Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER

Facility

$1,945.78

Service Code	CPT 26160
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 LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS

Facility

$3,897.84

Service Code	CPT 41112
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 OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); FOOT

Facility

$1,945.78

Service Code	CPT 28090
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 LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); TOE(S), EACH

Facility

$1,945.78

Service Code	CPT 28092
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 LINGUAL FRENUM (FRENECTOMY)

Facility

$1,846.31

Service Code	CPT 41115
Hospital Revenue Code	360
Min. Negotiated Rate	$1,318.79
Max. Negotiated Rate	$1,846.31
Rate for Payer: Anthem Medicare Advantage/PPO	$1,318.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,846.31
Rate for Payer: CareSource Just4Me Medicare	$1,780.37
Rate for Payer: Humana Medicare Advantage	$1,318.79
Rate for Payer: Molina Healthcare Benefit Exchange	$1,582.55

EXCISION OF LINGUAL TONSIL

Professional

Both

$800.00

Service Code	HCPCS 42870
Hospital Charge Code	76101713
Hospital Revenue Code	761
Min. Negotiated Rate	$219.96
Max. Negotiated Rate	$809.41
Rate for Payer: Aetna Commercial	$809.41
Rate for Payer: Anthem Medicaid	$219.96
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$798.79
Rate for Payer: Healthspan PPO	$682.59
Rate for Payer: Humana Medicaid	$219.96
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$736.46
Rate for Payer: Molina Healthcare CHIP/Medicaid	$224.36
Rate for Payer: Molina Healthcare Passport	$219.96
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$280.00
Rate for Payer: Wellcare CHIP/Medicaid	$222.16

EXCISION OF LINGUAL TONSIL

Facility

$800.00

Service Code	HCPCS 42870
Hospital Charge Code	76101713
Hospital Revenue Code	761
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$7,089.80
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem Medicaid	$275.12
Rate for Payer: Anthem Medicare Advantage/PPO	$5,064.14
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
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	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Humana KY Medicaid	$275.12
Rate for Payer: Humana Medicare Advantage	$5,064.14
Rate for Payer: Kentucky WC Medicaid	$277.92
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$6,076.97
Rate for Payer: Molina Healthcare Medicaid	$280.64
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$160.00
Rate for Payer: Ohio Health Group PPO No Differential	$104.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$248.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

EXCISION OF LINGUAL TONSIL

Facility

$800.00

Service Code	HCPCS 42870
Hospital Charge Code	76101713
Hospital Revenue Code	761
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$240.00
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$160.00
Rate for Payer: Ohio Health Group PPO No Differential	$104.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$248.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

EXCISION OF LINGUAL TONSIL(P

Professional

Both

$800.00

Service Code	HCPCS 42870
Hospital Charge Code	761P1713
Hospital Revenue Code	761
Min. Negotiated Rate	$219.96
Max. Negotiated Rate	$809.41
Rate for Payer: Aetna Commercial	$809.41
Rate for Payer: Anthem Medicaid	$219.96
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$798.79
Rate for Payer: Healthspan PPO	$682.59
Rate for Payer: Humana Medicaid	$219.96
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$736.46
Rate for Payer: Molina Healthcare CHIP/Medicaid	$224.36
Rate for Payer: Molina Healthcare Passport	$219.96
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$280.00
Rate for Payer: Wellcare CHIP/Medicaid	$222.16

EXCISION OF LIP

Facility

$1,400.00

Service Code	HCPCS 40510
Hospital Charge Code	76101626
Hospital Revenue Code	761
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$3,897.84
Rate for Payer: Aetna Commercial	$1,078.00
Rate for Payer: Anthem Medicaid	$481.46
Rate for Payer: Anthem Medicare Advantage/PPO	$2,784.17
Rate for Payer: Anthem POS/PPO/Traditional	$1,092.00
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	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cigna Commercial	$1,162.00
Rate for Payer: First Health Commercial	$1,330.00
Rate for Payer: Humana Commercial	$1,190.00
Rate for Payer: Humana KY Medicaid	$481.46
Rate for Payer: Humana Medicare Advantage	$2,784.17
Rate for Payer: Kentucky WC Medicaid	$486.36
Rate for Payer: Medical Mutual Of Ohio HMO	$1,148.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,033.20
Rate for Payer: Molina Healthcare Benefit Exchange	$3,341.00
Rate for Payer: Molina Healthcare Medicaid	$491.12
Rate for Payer: Ohio Health Choice Commercial	$1,232.00
Rate for Payer: Ohio Health Group HMO	$1,050.00
Rate for Payer: Ohio Health Group PPO Differential	$280.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$434.00
Rate for Payer: PHCS Commercial	$1,344.00
Rate for Payer: United Healthcare All Payer	$1,232.00

EXCISION OF LIP

Facility

$1,400.00

Service Code	HCPCS 40510
Hospital Charge Code	76101626
Hospital Revenue Code	761
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$1,344.00
Rate for Payer: Aetna Commercial	$1,078.00
Rate for Payer: Anthem POS/PPO/Traditional	$1,092.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cigna Commercial	$1,162.00
Rate for Payer: First Health Commercial	$1,330.00
Rate for Payer: Humana Commercial	$1,190.00
Rate for Payer: Medical Mutual Of Ohio HMO	$1,148.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,033.20
Rate for Payer: Molina Healthcare Benefit Exchange	$420.00
Rate for Payer: Ohio Health Choice Commercial	$1,232.00
Rate for Payer: Ohio Health Group HMO	$1,050.00
Rate for Payer: Ohio Health Group PPO Differential	$280.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$434.00
Rate for Payer: PHCS Commercial	$1,344.00
Rate for Payer: United Healthcare All Payer	$1,232.00

EXCISION OF LIP

Professional

Both

$1,400.00

Service Code	HCPCS 40510
Hospital Charge Code	76101626
Hospital Revenue Code	761
Min. Negotiated Rate	$273.73
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$511.91
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$273.73
Rate for Payer: Anthem Medicaid	$310.91
Rate for Payer: Buckeye Medicare Advantage	$1,400.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cigna Commercial	$660.01
Rate for Payer: Healthspan PPO	$563.95
Rate for Payer: Humana Medicaid	$310.91
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$456.07
Rate for Payer: Molina Healthcare CHIP/Medicaid	$317.13
Rate for Payer: Molina Healthcare Passport	$310.91
Rate for Payer: Multiplan PHCS	$840.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$980.00
Rate for Payer: UHCCP Medicaid	$287.42
Rate for Payer: Wellcare CHIP/Medicaid	$314.02

EXCISION OF LIP(P

Professional

Both

$1,400.00

Service Code	HCPCS 40510
Hospital Charge Code	761P1626
Hospital Revenue Code	761
Min. Negotiated Rate	$273.73
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$511.91
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$273.73
Rate for Payer: Anthem Medicaid	$310.91
Rate for Payer: Buckeye Medicare Advantage	$1,400.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cigna Commercial	$660.01
Rate for Payer: Healthspan PPO	$563.95
Rate for Payer: Humana Medicaid	$310.91
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$456.07
Rate for Payer: Molina Healthcare CHIP/Medicaid	$317.13
Rate for Payer: Molina Healthcare Passport	$310.91
Rate for Payer: Multiplan PHCS	$840.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$980.00
Rate for Payer: UHCCP Medicaid	$287.42
Rate for Payer: Wellcare CHIP/Medicaid	$314.02

EXCISION OF MESENTERY LESION

Facility

$1,950.00

Service Code	HCPCS 44820
Hospital Charge Code	76101866
Hospital Revenue Code	761
Min. Negotiated Rate	$253.50
Max. Negotiated Rate	$1,872.00
Rate for Payer: Aetna Commercial	$1,501.50
Rate for Payer: Anthem Medicaid	$670.60
Rate for Payer: Anthem POS/PPO/Traditional	$1,521.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cigna Commercial	$1,618.50
Rate for Payer: First Health Commercial	$1,852.50
Rate for Payer: Humana Commercial	$1,657.50
Rate for Payer: Humana KY Medicaid	$670.60
Rate for Payer: Kentucky WC Medicaid	$677.43
Rate for Payer: Medical Mutual Of Ohio HMO	$1,599.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,439.10
Rate for Payer: Molina Healthcare Benefit Exchange	$585.00
Rate for Payer: Molina Healthcare Medicaid	$684.06
Rate for Payer: Ohio Health Choice Commercial	$1,716.00
Rate for Payer: Ohio Health Group HMO	$1,462.50
Rate for Payer: Ohio Health Group PPO Differential	$390.00
Rate for Payer: Ohio Health Group PPO No Differential	$253.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$604.50
Rate for Payer: PHCS Commercial	$1,872.00
Rate for Payer: United Healthcare All Payer	$1,716.00

EXCISION OF MESENTERY LESION

Facility

$1,950.00

Service Code	HCPCS 44820
Hospital Charge Code	76101866
Hospital Revenue Code	761
Min. Negotiated Rate	$253.50
Max. Negotiated Rate	$1,872.00
Rate for Payer: Aetna Commercial	$1,501.50
Rate for Payer: Anthem POS/PPO/Traditional	$1,521.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cigna Commercial	$1,618.50
Rate for Payer: First Health Commercial	$1,852.50
Rate for Payer: Humana Commercial	$1,657.50
Rate for Payer: Medical Mutual Of Ohio HMO	$1,599.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,439.10
Rate for Payer: Molina Healthcare Benefit Exchange	$585.00
Rate for Payer: Ohio Health Choice Commercial	$1,716.00
Rate for Payer: Ohio Health Group HMO	$1,462.50
Rate for Payer: Ohio Health Group PPO Differential	$390.00
Rate for Payer: Ohio Health Group PPO No Differential	$253.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$604.50
Rate for Payer: PHCS Commercial	$1,872.00
Rate for Payer: United Healthcare All Payer	$1,716.00

EXCISION OF MESENTERY LESION

Professional

Both

$1,950.00

Service Code	HCPCS 44820
Hospital Charge Code	76101866
Hospital Revenue Code	761
Min. Negotiated Rate	$458.16
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,206.71
Rate for Payer: Anthem Medicaid	$458.16
Rate for Payer: Buckeye Medicare Advantage	$1,950.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cigna Commercial	$1,118.32
Rate for Payer: Healthspan PPO	$1,017.64
Rate for Payer: Humana Medicaid	$458.16
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,069.27
Rate for Payer: Molina Healthcare CHIP/Medicaid	$467.32
Rate for Payer: Molina Healthcare Passport	$458.16
Rate for Payer: Multiplan PHCS	$1,170.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,365.00
Rate for Payer: UHCCP Medicaid	$682.50
Rate for Payer: Wellcare CHIP/Medicaid	$462.74

EXCISION OF MESENTERY LESIO(P

Professional

Both

$1,950.00

Service Code	HCPCS 44820
Hospital Charge Code	761P1866
Hospital Revenue Code	761
Min. Negotiated Rate	$458.16
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,206.71
Rate for Payer: Anthem Medicaid	$458.16
Rate for Payer: Buckeye Medicare Advantage	$1,950.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cigna Commercial	$1,118.32
Rate for Payer: Healthspan PPO	$1,017.64
Rate for Payer: Humana Medicaid	$458.16
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,069.27
Rate for Payer: Molina Healthcare CHIP/Medicaid	$467.32
Rate for Payer: Molina Healthcare Passport	$458.16
Rate for Payer: Multiplan PHCS	$1,170.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,365.00
Rate for Payer: UHCCP Medicaid	$682.50
Rate for Payer: Wellcare CHIP/Medicaid	$462.74

EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS

Facility

$3,399.27

Service Code	CPT 46230
Hospital Revenue Code	360
Min. Negotiated Rate	$2,428.05
Max. Negotiated Rate	$3,399.27
Rate for Payer: Anthem Medicare Advantage/PPO	$2,428.05
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,399.27
Rate for Payer: CareSource Just4Me Medicare	$3,277.87
Rate for Payer: Humana Medicare Advantage	$2,428.05
Rate for Payer: Molina Healthcare Benefit Exchange	$2,913.66

EXCISION OF NECK CYST

Professional

Both

$1,500.00

Service Code	HCPCS 42815
Hospital Charge Code	76101705
Hospital Revenue Code	761
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$801.21
Rate for Payer: Anthem Medicaid	$452.46
Rate for Payer: Buckeye Medicare Advantage	$1,500.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cigna Commercial	$782.86
Rate for Payer: Healthspan PPO	$675.68
Rate for Payer: Humana Medicaid	$452.46
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$717.57
Rate for Payer: Molina Healthcare CHIP/Medicaid	$461.51
Rate for Payer: Molina Healthcare Passport	$452.46
Rate for Payer: Multiplan PHCS	$900.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,050.00
Rate for Payer: UHCCP Medicaid	$525.00
Rate for Payer: Wellcare CHIP/Medicaid	$456.98

EXCISION OF NECK CYST

Facility

$1,500.00

Service Code	HCPCS 42815
Hospital Charge Code	76101705
Hospital Revenue Code	761
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$7,089.80
Rate for Payer: Anthem Medicare Advantage/PPO	$5,064.14
Rate for Payer: Aetna Commercial	$1,155.00
Rate for Payer: Anthem Medicaid	$515.85
Rate for Payer: Anthem POS/PPO/Traditional	$1,170.00
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	$750.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cigna Commercial	$1,245.00
Rate for Payer: First Health Commercial	$1,425.00
Rate for Payer: Humana Commercial	$1,275.00
Rate for Payer: Humana KY Medicaid	$515.85
Rate for Payer: Humana Medicare Advantage	$5,064.14
Rate for Payer: Kentucky WC Medicaid	$521.10
Rate for Payer: Medical Mutual Of Ohio HMO	$1,230.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,107.00
Rate for Payer: Molina Healthcare Benefit Exchange	$6,076.97
Rate for Payer: Molina Healthcare Medicaid	$526.20
Rate for Payer: Ohio Health Choice Commercial	$1,320.00
Rate for Payer: Ohio Health Group HMO	$1,125.00
Rate for Payer: Ohio Health Group PPO Differential	$300.00
Rate for Payer: Ohio Health Group PPO No Differential	$195.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.00
Rate for Payer: PHCS Commercial	$1,440.00
Rate for Payer: United Healthcare All Payer	$1,320.00

EXCISION OF NECK CYST

Facility

$1,500.00

Service Code	HCPCS 42815
Hospital Charge Code	76101705
Hospital Revenue Code	761
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$1,440.00
Rate for Payer: Aetna Commercial	$1,155.00
Rate for Payer: Anthem POS/PPO/Traditional	$1,170.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cigna Commercial	$1,245.00
Rate for Payer: First Health Commercial	$1,425.00
Rate for Payer: Humana Commercial	$1,275.00
Rate for Payer: Medical Mutual Of Ohio HMO	$1,230.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,107.00
Rate for Payer: Molina Healthcare Benefit Exchange	$450.00
Rate for Payer: Ohio Health Choice Commercial	$1,320.00
Rate for Payer: Ohio Health Group HMO	$1,125.00
Rate for Payer: Ohio Health Group PPO Differential	$300.00
Rate for Payer: Ohio Health Group PPO No Differential	$195.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.00
Rate for Payer: PHCS Commercial	$1,440.00
Rate for Payer: United Healthcare All Payer	$1,320.00

EXCISION OF NECK CYST(P

Professional

Both

$1,500.00

Service Code	HCPCS 42815
Hospital Charge Code	761P1705
Hospital Revenue Code	761
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$801.21
Rate for Payer: Anthem Medicaid	$452.46
Rate for Payer: Buckeye Medicare Advantage	$1,500.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cash Price	$750.00
Rate for Payer: Cigna Commercial	$782.86
Rate for Payer: Healthspan PPO	$675.68
Rate for Payer: Humana Medicaid	$452.46
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$717.57
Rate for Payer: Molina Healthcare CHIP/Medicaid	$461.51
Rate for Payer: Molina Healthcare Passport	$452.46
Rate for Payer: Multiplan PHCS	$900.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,050.00
Rate for Payer: UHCCP Medicaid	$525.00
Rate for Payer: Wellcare CHIP/Medicaid	$456.98

EXCISION OF PAROTID TUMOR OR P

Professional

Both

$1,008.00

Service Code	HCPCS 42410
Hospital Charge Code	761P1688
Hospital Revenue Code	761
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$915.99
Rate for Payer: Anthem Medicaid	$442.25
Rate for Payer: Buckeye Medicare Advantage	$1,008.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cigna Commercial	$902.85
Rate for Payer: Healthspan PPO	$772.47
Rate for Payer: Humana Medicaid	$442.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$807.66
Rate for Payer: Molina Healthcare CHIP/Medicaid	$451.10
Rate for Payer: Molina Healthcare Passport	$442.25
Rate for Payer: Multiplan PHCS	$604.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$705.60
Rate for Payer: UHCCP Medicaid	$352.80
Rate for Payer: Wellcare CHIP/Medicaid	$446.67

EXCISION OF PAROTID TUMOR OR P

Professional

Both

$1,008.00

Service Code	HCPCS 42410
Hospital Charge Code	76101688
Hospital Revenue Code	761
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$915.99
Rate for Payer: Anthem Medicaid	$442.25
Rate for Payer: Buckeye Medicare Advantage	$1,008.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cigna Commercial	$902.85
Rate for Payer: Healthspan PPO	$772.47
Rate for Payer: Humana Medicaid	$442.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$807.66
Rate for Payer: Molina Healthcare CHIP/Medicaid	$451.10
Rate for Payer: Molina Healthcare Passport	$442.25
Rate for Payer: Multiplan PHCS	$604.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$705.60
Rate for Payer: UHCCP Medicaid	$352.80
Rate for Payer: Wellcare CHIP/Medicaid	$446.67

EXCISION OF PAROTID TUMOR OR P

Facility

$1,008.00

Service Code	HCPCS 42410
Hospital Charge Code	76101688
Hospital Revenue Code	761
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$7,089.80
Rate for Payer: Aetna Commercial	$776.16
Rate for Payer: Anthem Medicaid	$346.65
Rate for Payer: Anthem Medicare Advantage/PPO	$5,064.14
Rate for Payer: Anthem POS/PPO/Traditional	$786.24
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	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cigna Commercial	$836.64
Rate for Payer: First Health Commercial	$957.60
Rate for Payer: Humana Commercial	$856.80
Rate for Payer: Humana KY Medicaid	$346.65
Rate for Payer: Humana Medicare Advantage	$5,064.14
Rate for Payer: Kentucky WC Medicaid	$350.18
Rate for Payer: Medical Mutual Of Ohio HMO	$826.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$743.90
Rate for Payer: Molina Healthcare Benefit Exchange	$6,076.97
Rate for Payer: Molina Healthcare Medicaid	$353.61
Rate for Payer: Ohio Health Choice Commercial	$887.04
Rate for Payer: Ohio Health Group HMO	$756.00
Rate for Payer: Ohio Health Group PPO Differential	$201.60
Rate for Payer: Ohio Health Group PPO No Differential	$131.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$312.48
Rate for Payer: PHCS Commercial	$967.68
Rate for Payer: United Healthcare All Payer	$887.04

Know your out-of-pocket cost for care.

All Charges