|
EXCISION, PREPATELLAR BURSA
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
76100820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
EXCISION, PREPATELLAR BURSA
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 27340
|
| Hospital Charge Code |
76100820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$1,113.60 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.60
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
EXCISION, PREPATELLAR BURSA(P
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 27340
|
| Hospital Charge Code |
761P0820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.36 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Anthem Medicaid |
$233.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,160.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$575.88
|
| Rate for Payer: Healthspan PPO |
$472.18
|
| Rate for Payer: Humana Medicaid |
$233.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.03
|
| Rate for Payer: Molina Healthcare Passport |
$233.36
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$812.00
|
| Rate for Payer: UHCCP Medicaid |
$406.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.69
|
|
|
EXCISION - PRESSURE ULCER
|
Facility
|
IP
|
$5,435.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.61 |
| Max. Negotiated Rate |
$5,218.01 |
| Rate for Payer: Aetna Commercial |
$4,185.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,239.64
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cigna Commercial |
$4,511.41
|
| Rate for Payer: First Health Commercial |
$5,163.66
|
| Rate for Payer: Humana Commercial |
$4,620.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,457.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,011.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,630.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,783.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,076.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$706.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,684.98
|
| Rate for Payer: PHCS Commercial |
$5,218.01
|
| Rate for Payer: United Healthcare All Payer |
$4,783.18
|
|
|
EXCISION - PRESSURE ULCER
|
Professional
|
Both
|
$5,435.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.07 |
| Max. Negotiated Rate |
$5,435.43 |
| Rate for Payer: Aetna Commercial |
$820.76
|
| Rate for Payer: Anthem Medicaid |
$294.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,435.43
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cigna Commercial |
$777.59
|
| Rate for Payer: Healthspan PPO |
$656.27
|
| Rate for Payer: Humana Medicaid |
$294.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$709.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.95
|
| Rate for Payer: Molina Healthcare Passport |
$294.07
|
| Rate for Payer: Multiplan PHCS |
$3,261.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,804.80
|
| Rate for Payer: UHCCP Medicaid |
$1,902.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.01
|
|
|
EXCISION - PRESSURE ULCER
|
Facility
|
OP
|
$5,435.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.61 |
| Max. Negotiated Rate |
$5,218.01 |
| Rate for Payer: Aetna Commercial |
$4,185.28
|
| Rate for Payer: Anthem Medicaid |
$1,869.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,239.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cigna Commercial |
$4,511.41
|
| Rate for Payer: First Health Commercial |
$5,163.66
|
| Rate for Payer: Humana Commercial |
$4,620.12
|
| Rate for Payer: Humana KY Medicaid |
$1,869.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,888.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,457.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,011.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,906.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,783.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,076.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$706.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,684.98
|
| Rate for Payer: PHCS Commercial |
$5,218.01
|
| Rate for Payer: United Healthcare All Payer |
$4,783.18
|
|
|
EXCISION - PRESSURE ULCER(P
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761P0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.95 |
| Max. Negotiated Rate |
$820.76 |
| Rate for Payer: Aetna Commercial |
$820.76
|
| Rate for Payer: Anthem Medicaid |
$294.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.00
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$777.59
|
| Rate for Payer: Healthspan PPO |
$656.27
|
| Rate for Payer: Humana Medicaid |
$294.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$709.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.95
|
| Rate for Payer: Molina Healthcare Passport |
$294.07
|
| Rate for Payer: Multiplan PHCS |
$466.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.90
|
| Rate for Payer: UHCCP Medicaid |
$271.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.01
|
|
|
EXCISION - PRESSURE ULCER(T
|
Facility
|
IP
|
$4,658.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761T0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.60 |
| Max. Negotiated Rate |
$4,472.09 |
| Rate for Payer: Aetna Commercial |
$3,586.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.58
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cigna Commercial |
$3,866.50
|
| Rate for Payer: First Health Commercial |
$4,425.51
|
| Rate for Payer: Humana Commercial |
$3,959.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,819.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,437.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,493.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.11
|
| Rate for Payer: PHCS Commercial |
$4,472.09
|
| Rate for Payer: United Healthcare All Payer |
$4,099.42
|
|
|
EXCISION - PRESSURE ULCER(T
|
Facility
|
OP
|
$4,658.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761T0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.60 |
| Max. Negotiated Rate |
$4,472.09 |
| Rate for Payer: Aetna Commercial |
$3,586.99
|
| Rate for Payer: Anthem Medicaid |
$1,602.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cigna Commercial |
$3,866.50
|
| Rate for Payer: First Health Commercial |
$4,425.51
|
| Rate for Payer: Humana Commercial |
$3,959.67
|
| Rate for Payer: Humana KY Medicaid |
$1,602.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,618.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,819.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,437.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,634.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,493.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.11
|
| Rate for Payer: PHCS Commercial |
$4,472.09
|
| Rate for Payer: United Healthcare All Payer |
$4,099.42
|
|
|
EXCISION, RADIAL HEAD
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
EXCISION, RADIAL HEAD
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna Commercial |
$729.45
|
| Rate for Payer: Anthem Medicaid |
$381.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$807.26
|
| Rate for Payer: Healthspan PPO |
$660.72
|
| Rate for Payer: Humana Medicaid |
$381.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Molina Healthcare Passport |
$381.37
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.18
|
|
|
EXCISION, RADIAL HEAD
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
EXCISION, RADIAL HEAD(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
761P0510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna Commercial |
$729.45
|
| Rate for Payer: Anthem Medicaid |
$381.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$807.26
|
| Rate for Payer: Healthspan PPO |
$660.72
|
| Rate for Payer: Humana Medicaid |
$381.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Molina Healthcare Passport |
$381.37
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.18
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$502.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.31
|
| Rate for Payer: Anthem Medicaid |
$197.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$545.16
|
| Rate for Payer: Healthspan PPO |
$569.46
|
| Rate for Payer: Humana Medicaid |
$197.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.87
|
| Rate for Payer: Molina Healthcare Passport |
$197.91
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$170.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.89
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION - SKIN - SUBCUTANEO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
761P0813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$502.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.31
|
| Rate for Payer: Anthem Medicaid |
$197.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$545.16
|
| Rate for Payer: Healthspan PPO |
$569.46
|
| Rate for Payer: Humana Medicaid |
$197.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.87
|
| Rate for Payer: Molina Healthcare Passport |
$197.91
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$170.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.89
|
|
|
EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 27062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
EXCISION TUMOR NECK
|
Professional
|
Both
|
$7,111.38
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.41 |
| Max. Negotiated Rate |
$7,111.38 |
| Rate for Payer: Aetna Commercial |
$595.01
|
| Rate for Payer: Anthem Medicaid |
$272.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,111.38
|
| Rate for Payer: Cash Price |
$3,555.69
|
| Rate for Payer: Cash Price |
$3,555.69
|
| Rate for Payer: Cigna Commercial |
$633.67
|
| Rate for Payer: Healthspan PPO |
$538.95
|
| Rate for Payer: Humana Medicaid |
$272.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.86
|
| Rate for Payer: Molina Healthcare Passport |
$272.41
|
| Rate for Payer: Multiplan PHCS |
$4,266.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,977.97
|
| Rate for Payer: UHCCP Medicaid |
$2,488.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.13
|
|
|
EXCISION TUMOR NECK
|
Facility
|
OP
|
$7,111.38
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.48 |
| Max. Negotiated Rate |
$6,826.92 |
| Rate for Payer: Aetna Commercial |
$5,475.76
|
| Rate for Payer: Anthem Medicaid |
$2,445.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.88
|
| 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 |
$3,555.69
|
| Rate for Payer: Cash Price |
$3,555.69
|
| Rate for Payer: Cigna Commercial |
$5,902.45
|
| Rate for Payer: First Health Commercial |
$6,755.81
|
| Rate for Payer: Humana Commercial |
$6,044.67
|
| Rate for Payer: Humana KY Medicaid |
$2,445.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.53
|
| Rate for Payer: PHCS Commercial |
$6,826.92
|
| Rate for Payer: United Healthcare All Payer |
$6,258.01
|
|
|
EXCISION TUMOR NECK
|
Facility
|
IP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,771.34
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
EXCISION TUMOR NECK
|
Professional
|
Both
|
$5,714.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$5,714.00 |
| Rate for Payer: Aetna Commercial |
$476.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.81
|
| Rate for Payer: Anthem Medicaid |
$169.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$502.77
|
| Rate for Payer: Healthspan PPO |
$543.97
|
| Rate for Payer: Humana Medicaid |
$169.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.39
|
| Rate for Payer: Molina Healthcare Passport |
$169.01
|
| Rate for Payer: Multiplan PHCS |
$3,428.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,999.80
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.70
|
|
|
EXCISION TUMOR NECK
|
Facility
|
IP
|
$7,111.38
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.48 |
| Max. Negotiated Rate |
$6,826.92 |
| Rate for Payer: Aetna Commercial |
$5,475.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.88
|
| Rate for Payer: Cash Price |
$3,555.69
|
| Rate for Payer: Cigna Commercial |
$5,902.45
|
| Rate for Payer: First Health Commercial |
$6,755.81
|
| Rate for Payer: Humana Commercial |
$6,044.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,333.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.53
|
| Rate for Payer: PHCS Commercial |
$6,826.92
|
| Rate for Payer: United Healthcare All Payer |
$6,258.01
|
|
|
EXCISION TUMOR NECK
|
Facility
|
OP
|
$5,714.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$5,485.44 |
| Rate for Payer: Aetna Commercial |
$4,399.78
|
| Rate for Payer: Anthem Medicaid |
$1,965.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,456.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cash Price |
$2,857.00
|
| Rate for Payer: Cigna Commercial |
$4,742.62
|
| Rate for Payer: First Health Commercial |
$5,428.30
|
| Rate for Payer: Humana Commercial |
$4,856.90
|
| Rate for Payer: Humana KY Medicaid |
$1,965.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,985.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,685.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,216.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,004.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$742.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,771.34
|
| Rate for Payer: PHCS Commercial |
$5,485.44
|
| Rate for Payer: United Healthcare All Payer |
$5,028.32
|
|
|
EXCISION TUMOR NECK(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761P0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.41 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$595.01
|
| Rate for Payer: Anthem Medicaid |
$272.41
|
| 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 |
$633.67
|
| Rate for Payer: Healthspan PPO |
$538.95
|
| Rate for Payer: Humana Medicaid |
$272.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.86
|
| Rate for Payer: Molina Healthcare Passport |
$272.41
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.13
|
|
