| Rate for Payer: Aetna Commercial |
$6,377.91
|
| Rate for Payer: Anthem Medicaid |
$2,848.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.74
|
| 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 |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$6,874.89
|
| Rate for Payer: First Health Commercial |
$7,868.85
|
| Rate for Payer: Humana Commercial |
$7,040.55
|
| Rate for Payer: Humana KY Medicaid |
$2,848.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.73
|
| Rate for Payer: PHCS Commercial |
$7,951.68
|
| Rate for Payer: United Healthcare All Payer |
$7,289.04
|
|
|
EXCISION H/P/P/U COMPLEX RPR(P
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761P0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.47 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$477.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.47
|
| Rate for Payer: Anthem Medicaid |
$202.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,320.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$444.02
|
| Rate for Payer: Healthspan PPO |
$531.49
|
| Rate for Payer: Humana Medicaid |
$202.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.70
|
| Rate for Payer: Molina Healthcare Passport |
$202.65
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$924.00
|
| Rate for Payer: UHCCP Medicaid |
$189.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.68
|
|
|
EXCISION H/P/P/U COMPLEX RPR(T
|
Facility
|
OP
|
$6,963.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761T0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.19 |
| Max. Negotiated Rate |
$6,684.48 |
| Rate for Payer: Aetna Commercial |
$5,361.51
|
| Rate for Payer: Anthem Medicaid |
$2,394.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,431.14
|
| 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 |
$3,481.50
|
| Rate for Payer: Cash Price |
$3,481.50
|
| Rate for Payer: Cigna Commercial |
$5,779.29
|
| Rate for Payer: First Health Commercial |
$6,614.85
|
| Rate for Payer: Humana Commercial |
$5,918.55
|
| Rate for Payer: Humana KY Medicaid |
$2,394.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,709.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,138.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,442.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,127.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,222.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,158.53
|
| Rate for Payer: PHCS Commercial |
$6,684.48
|
| Rate for Payer: United Healthcare All Payer |
$6,127.44
|
|
|
EXCISION H/P/P/U COMPLEX RPR(T
|
Facility
|
IP
|
$6,963.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761T0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.19 |
| Max. Negotiated Rate |
$6,684.48 |
| Rate for Payer: Aetna Commercial |
$5,361.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,431.14
|
| Rate for Payer: Cash Price |
$3,481.50
|
| Rate for Payer: Cigna Commercial |
$5,779.29
|
| Rate for Payer: First Health Commercial |
$6,614.85
|
| Rate for Payer: Humana Commercial |
$5,918.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,709.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,138.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,127.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,222.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,158.53
|
| Rate for Payer: PHCS Commercial |
$6,684.48
|
| Rate for Payer: United Healthcare All Payer |
$6,127.44
|
|
|
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 28080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.25
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.25
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$693.09
|
| Rate for Payer: Anthem Medicaid |
$339.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.00
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$762.24
|
| Rate for Payer: Healthspan PPO |
$627.79
|
| Rate for Payer: Humana Medicaid |
$339.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.09
|
| Rate for Payer: Molina Healthcare Passport |
$339.30
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.50
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.69
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
761P0821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$693.09
|
| Rate for Payer: Anthem Medicaid |
$339.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.00
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$762.24
|
| Rate for Payer: Healthspan PPO |
$627.79
|
| Rate for Payer: Humana Medicaid |
$339.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.09
|
| Rate for Payer: Molina Healthcare Passport |
$339.30
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.50
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.69
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
IP
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$648.31 |
| Max. Negotiated Rate |
$4,787.52 |
| Rate for Payer: Aetna Commercial |
$3,839.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,889.86
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$4,139.21
|
| Rate for Payer: First Health Commercial |
$4,737.65
|
| Rate for Payer: Humana Commercial |
$4,238.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,089.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,680.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,388.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,740.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.97
|
| Rate for Payer: PHCS Commercial |
$4,787.52
|
| Rate for Payer: United Healthcare All Payer |
$4,388.56
|
|
|
EXCISION LESION MOUTH ROOF
|
Professional
|
Both
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.05 |
| Max. Negotiated Rate |
$4,987.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.85
|
| Rate for Payer: Anthem Medicaid |
$112.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,987.00
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$329.42
|
| Rate for Payer: Healthspan PPO |
$305.09
|
| Rate for Payer: Humana Medicaid |
$112.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.29
|
| Rate for Payer: Molina Healthcare Passport |
$112.05
|
| Rate for Payer: Multiplan PHCS |
$2,992.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,490.90
|
| Rate for Payer: UHCCP Medicaid |
$127.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.17
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
OP
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$648.31 |
| Max. Negotiated Rate |
$4,787.52 |
| Rate for Payer: Aetna Commercial |
$3,839.99
|
| Rate for Payer: Anthem Medicaid |
$1,715.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,889.86
|
| 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 |
$2,493.50
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$4,139.21
|
| Rate for Payer: First Health Commercial |
$4,737.65
|
| Rate for Payer: Humana Commercial |
$4,238.95
|
| Rate for Payer: Humana KY Medicaid |
$1,715.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,732.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,089.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,680.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,749.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,388.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,740.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.97
|
| Rate for Payer: PHCS Commercial |
$4,787.52
|
| Rate for Payer: United Healthcare All Payer |
$4,388.56
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
OP
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.96 |
| Max. Negotiated Rate |
$7,192.32 |
| Rate for Payer: Aetna Commercial |
$5,768.84
|
| Rate for Payer: Anthem Medicaid |
$2,576.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,843.76
|
| 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 |
$3,746.00
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$6,218.36
|
| Rate for Payer: First Health Commercial |
$7,117.40
|
| Rate for Payer: Humana Commercial |
$6,368.20
|
| Rate for Payer: Humana KY Medicaid |
$2,576.50
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,143.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,592.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.52
|
| Rate for Payer: PHCS Commercial |
$7,192.32
|
| Rate for Payer: United Healthcare All Payer |
$6,592.96
|
|
|
EXCISION LESION MOUTH ROOF
|
Professional
|
Both
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.24 |
| Max. Negotiated Rate |
$7,492.00 |
| Rate for Payer: Aetna Commercial |
$495.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.92
|
| Rate for Payer: Anthem Medicaid |
$201.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,492.00
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$488.13
|
| Rate for Payer: Healthspan PPO |
$532.49
|
| Rate for Payer: Humana Medicaid |
$201.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.26
|
| Rate for Payer: Molina Healthcare Passport |
$201.24
|
| Rate for Payer: Multiplan PHCS |
$4,495.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,244.40
|
| Rate for Payer: UHCCP Medicaid |
$268.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.25
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
IP
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.96 |
| Max. Negotiated Rate |
$7,192.32 |
| Rate for Payer: Aetna Commercial |
$5,768.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,843.76
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$6,218.36
|
| Rate for Payer: First Health Commercial |
$7,117.40
|
| Rate for Payer: Humana Commercial |
$6,368.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,143.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,592.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.52
|
| Rate for Payer: PHCS Commercial |
$7,192.32
|
| Rate for Payer: United Healthcare All Payer |
$6,592.96
|
|
