|
EXCISION OF FRENUM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXCISION OF FRENUM(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
761P1640
|
|
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 GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 25111
|
|
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 OF HIP JOINT/MUSCLE
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
76100765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.95 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem Medicaid |
$417.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Humana KY Medicaid |
$417.84
|
| Rate for Payer: Kentucky WC Medicaid |
$422.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.65
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
EXCISION OF HIP JOINT/MUSCLE
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
76100765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.95 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.65
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
EXCISION OF HIP JOINT/MUSCLE
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
76100765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$1,604.15 |
| Rate for Payer: Aetna Commercial |
$1,485.94
|
| Rate for Payer: Anthem Medicaid |
$686.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,215.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,604.15
|
| Rate for Payer: Healthspan PPO |
$1,345.95
|
| Rate for Payer: Humana Medicaid |
$686.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,253.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$699.84
|
| Rate for Payer: Molina Healthcare Passport |
$686.12
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$850.50
|
| Rate for Payer: UHCCP Medicaid |
$425.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$692.98
|
|
|
EXCISION OF HIP JOINT/MUSCL(P
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
761P0765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$1,604.15 |
| Rate for Payer: Aetna Commercial |
$1,485.94
|
| Rate for Payer: Anthem Medicaid |
$686.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,215.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,604.15
|
| Rate for Payer: Healthspan PPO |
$1,345.95
|
| Rate for Payer: Humana Medicaid |
$686.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,253.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$699.84
|
| Rate for Payer: Molina Healthcare Passport |
$686.12
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$850.50
|
| Rate for Payer: UHCCP Medicaid |
$425.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$692.98
|
|
|
EXCISION OF HYDROCELE; UNI
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EXCISION OF HYDROCELE; UNI
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Anthem Medicaid |
$295.37
|
| 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 |
$485.50
|
| Rate for Payer: Healthspan PPO |
$527.85
|
| Rate for Payer: Humana Medicaid |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.28
|
| Rate for Payer: Molina Healthcare Passport |
$295.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.32
|
|
|
EXCISION OF HYDROCELE; UNI
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EXCISION OF HYDROCELE; UNILATERAL
|
Facility
|
OP
|
$4,188.46
|
|
|
Service Code
|
CPT 55040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,991.76 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
|
|
EXCISION OF HYDROCELE; UNI(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
761P2143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Anthem Medicaid |
$295.37
|
| 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 |
$485.50
|
| Rate for Payer: Healthspan PPO |
$527.85
|
| Rate for Payer: Humana Medicaid |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.28
|
| Rate for Payer: Molina Healthcare Passport |
$295.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.32
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.29 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$982.24
|
| Rate for Payer: Anthem Medicaid |
$481.29
|
| 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 |
$971.95
|
| Rate for Payer: Healthspan PPO |
$965.74
|
| Rate for Payer: Humana Medicaid |
$481.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.92
|
| Rate for Payer: Molina Healthcare Passport |
$481.29
|
| 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 |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.10
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
761P1427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.29 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$982.24
|
| Rate for Payer: Anthem Medicaid |
$481.29
|
| 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 |
$971.95
|
| Rate for Payer: Healthspan PPO |
$965.74
|
| Rate for Payer: Humana Medicaid |
$481.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.92
|
| Rate for Payer: Molina Healthcare Passport |
$481.29
|
| 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 |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.10
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
|
Facility
|
OP
|
$2,829.05
|
|
|
Service Code
|
CPT 68115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,020.75 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
|
|
EXCISION OF LESION OF MUCOSA
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.49 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$449.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.53
|
| Rate for Payer: Anthem Medicaid |
$154.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$526.57
|
| Rate for Payer: Healthspan PPO |
$463.67
|
| Rate for Payer: Humana Medicaid |
$154.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$402.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.58
|
| Rate for Payer: Molina Healthcare Passport |
$154.49
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$217.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.03
|
|
|
EXCISION OF LESION OF MUCOSA
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
EXCISION OF LESION OF MUCOSA
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
EXCISION OF LESION OF MUCOSA(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
761P1638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.49 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$449.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.53
|
| Rate for Payer: Anthem Medicaid |
$154.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$526.57
|
| Rate for Payer: Healthspan PPO |
$463.67
|
| Rate for Payer: Humana Medicaid |
$154.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$402.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.58
|
| Rate for Payer: Molina Healthcare Passport |
$154.49
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$217.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.03
|
|
|
EXCISION OF LESION OF SPERMATI
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXCISION OF LESION OF SPERMATI
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXCISION OF LESION OF SPERMATI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
761P2151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.92 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$632.26
|
| Rate for Payer: Anthem Medicaid |
$263.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$577.79
|
| Rate for Payer: Healthspan PPO |
$612.19
|
| Rate for Payer: Humana Medicaid |
$263.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.20
|
| Rate for Payer: Molina Healthcare Passport |
$263.92
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.56
|
|
|
EXCISION OF LESION OF SPERMATI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.92 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$632.26
|
| Rate for Payer: Anthem Medicaid |
$263.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$577.79
|
| Rate for Payer: Healthspan PPO |
$612.19
|
| Rate for Payer: Humana Medicaid |
$263.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.20
|
| Rate for Payer: Molina Healthcare Passport |
$263.92
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.56
|
|
