|
EXCISION LESION MOUTH ROOF(P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761P1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.24 |
| Max. Negotiated Rate |
$545.00 |
| 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 |
$545.00
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| 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 |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$268.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.25
|
|
|
EXCISION LESION MOUTH ROOF(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761P1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.05 |
| Max. Negotiated Rate |
$750.00 |
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| 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 |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$127.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.17
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
OP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761T1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.81 |
| Max. Negotiated Rate |
$4,067.52 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem Medicaid |
$1,457.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| 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 |
$2,118.50
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Humana KY Medicaid |
$1,457.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,471.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,486.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$847.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.47
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761T1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem Medicaid |
$2,389.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| 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 |
$3,473.50
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Humana KY Medicaid |
$2,389.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761T1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$6,669.12 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
IP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761T1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.81 |
| Max. Negotiated Rate |
$4,067.52 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$847.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.47
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
EXCISION LESION PHARYNX
|
Professional
|
Both
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$4,948.00 |
| Rate for Payer: Aetna Commercial |
$239.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.66
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,948.00
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$240.65
|
| Rate for Payer: Healthspan PPO |
$268.34
|
| Rate for Payer: Humana Medicaid |
$140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.47
|
| Rate for Payer: Molina Healthcare Passport |
$140.66
|
| Rate for Payer: Multiplan PHCS |
$2,968.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,463.60
|
| Rate for Payer: UHCCP Medicaid |
$141.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.07
|
|
|
EXCISION LESION PHARYNX
|
Facility
|
IP
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.24 |
| Max. Negotiated Rate |
$4,750.08 |
| Rate for Payer: Aetna Commercial |
$3,809.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,859.44
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$4,106.84
|
| Rate for Payer: First Health Commercial |
$4,700.60
|
| Rate for Payer: Humana Commercial |
$4,205.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,057.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,651.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.88
|
| Rate for Payer: PHCS Commercial |
$4,750.08
|
| Rate for Payer: United Healthcare All Payer |
$4,354.24
|
|
|
EXCISION LESION PHARYNX
|
Facility
|
OP
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.24 |
| Max. Negotiated Rate |
$4,750.08 |
| Rate for Payer: Aetna Commercial |
$3,809.96
|
| Rate for Payer: Anthem Medicaid |
$1,701.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,859.44
|
| 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 |
$2,474.00
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$4,106.84
|
| Rate for Payer: First Health Commercial |
$4,700.60
|
| Rate for Payer: Humana Commercial |
$4,205.80
|
| Rate for Payer: Humana KY Medicaid |
$1,701.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,057.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,651.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,735.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.88
|
| Rate for Payer: PHCS Commercial |
$4,750.08
|
| Rate for Payer: United Healthcare All Payer |
$4,354.24
|
|
|
EXCISION LESION PHARYNX(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761P1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$239.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.66
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| 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 |
$240.65
|
| Rate for Payer: Healthspan PPO |
$268.34
|
| Rate for Payer: Humana Medicaid |
$140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.47
|
| Rate for Payer: Molina Healthcare Passport |
$140.66
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$141.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.07
|
|
|
EXCISION LESION PHARYNX(T
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761T1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.74 |
| Max. Negotiated Rate |
$4,318.08 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.38
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
EXCISION LESION PHARYNX(T
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761T1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.74 |
| Max. Negotiated Rate |
$4,318.08 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem Medicaid |
$1,546.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| 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 |
$2,249.00
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Humana KY Medicaid |
$1,546.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.38
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
EXCISION - LOCAL; MALIGNANT (P
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
761P1784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$3,338.00 |
| Rate for Payer: Aetna Commercial |
$1,755.03
|
| Rate for Payer: Anthem Medicaid |
$625.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,338.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$1,625.76
|
| Rate for Payer: Healthspan PPO |
$1,480.05
|
| Rate for Payer: Humana Medicaid |
$625.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.94
|
| Rate for Payer: Molina Healthcare Passport |
$625.43
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,336.60
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.68
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.94 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.78
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.94 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem Medicaid |
$1,147.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Humana KY Medicaid |
$1,147.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.78
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$3,338.00 |
| Rate for Payer: Aetna Commercial |
$1,755.03
|
| Rate for Payer: Anthem Medicaid |
$625.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,338.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$1,625.76
|
| Rate for Payer: Healthspan PPO |
$1,480.05
|
| Rate for Payer: Humana Medicaid |
$625.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.94
|
| Rate for Payer: Molina Healthcare Passport |
$625.43
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,336.60
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.68
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
IP
|
$8,710.25
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.84 |
| Rate for Payer: Aetna Commercial |
$6,706.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.12
|
| Rate for Payer: Cigna Commercial |
$7,229.51
|
| Rate for Payer: First Health Commercial |
$8,274.74
|
| Rate for Payer: Humana Commercial |
$7,403.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.02
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.84
|
| Rate for Payer: United Healthcare All Payer |
$7,665.02
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
OP
|
$8,710.25
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.84 |
| Rate for Payer: Aetna Commercial |
$6,706.89
|
| Rate for Payer: Anthem Medicaid |
$2,995.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$4,355.12
|
| Rate for Payer: Cash Price |
$4,355.12
|
| Rate for Payer: Cigna Commercial |
$7,229.51
|
| Rate for Payer: First Health Commercial |
$8,274.74
|
| Rate for Payer: Humana Commercial |
$7,403.71
|
| Rate for Payer: Humana KY Medicaid |
$2,995.45
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,025.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.02
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.84
|
| Rate for Payer: United Healthcare All Payer |
$7,665.02
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
IP
|
$2,267.00
|
|
| Hospital Charge Code |
76102566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.71 |
| Max. Negotiated Rate |
$2,176.32 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.77
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Professional
|
Both
|
$8,710.25
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.35 |
| Max. Negotiated Rate |
$8,710.25 |
| Rate for Payer: Aetna Commercial |
$736.22
|
| Rate for Payer: Anthem Medicaid |
$287.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,710.25
|
| Rate for Payer: Cash Price |
$4,355.12
|
| Rate for Payer: Cash Price |
$4,355.12
|
| Rate for Payer: Cigna Commercial |
$594.05
|
| Rate for Payer: Healthspan PPO |
$588.67
|
| Rate for Payer: Humana Medicaid |
$287.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$665.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.10
|
| Rate for Payer: Molina Healthcare Passport |
$287.35
|
| Rate for Payer: Multiplan PHCS |
$5,226.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,097.18
|
| Rate for Payer: UHCCP Medicaid |
$3,048.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.22
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
OP
|
$2,267.00
|
|
| Hospital Charge Code |
76102566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.71 |
| Max. Negotiated Rate |
$2,176.32 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem Medicaid |
$779.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Humana KY Medicaid |
$779.62
|
| Rate for Payer: Kentucky WC Medicaid |
$787.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$795.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.77
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
EXCISION LYMPHATIC SYSTEM(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
761P1600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.35 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$736.22
|
| Rate for Payer: Anthem Medicaid |
$287.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$594.05
|
| Rate for Payer: Healthspan PPO |
$588.67
|
| Rate for Payer: Humana Medicaid |
$287.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$665.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.10
|
| Rate for Payer: Molina Healthcare Passport |
$287.35
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.22
|
|
|
EXCISION LYMPHATIC SYSTEM(T
|
Facility
|
IP
|
$7,460.25
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
761T1600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$969.83 |
| Max. Negotiated Rate |
$7,161.84 |
| Rate for Payer: Aetna Commercial |
$5,744.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,819.00
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cigna Commercial |
$6,192.01
|
| Rate for Payer: First Health Commercial |
$7,087.24
|
| Rate for Payer: Humana Commercial |
$6,341.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,117.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,505.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,565.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,595.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,312.68
|
| Rate for Payer: PHCS Commercial |
$7,161.84
|
| Rate for Payer: United Healthcare All Payer |
$6,565.02
|
|
