EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 21931
|
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 BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 21930
|
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 BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 21933
|
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 FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 21014
|
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 FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 21012
|
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 FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 28039
|
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 FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 25071
|
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 FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 25075
|
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 LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 27632
|
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 NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 21552
|
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 NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 21555
|
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 NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 21554
|
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 NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 21556
|
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 PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 27043
|
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 PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 27047
|
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 SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 23071
|
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 SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 23076
|
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 THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 27337
|
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 THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 27327
|
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 THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 27339
|
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 UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 24071
|
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 UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$1,962.83
|
|
Service Code
|
CPT 24075
|
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 UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
Service Code
|
CPT 24073
|
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 VAG CUFF ENDOMETRIOMA
|
Professional
|
Both
|
$2,500.00
|
|
Service Code
|
HCPCS 58999
|
Hospital Charge Code |
761P2267
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$2,500.00 |
Rate for Payer: Anthem Medicaid |
$570.00
|
Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
Rate for Payer: Cash Price |
$1,250.00
|
Rate for Payer: Cash Price |
$1,250.00
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Humana Medicaid |
$570.00
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$581.40
|
Rate for Payer: Molina Healthcare Passport |
$570.00
|
Rate for Payer: Multiplan PHCS |
$1,500.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
Rate for Payer: UHCCP Medicaid |
$875.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$575.70
|
|
EXCISION VAG CUFF ENDOMETRIOMA
|
Facility
|
OP
|
$2,500.00
|
|
Service Code
|
HCPCS 58999
|
Hospital Charge Code |
76102267
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$172.32 |
Max. Negotiated Rate |
$2,400.00 |
Rate for Payer: Aetna Commercial |
$1,925.00
|
Rate for Payer: Anthem Medicaid |
$859.75
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
Rate for Payer: Cash Price |
$1,250.00
|
Rate for Payer: Cash Price |
$1,250.00
|
Rate for Payer: Cigna Commercial |
$2,075.00
|
Rate for Payer: First Health Commercial |
$2,375.00
|
Rate for Payer: Humana Commercial |
$2,125.00
|
Rate for Payer: Humana KY Medicaid |
$859.75
|
Rate for Payer: Humana Medicare Advantage |
$172.32
|
Rate for Payer: Kentucky WC Medicaid |
$868.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
Rate for Payer: PHCS Commercial |
$2,400.00
|
Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|