|
EXCISION TUMOR NECK(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761P0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$700.00 |
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| 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 |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.70
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
IP
|
$6,261.38
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761T0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.98 |
| Max. Negotiated Rate |
$6,010.92 |
| Rate for Payer: Aetna Commercial |
$4,821.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,883.88
|
| Rate for Payer: Cash Price |
$3,130.69
|
| Rate for Payer: Cigna Commercial |
$5,196.95
|
| Rate for Payer: First Health Commercial |
$5,948.31
|
| Rate for Payer: Humana Commercial |
$5,322.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,134.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,620.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,878.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,510.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,696.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,941.03
|
| Rate for Payer: PHCS Commercial |
$6,010.92
|
| Rate for Payer: United Healthcare All Payer |
$5,510.01
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
OP
|
$5,014.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761T0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.82 |
| Max. Negotiated Rate |
$4,813.44 |
| Rate for Payer: Aetna Commercial |
$3,860.78
|
| Rate for Payer: Anthem Medicaid |
$1,724.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,910.92
|
| 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 |
$2,507.00
|
| Rate for Payer: Cash Price |
$2,507.00
|
| Rate for Payer: Cigna Commercial |
$4,161.62
|
| Rate for Payer: First Health Commercial |
$4,763.30
|
| Rate for Payer: Humana Commercial |
$4,261.90
|
| Rate for Payer: Humana KY Medicaid |
$1,724.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,741.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,111.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,700.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,758.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,412.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,760.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,002.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,554.34
|
| Rate for Payer: PHCS Commercial |
$4,813.44
|
| Rate for Payer: United Healthcare All Payer |
$4,412.32
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
IP
|
$5,014.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761T0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.82 |
| Max. Negotiated Rate |
$4,813.44 |
| Rate for Payer: Aetna Commercial |
$3,860.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,910.92
|
| Rate for Payer: Cash Price |
$2,507.00
|
| Rate for Payer: Cigna Commercial |
$4,161.62
|
| Rate for Payer: First Health Commercial |
$4,763.30
|
| Rate for Payer: Humana Commercial |
$4,261.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,111.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,700.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,412.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,760.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,002.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,554.34
|
| Rate for Payer: PHCS Commercial |
$4,813.44
|
| Rate for Payer: United Healthcare All Payer |
$4,412.32
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
OP
|
$6,261.38
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761T0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.98 |
| Max. Negotiated Rate |
$6,010.92 |
| Rate for Payer: Aetna Commercial |
$4,821.26
|
| Rate for Payer: Anthem Medicaid |
$2,153.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,883.88
|
| 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 |
$3,130.69
|
| Rate for Payer: Cash Price |
$3,130.69
|
| Rate for Payer: Cigna Commercial |
$5,196.95
|
| Rate for Payer: First Health Commercial |
$5,948.31
|
| Rate for Payer: Humana Commercial |
$5,322.17
|
| Rate for Payer: Humana KY Medicaid |
$2,153.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,175.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,134.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,620.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,196.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,510.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,696.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,941.03
|
| Rate for Payer: PHCS Commercial |
$6,010.92
|
| Rate for Payer: United Healthcare All Payer |
$5,510.01
|
|
|
EXCISION - TUMOR - PELVIS AN
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$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 |
$2,457.19
|
| 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 |
$2,948.63
|
| 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 - TUMOR - PELVIS AN
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
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 - TUMOR - PELVIS AN
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| 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 |
$742.08
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$303.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$740.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.39
|
| Rate for Payer: Molina Healthcare Passport |
$303.32
|
| 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 |
$306.35
|
|
|
EXCISION - TUMOR - PELVIS AN(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
761P0769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| 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 |
$742.08
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$303.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$740.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.39
|
| Rate for Payer: Molina Healthcare Passport |
$303.32
|
| 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 |
$306.35
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Facility
|
IP
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$815.75 |
| Max. Negotiated Rate |
$6,024.00 |
| Rate for Payer: Aetna Commercial |
$4,831.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,894.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$5,208.25
|
| Rate for Payer: First Health Commercial |
$5,961.25
|
| Rate for Payer: Humana Commercial |
$5,333.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,145.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,630.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,882.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,522.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$815.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,945.25
|
| Rate for Payer: PHCS Commercial |
$6,024.00
|
| Rate for Payer: United Healthcare All Payer |
$5,522.00
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Facility
|
OP
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$815.75 |
| Max. Negotiated Rate |
$6,024.00 |
| Rate for Payer: Aetna Commercial |
$4,831.75
|
| Rate for Payer: Anthem Medicaid |
$2,157.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,894.50
|
| 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 |
$3,137.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$5,208.25
|
| Rate for Payer: First Health Commercial |
$5,961.25
|
| Rate for Payer: Humana Commercial |
$5,333.75
|
| Rate for Payer: Humana KY Medicaid |
$2,157.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,179.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,145.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,630.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,201.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,522.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$815.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,945.25
|
| Rate for Payer: PHCS Commercial |
$6,024.00
|
| Rate for Payer: United Healthcare All Payer |
$5,522.00
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Professional
|
Both
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.67 |
| Max. Negotiated Rate |
$6,275.00 |
| Rate for Payer: Aetna Commercial |
$819.60
|
| Rate for Payer: Anthem Medicaid |
$319.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,275.00
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$881.75
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$319.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$670.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.06
|
| Rate for Payer: Molina Healthcare Passport |
$319.67
|
| Rate for Payer: Multiplan PHCS |
$3,765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,392.50
|
| Rate for Payer: UHCCP Medicaid |
$2,196.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$322.87
|
|
|
EXCISION TUMOR SHOULDER DEEP(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761P0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.67 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$819.60
|
| Rate for Payer: Anthem Medicaid |
$319.67
|
| 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 |
$881.75
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$319.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$670.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.06
|
| Rate for Payer: Molina Healthcare Passport |
$319.67
|
| 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 |
$322.87
|
|
|
EXCISION TUMOR SHOULDER DEEP(T
|
Facility
|
IP
|
$5,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761T0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.75 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$4,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.50
|
| Rate for Payer: Cash Price |
$2,637.50
|
| Rate for Payer: Cigna Commercial |
$4,378.25
|
| Rate for Payer: First Health Commercial |
$5,011.25
|
| Rate for Payer: Humana Commercial |
$4,483.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,055.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.25
|
| Rate for Payer: PHCS Commercial |
$5,064.00
|
| Rate for Payer: United Healthcare All Payer |
$4,642.00
|
|
|
EXCISION TUMOR SHOULDER DEEP(T
|
Facility
|
OP
|
$5,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761T0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.75 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$4,061.75
|
| Rate for Payer: Anthem Medicaid |
$1,814.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,637.50
|
| Rate for Payer: Cash Price |
$2,637.50
|
| Rate for Payer: Cigna Commercial |
$4,378.25
|
| Rate for Payer: First Health Commercial |
$5,011.25
|
| Rate for Payer: Humana Commercial |
$4,483.75
|
| Rate for Payer: Humana KY Medicaid |
$1,814.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,055.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.25
|
| Rate for Payer: PHCS Commercial |
$5,064.00
|
| Rate for Payer: United Healthcare All Payer |
$4,642.00
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Facility
|
IP
|
$4,365.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.45 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Aetna Commercial |
$3,361.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.70
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$3,622.95
|
| Rate for Payer: First Health Commercial |
$4,146.75
|
| Rate for Payer: Humana Commercial |
$3,710.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.15
|
| Rate for Payer: PHCS Commercial |
$4,190.40
|
| Rate for Payer: United Healthcare All Payer |
$3,841.20
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Professional
|
Both
|
$4,365.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$4,365.00 |
| Rate for Payer: Aetna Commercial |
$447.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.09
|
| Rate for Payer: Anthem Medicaid |
$172.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,365.00
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$602.85
|
| Rate for Payer: Healthspan PPO |
$591.74
|
| Rate for Payer: Humana Medicaid |
$172.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.28
|
| Rate for Payer: Molina Healthcare Passport |
$172.82
|
| Rate for Payer: Multiplan PHCS |
$2,619.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,055.50
|
| Rate for Payer: UHCCP Medicaid |
$178.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.55
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Facility
|
OP
|
$4,365.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.45 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Aetna Commercial |
$3,361.05
|
| Rate for Payer: Anthem Medicaid |
$1,501.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.70
|
| 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 |
$2,182.50
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$3,622.95
|
| Rate for Payer: First Health Commercial |
$4,146.75
|
| Rate for Payer: Humana Commercial |
$3,710.25
|
| Rate for Payer: Humana KY Medicaid |
$1,501.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,531.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.15
|
| Rate for Payer: PHCS Commercial |
$4,190.40
|
| Rate for Payer: United Healthcare All Payer |
$3,841.20
|
|
|
EXCISION TUMOR SOFT TIS ARM(P
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761P0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$447.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.09
|
| Rate for Payer: Anthem Medicaid |
$172.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cigna Commercial |
$602.85
|
| Rate for Payer: Healthspan PPO |
$591.74
|
| Rate for Payer: Humana Medicaid |
$172.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.28
|
| Rate for Payer: Molina Healthcare Passport |
$172.82
|
| Rate for Payer: Multiplan PHCS |
$386.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.80
|
| Rate for Payer: UHCCP Medicaid |
$178.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.55
|
|
|
EXCISION TUMOR SOFT TIS ARM(T
|
Facility
|
OP
|
$3,721.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761T0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.73 |
| Max. Negotiated Rate |
$3,572.16 |
| Rate for Payer: Aetna Commercial |
$2,865.17
|
| Rate for Payer: Anthem Medicaid |
$1,279.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.38
|
| 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 |
$1,860.50
|
| Rate for Payer: Cash Price |
$1,860.50
|
| Rate for Payer: Cigna Commercial |
$3,088.43
|
| Rate for Payer: First Health Commercial |
$3,534.95
|
| Rate for Payer: Humana Commercial |
$3,162.85
|
| Rate for Payer: Humana KY Medicaid |
$1,279.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.51
|
| Rate for Payer: PHCS Commercial |
$3,572.16
|
| Rate for Payer: United Healthcare All Payer |
$3,274.48
|
|
|
EXCISION TUMOR SOFT TIS ARM(T
|
Facility
|
IP
|
$3,721.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761T0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.73 |
| Max. Negotiated Rate |
$3,572.16 |
| Rate for Payer: Aetna Commercial |
$2,865.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.38
|
| Rate for Payer: Cash Price |
$1,860.50
|
| Rate for Payer: Cigna Commercial |
$3,088.43
|
| Rate for Payer: First Health Commercial |
$3,534.95
|
| Rate for Payer: Humana Commercial |
$3,162.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.51
|
| Rate for Payer: PHCS Commercial |
$3,572.16
|
| Rate for Payer: United Healthcare All Payer |
$3,274.48
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 22903
|
|
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 22902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 22901
|
|
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 22900
|
|
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
|
|
