|
EXCISION OF PAROTID TUMOR OR P
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
76101688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$967.68 |
| Rate for Payer: Aetna Commercial |
$776.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$786.24
|
| 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: 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 |
$302.40
|
| 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
|
|
|
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF FACIAL NERVE
|
Facility
|
OP
|
$7,089.80
|
|
|
Service Code
|
CPT 42415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,064.14 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
OP
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$620.32 |
| Max. Negotiated Rate |
$4,580.83 |
| Rate for Payer: Aetna Commercial |
$3,674.21
|
| Rate for Payer: Anthem Medicaid |
$1,640.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,721.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$3,960.51
|
| Rate for Payer: First Health Commercial |
$4,533.12
|
| Rate for Payer: Humana Commercial |
$4,055.94
|
| Rate for Payer: Humana KY Medicaid |
$1,640.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,657.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,912.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,521.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,673.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,578.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.23
|
| Rate for Payer: PHCS Commercial |
$4,580.83
|
| Rate for Payer: United Healthcare All Payer |
$4,199.10
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
IP
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$620.32 |
| Max. Negotiated Rate |
$4,580.83 |
| Rate for Payer: Aetna Commercial |
$3,674.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,721.93
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$3,960.51
|
| Rate for Payer: First Health Commercial |
$4,533.12
|
| Rate for Payer: Humana Commercial |
$4,055.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,912.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,521.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,578.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.23
|
| Rate for Payer: PHCS Commercial |
$4,580.83
|
| Rate for Payer: United Healthcare All Payer |
$4,199.10
|
|
|
EXCISION OF PENIS LESION(S)
|
Professional
|
Both
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$4,771.70 |
| Rate for Payer: Aetna Commercial |
$203.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.92
|
| Rate for Payer: Anthem Medicaid |
$89.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,771.70
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$281.63
|
| Rate for Payer: Healthspan PPO |
$279.65
|
| Rate for Payer: Humana Medicaid |
$89.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.25
|
| Rate for Payer: Molina Healthcare Passport |
$89.46
|
| Rate for Payer: Multiplan PHCS |
$2,863.02
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,340.19
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.35
|
|
|
EXCISION OF PENIS LESION(S)(P
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761P2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna Commercial |
$203.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.92
|
| Rate for Payer: Anthem Medicaid |
$89.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.00
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$281.63
|
| Rate for Payer: Healthspan PPO |
$279.65
|
| Rate for Payer: Humana Medicaid |
$89.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.25
|
| Rate for Payer: Molina Healthcare Passport |
$89.46
|
| Rate for Payer: Multiplan PHCS |
$357.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$416.50
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.35
|
|
|
EXCISION OF PENIS LESION(S)(T
|
Facility
|
IP
|
$4,176.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761T2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.97 |
| Max. Negotiated Rate |
$4,009.63 |
| Rate for Payer: Aetna Commercial |
$3,216.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,257.83
|
| Rate for Payer: Cash Price |
$2,088.35
|
| Rate for Payer: Cigna Commercial |
$3,466.66
|
| Rate for Payer: First Health Commercial |
$3,967.86
|
| Rate for Payer: Humana Commercial |
$3,550.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,424.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.78
|
| Rate for Payer: PHCS Commercial |
$4,009.63
|
| Rate for Payer: United Healthcare All Payer |
$3,675.50
|
|
|
EXCISION OF PENIS LESION(S)(T
|
Facility
|
OP
|
$4,176.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761T2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.97 |
| Max. Negotiated Rate |
$4,009.63 |
| Rate for Payer: Aetna Commercial |
$3,216.06
|
| Rate for Payer: Anthem Medicaid |
$1,436.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,257.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,088.35
|
| Rate for Payer: Cash Price |
$2,088.35
|
| Rate for Payer: Cigna Commercial |
$3,466.66
|
| Rate for Payer: First Health Commercial |
$3,967.86
|
| Rate for Payer: Humana Commercial |
$3,550.20
|
| Rate for Payer: Humana KY Medicaid |
$1,436.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,450.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,424.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.78
|
| Rate for Payer: PHCS Commercial |
$4,009.63
|
| Rate for Payer: United Healthcare All Payer |
$3,675.50
|
|
|
EXCISION OF PILONDIAL CYST
|
Facility
|
IP
|
$6,896.04
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.49 |
| Max. Negotiated Rate |
$6,620.20 |
| Rate for Payer: Aetna Commercial |
$5,309.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,378.91
|
| Rate for Payer: Cash Price |
$3,448.02
|
| Rate for Payer: Cigna Commercial |
$5,723.71
|
| Rate for Payer: First Health Commercial |
$6,551.24
|
| Rate for Payer: Humana Commercial |
$5,861.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.77
|
| Rate for Payer: PHCS Commercial |
$6,620.20
|
| Rate for Payer: United Healthcare All Payer |
$6,068.52
|
|
|
EXCISION OF PILONDIAL CYST
|
Professional
|
Both
|
$6,896.04
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$6,896.04 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.84
|
| Rate for Payer: Anthem Medicaid |
$157.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,896.04
|
| Rate for Payer: Cash Price |
$3,448.02
|
| Rate for Payer: Cash Price |
$3,448.02
|
| Rate for Payer: Cigna Commercial |
$330.63
|
| Rate for Payer: Healthspan PPO |
$287.82
|
| Rate for Payer: Humana Medicaid |
$157.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.58
|
| Rate for Payer: Molina Healthcare Passport |
$157.43
|
| Rate for Payer: Multiplan PHCS |
$4,137.62
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,827.23
|
| Rate for Payer: UHCCP Medicaid |
$118.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.00
|
|
|
EXCISION OF PILONDIAL CYST
|
Facility
|
OP
|
$6,896.04
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.49 |
| Max. Negotiated Rate |
$6,620.20 |
| Rate for Payer: Aetna Commercial |
$5,309.95
|
| Rate for Payer: Anthem Medicaid |
$2,371.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,378.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,448.02
|
| Rate for Payer: Cash Price |
$3,448.02
|
| Rate for Payer: Cigna Commercial |
$5,723.71
|
| Rate for Payer: First Health Commercial |
$6,551.24
|
| Rate for Payer: Humana Commercial |
$5,861.63
|
| Rate for Payer: Humana KY Medicaid |
$2,371.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,395.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,419.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.77
|
| Rate for Payer: PHCS Commercial |
$6,620.20
|
| Rate for Payer: United Healthcare All Payer |
$6,068.52
|
|
|
EXCISION OF PILONDIAL CYST(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761P0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.84
|
| Rate for Payer: Anthem Medicaid |
$157.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$330.63
|
| Rate for Payer: Healthspan PPO |
$287.82
|
| Rate for Payer: Humana Medicaid |
$157.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.58
|
| Rate for Payer: Molina Healthcare Passport |
$157.43
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$118.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.00
|
|
|
EXCISION OF PILONDIAL CYST(T
|
Facility
|
OP
|
$6,246.04
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761T0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.99 |
| Max. Negotiated Rate |
$5,996.20 |
| Rate for Payer: Aetna Commercial |
$4,809.45
|
| Rate for Payer: Anthem Medicaid |
$2,148.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,871.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,123.02
|
| Rate for Payer: Cash Price |
$3,123.02
|
| Rate for Payer: Cigna Commercial |
$5,184.21
|
| Rate for Payer: First Health Commercial |
$5,933.74
|
| Rate for Payer: Humana Commercial |
$5,309.13
|
| Rate for Payer: Humana KY Medicaid |
$2,148.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,169.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,121.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,191.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,496.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,684.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,936.27
|
| Rate for Payer: PHCS Commercial |
$5,996.20
|
| Rate for Payer: United Healthcare All Payer |
$5,496.52
|
|
|
EXCISION OF PILONDIAL CYST(T
|
Facility
|
IP
|
$6,246.04
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761T0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.99 |
| Max. Negotiated Rate |
$5,996.20 |
| Rate for Payer: Aetna Commercial |
$4,809.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,871.91
|
| Rate for Payer: Cash Price |
$3,123.02
|
| Rate for Payer: Cigna Commercial |
$5,184.21
|
| Rate for Payer: First Health Commercial |
$5,933.74
|
| Rate for Payer: Humana Commercial |
$5,309.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,121.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,873.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,496.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,684.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,936.27
|
| Rate for Payer: PHCS Commercial |
$5,996.20
|
| Rate for Payer: United Healthcare All Payer |
$5,496.52
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 11772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 11771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 11770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
EXCISION OF RIB, PARTIAL
|
Professional
|
Both
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.07 |
| Max. Negotiated Rate |
$9,668.00 |
| Rate for Payer: Aetna Commercial |
$799.50
|
| Rate for Payer: Anthem Medicaid |
$326.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,668.00
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$850.33
|
| Rate for Payer: Healthspan PPO |
$724.17
|
| Rate for Payer: Humana Medicaid |
$326.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$702.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Molina Healthcare Passport |
$326.07
|
| Rate for Payer: Multiplan PHCS |
$5,800.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,767.60
|
| Rate for Payer: UHCCP Medicaid |
$3,383.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.33
|
|
|
EXCISION OF RIB, PARTIAL
|
Facility
|
OP
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.84 |
| Max. Negotiated Rate |
$9,281.28 |
| Rate for Payer: Aetna Commercial |
$7,444.36
|
| Rate for Payer: Anthem Medicaid |
$3,324.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,541.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$8,024.44
|
| Rate for Payer: First Health Commercial |
$9,184.60
|
| Rate for Payer: Humana Commercial |
$8,217.80
|
| Rate for Payer: Humana KY Medicaid |
$3,324.83
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,358.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,927.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,134.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,391.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,507.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.08
|
| Rate for Payer: PHCS Commercial |
$9,281.28
|
| Rate for Payer: United Healthcare All Payer |
$8,507.84
|
|
|
EXCISION OF RIB, PARTIAL
|
Facility
|
IP
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.84 |
| Max. Negotiated Rate |
$9,281.28 |
| Rate for Payer: Aetna Commercial |
$7,444.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,541.04
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$8,024.44
|
| Rate for Payer: First Health Commercial |
$9,184.60
|
| Rate for Payer: Humana Commercial |
$8,217.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,927.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,134.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,507.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.08
|
| Rate for Payer: PHCS Commercial |
$9,281.28
|
| Rate for Payer: United Healthcare All Payer |
$8,507.84
|
|
|
EXCISION OF RIB, PARTIAL(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761P0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.07 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$799.50
|
| Rate for Payer: Anthem Medicaid |
$326.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$850.33
|
| Rate for Payer: Healthspan PPO |
$724.17
|
| Rate for Payer: Humana Medicaid |
$326.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$702.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Molina Healthcare Passport |
$326.07
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.33
|
|
|
EXCISION OF RIB, PARTIAL(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761T0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
EXCISION OF RIB, PARTIAL(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761T0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
EXCISION OF SALIVARY CYST
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
76101686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
EXCISION OF SALIVARY CYST
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
76101686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.88 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$478.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$223.88
|
| Rate for Payer: Anthem Medicaid |
$225.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Healthspan PPO |
$533.90
|
| Rate for Payer: Humana Medicaid |
$225.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$423.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.05
|
| Rate for Payer: Molina Healthcare Passport |
$225.54
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$235.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.80
|
|
