|
EXCISION - NASAL LESION UP T(P
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
761P0088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$113.16
|
| Rate for Payer: Anthem Medicaid |
$102.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$297.19
|
| Rate for Payer: Healthspan PPO |
$255.48
|
| Rate for Payer: Humana Medicaid |
$102.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.58
|
| Rate for Payer: Molina Healthcare Passport |
$102.53
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$118.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.56
|
|
|
EXCISION - NASAL LESION UP T(T
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
761T0088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.51 |
| Max. Negotiated Rate |
$2,041.92 |
| Rate for Payer: Aetna Commercial |
$1,637.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.06
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,765.41
|
| Rate for Payer: First Health Commercial |
$2,020.65
|
| Rate for Payer: Humana Commercial |
$1,807.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.37
|
| Rate for Payer: PHCS Commercial |
$2,041.92
|
| Rate for Payer: United Healthcare All Payer |
$1,871.76
|
|
|
EXCISION - NASAL LESION UP T(T
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
761T0088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.51 |
| Max. Negotiated Rate |
$2,041.92 |
| Rate for Payer: Aetna Commercial |
$1,637.79
|
| Rate for Payer: Anthem Medicaid |
$731.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,063.50
|
| Rate for Payer: Cigna Commercial |
$1,765.41
|
| Rate for Payer: First Health Commercial |
$2,020.65
|
| Rate for Payer: Humana Commercial |
$1,807.95
|
| Rate for Payer: Humana KY Medicaid |
$731.48
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$738.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.37
|
| Rate for Payer: PHCS Commercial |
$2,041.92
|
| Rate for Payer: United Healthcare All Payer |
$1,871.76
|
|
|
EXCISION NASAL POLYP
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
76101120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$185.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.46
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| 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 |
$286.78
|
| Rate for Payer: Healthspan PPO |
$256.19
|
| Rate for Payer: Humana Medicaid |
$67.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.40
|
| Rate for Payer: Molina Healthcare Passport |
$67.06
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$92.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.73
|
|
|
EXCISION NASAL POLYP
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
76101120
|
|
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 NASAL POLYP
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
76101120
|
|
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 NASAL POLYP(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
761P1120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$185.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.46
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| 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 |
$286.78
|
| Rate for Payer: Healthspan PPO |
$256.19
|
| Rate for Payer: Humana Medicaid |
$67.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.40
|
| Rate for Payer: Molina Healthcare Passport |
$67.06
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$92.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.73
|
|
|
EXCISION OF BARTHOLIN'S GLAND OR CYST
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 56740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
EX CISION OF BENIGN LESION
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.48
|
| Rate for Payer: Anthem Medicaid |
$158.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,736.00
|
| Rate for Payer: Cash Price |
$2,368.00
|
| Rate for Payer: Cash Price |
$2,368.00
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: Healthspan PPO |
$420.48
|
| Rate for Payer: Humana Medicaid |
$158.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.70
|
| Rate for Payer: Molina Healthcare Passport |
$158.53
|
| Rate for Payer: Multiplan PHCS |
$2,841.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,315.20
|
| Rate for Payer: UHCCP Medicaid |
$170.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.12
|
|
|
EX CISION OF BENIGN LESION
|
Facility
|
OP
|
$4,736.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.68 |
| Max. Negotiated Rate |
$4,546.56 |
| Rate for Payer: Aetna Commercial |
$3,646.72
|
| Rate for Payer: Anthem Medicaid |
$1,628.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,694.08
|
| 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 |
$2,368.00
|
| Rate for Payer: Cash Price |
$2,368.00
|
| Rate for Payer: Cigna Commercial |
$3,930.88
|
| Rate for Payer: First Health Commercial |
$4,499.20
|
| Rate for Payer: Humana Commercial |
$4,025.60
|
| Rate for Payer: Humana KY Medicaid |
$1,628.71
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,645.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,883.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,495.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,661.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,167.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,552.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.16
|
| Rate for Payer: PHCS Commercial |
$4,546.56
|
| Rate for Payer: United Healthcare All Payer |
$4,167.68
|
|
|
EX CISION OF BENIGN LESION
|
Facility
|
IP
|
$4,736.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.68 |
| Max. Negotiated Rate |
$4,546.56 |
| Rate for Payer: Aetna Commercial |
$3,646.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,694.08
|
| Rate for Payer: Cash Price |
$2,368.00
|
| Rate for Payer: Cigna Commercial |
$3,930.88
|
| Rate for Payer: First Health Commercial |
$4,499.20
|
| Rate for Payer: Humana Commercial |
$4,025.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,883.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,495.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,167.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,552.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.16
|
| Rate for Payer: PHCS Commercial |
$4,546.56
|
| Rate for Payer: United Healthcare All Payer |
$4,167.68
|
|
|
EX CISION OF BENIGN LESION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761P0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.48
|
| Rate for Payer: Anthem Medicaid |
$158.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: Healthspan PPO |
$420.48
|
| Rate for Payer: Humana Medicaid |
$158.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.70
|
| Rate for Payer: Molina Healthcare Passport |
$158.53
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$170.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.12
|
|
|
EX CISION OF BENIGN LESION(T
|
Facility
|
OP
|
$3,886.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761T0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.18 |
| Max. Negotiated Rate |
$3,730.56 |
| Rate for Payer: Aetna Commercial |
$2,992.22
|
| Rate for Payer: Anthem Medicaid |
$1,336.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,943.00
|
| Rate for Payer: Cash Price |
$1,943.00
|
| Rate for Payer: Cigna Commercial |
$3,225.38
|
| Rate for Payer: First Health Commercial |
$3,691.70
|
| Rate for Payer: Humana Commercial |
$3,303.10
|
| Rate for Payer: Humana KY Medicaid |
$1,336.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,350.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,363.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.66
|
| Rate for Payer: PHCS Commercial |
$3,730.56
|
| Rate for Payer: United Healthcare All Payer |
$3,419.68
|
|
|
EX CISION OF BENIGN LESION(T
|
Facility
|
IP
|
$3,886.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761T0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.18 |
| Max. Negotiated Rate |
$3,730.56 |
| Rate for Payer: Aetna Commercial |
$2,992.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.08
|
| Rate for Payer: Cash Price |
$1,943.00
|
| Rate for Payer: Cigna Commercial |
$3,225.38
|
| Rate for Payer: First Health Commercial |
$3,691.70
|
| Rate for Payer: Humana Commercial |
$3,303.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.66
|
| Rate for Payer: PHCS Commercial |
$3,730.56
|
| Rate for Payer: United Healthcare All Payer |
$3,419.68
|
|
|
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; SINGLE LESION
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
Excision of carotid body tumor
|
Professional
|
Both
|
$1,614.29
|
|
|
Service Code
|
HCPCS 60600
|
| Hospital Charge Code |
761P2643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,123.82 |
| Rate for Payer: Aetna Commercial |
$2,123.82
|
| Rate for Payer: Anthem Medicaid |
$826.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,614.29
|
| Rate for Payer: Cash Price |
$807.14
|
| Rate for Payer: Cash Price |
$807.14
|
| Rate for Payer: Cigna Commercial |
$2,025.93
|
| Rate for Payer: Healthspan PPO |
$1,791.06
|
| Rate for Payer: Humana Medicaid |
$826.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,889.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$842.90
|
| Rate for Payer: Molina Healthcare Passport |
$826.37
|
| Rate for Payer: Multiplan PHCS |
$968.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,130.00
|
| Rate for Payer: UHCCP Medicaid |
$565.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.63
|
|
|
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
IP
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.11 |
| Max. Negotiated Rate |
$8,685.12 |
| Rate for Payer: Aetna Commercial |
$6,966.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,056.66
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$7,509.01
|
| Rate for Payer: First Health Commercial |
$8,594.65
|
| Rate for Payer: Humana Commercial |
$7,689.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,418.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,676.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,961.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,809.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$8,685.12
|
| Rate for Payer: United Healthcare All Payer |
$7,961.36
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
OP
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.11 |
| Max. Negotiated Rate |
$8,685.12 |
| Rate for Payer: Aetna Commercial |
$6,966.19
|
| Rate for Payer: Anthem Medicaid |
$3,111.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,056.66
|
| 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 |
$4,523.50
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$7,509.01
|
| Rate for Payer: First Health Commercial |
$8,594.65
|
| Rate for Payer: Humana Commercial |
$7,689.95
|
| Rate for Payer: Humana KY Medicaid |
$3,111.26
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,142.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,418.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,676.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,173.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,961.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,809.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$8,685.12
|
| Rate for Payer: United Healthcare All Payer |
$7,961.36
|
|
|
EXCISION OF FACIAL BONE(S)
|
Professional
|
Both
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.84 |
| Max. Negotiated Rate |
$9,047.00 |
| Rate for Payer: Aetna Commercial |
$686.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.85
|
| Rate for Payer: Anthem Medicaid |
$181.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,047.00
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$874.47
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$181.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.48
|
| Rate for Payer: Molina Healthcare Passport |
$181.84
|
| Rate for Payer: Multiplan PHCS |
$5,428.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,332.90
|
| Rate for Payer: UHCCP Medicaid |
$228.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.66
|
|
|
EXCISION OF FACIAL BONE(S)(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761P0368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.84 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$686.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.85
|
| Rate for Payer: Anthem Medicaid |
$181.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$874.47
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$181.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.48
|
| Rate for Payer: Molina Healthcare Passport |
$181.84
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$228.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.66
|
|
|
EXCISION OF FACIAL BONE(S)(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761T0368
|
|
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 OF FACIAL BONE(S)(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761T0368
|
|
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 OF FRENUM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.21 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$329.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.08
|
| Rate for Payer: Anthem Medicaid |
$86.21
|
| 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 |
$392.32
|
| Rate for Payer: Healthspan PPO |
$348.83
|
| Rate for Payer: Humana Medicaid |
$86.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$294.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.93
|
| Rate for Payer: Molina Healthcare Passport |
$86.21
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$134.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.07
|
|
|
EXCISION OF FRENUM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
