|
EXC LEG/ANKLE TUM DEP 5 CM/(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27634
|
| Hospital Charge Code |
761P0902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.38 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,035.39
|
| Rate for Payer: Anthem Medicaid |
$489.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,181.31
|
| Rate for Payer: Healthspan PPO |
$738.86
|
| Rate for Payer: Humana Medicaid |
$489.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$854.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$499.17
|
| Rate for Payer: Molina Healthcare Passport |
$489.38
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$494.27
|
|
|
EXC. LESIN OF TENDON SHEATH
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
76100900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXC. LESIN OF TENDON SHEATH
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
76100900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$543.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.11
|
| Rate for Payer: Anthem Medicaid |
$230.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$602.70
|
| Rate for Payer: Healthspan PPO |
$676.54
|
| Rate for Payer: Humana Medicaid |
$230.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.39
|
| Rate for Payer: Molina Healthcare Passport |
$230.77
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$193.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.08
|
|
|
EXC. LESIN OF TENDON SHEATH
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
76100900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXC. LESIN OF TENDON SHEATH(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
761P0900
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$543.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.11
|
| Rate for Payer: Anthem Medicaid |
$230.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$602.70
|
| Rate for Payer: Healthspan PPO |
$676.54
|
| Rate for Payer: Humana Medicaid |
$230.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.39
|
| Rate for Payer: Molina Healthcare Passport |
$230.77
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$193.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.08
|
|
|
EXC LESION FLOOR OF MOUTH
|
Professional
|
Both
|
$6,428.72
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
76101659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$6,428.72 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.65
|
| Rate for Payer: Anthem Medicaid |
$142.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,428.72
|
| Rate for Payer: Cash Price |
$3,214.36
|
| Rate for Payer: Cash Price |
$3,214.36
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Healthspan PPO |
$369.67
|
| Rate for Payer: Humana Medicaid |
$142.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Molina Healthcare Passport |
$142.60
|
| Rate for Payer: Multiplan PHCS |
$3,857.23
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,500.10
|
| Rate for Payer: UHCCP Medicaid |
$148.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.03
|
|
|
EXC LESION FLOOR OF MOUTH
|
Facility
|
OP
|
$6,428.72
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
76101659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.73 |
| Max. Negotiated Rate |
$6,171.57 |
| Rate for Payer: Aetna Commercial |
$4,950.11
|
| Rate for Payer: Anthem Medicaid |
$2,210.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,014.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$3,214.36
|
| Rate for Payer: Cash Price |
$3,214.36
|
| Rate for Payer: Cigna Commercial |
$5,335.84
|
| Rate for Payer: First Health Commercial |
$6,107.28
|
| Rate for Payer: Humana Commercial |
$5,464.41
|
| Rate for Payer: Humana KY Medicaid |
$2,210.84
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,233.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,271.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,744.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,255.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,657.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,821.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,285.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,992.90
|
| Rate for Payer: PHCS Commercial |
$6,171.57
|
| Rate for Payer: United Healthcare All Payer |
$5,657.27
|
|
|
EXC LESION FLOOR OF MOUTH
|
Facility
|
IP
|
$6,428.72
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
76101659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.73 |
| Max. Negotiated Rate |
$6,171.57 |
| Rate for Payer: Aetna Commercial |
$4,950.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,014.40
|
| Rate for Payer: Cash Price |
$3,214.36
|
| Rate for Payer: Cigna Commercial |
$5,335.84
|
| Rate for Payer: First Health Commercial |
$6,107.28
|
| Rate for Payer: Humana Commercial |
$5,464.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,271.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,744.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,928.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,657.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,821.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,285.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,992.90
|
| Rate for Payer: PHCS Commercial |
$6,171.57
|
| Rate for Payer: United Healthcare All Payer |
$5,657.27
|
|
|
EXC LESION FLOOR OF MOUTH(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
761P1659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.65
|
| Rate for Payer: Anthem Medicaid |
$142.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Healthspan PPO |
$369.67
|
| Rate for Payer: Humana Medicaid |
$142.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Molina Healthcare Passport |
$142.60
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$148.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.03
|
|
|
EXC LESION FLOOR OF MOUTH(T
|
Facility
|
OP
|
$5,628.72
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
761T1659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.73 |
| Max. Negotiated Rate |
$5,403.57 |
| Rate for Payer: Aetna Commercial |
$4,334.11
|
| Rate for Payer: Anthem Medicaid |
$1,935.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,390.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,814.36
|
| Rate for Payer: Cash Price |
$2,814.36
|
| Rate for Payer: Cigna Commercial |
$4,671.84
|
| Rate for Payer: First Health Commercial |
$5,347.28
|
| Rate for Payer: Humana Commercial |
$4,784.41
|
| Rate for Payer: Humana KY Medicaid |
$1,935.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,955.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,615.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,974.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,953.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,221.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,125.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,744.90
|
| Rate for Payer: PHCS Commercial |
$5,403.57
|
| Rate for Payer: United Healthcare All Payer |
$4,953.27
|
|
|
EXC LESION FLOOR OF MOUTH(T
|
Facility
|
IP
|
$5,628.72
|
|
|
Service Code
|
HCPCS 41116
|
| Hospital Charge Code |
761T1659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.73 |
| Max. Negotiated Rate |
$5,403.57 |
| Rate for Payer: Aetna Commercial |
$4,334.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,390.40
|
| Rate for Payer: Cash Price |
$2,814.36
|
| Rate for Payer: Cigna Commercial |
$4,671.84
|
| Rate for Payer: First Health Commercial |
$5,347.28
|
| Rate for Payer: Humana Commercial |
$4,784.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,615.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,688.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,953.27
|
| Rate for Payer: Ohio Health Group HMO |
$4,221.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,125.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,744.90
|
| Rate for Payer: PHCS Commercial |
$5,403.57
|
| Rate for Payer: United Healthcare All Payer |
$4,953.27
|
|
|
EXC LESION OF PALATE UVULA
|
Professional
|
Both
|
$4,580.82
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
76101669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$4,580.82 |
| Rate for Payer: Aetna Commercial |
$195.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.97
|
| Rate for Payer: Anthem Medicaid |
$72.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,580.82
|
| Rate for Payer: Cash Price |
$2,290.41
|
| Rate for Payer: Cash Price |
$2,290.41
|
| Rate for Payer: Cigna Commercial |
$255.75
|
| Rate for Payer: Healthspan PPO |
$239.37
|
| Rate for Payer: Humana Medicaid |
$72.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.96
|
| Rate for Payer: Molina Healthcare Passport |
$72.51
|
| Rate for Payer: Multiplan PHCS |
$2,748.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,206.57
|
| Rate for Payer: UHCCP Medicaid |
$99.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.24
|
|
|
EXC LESION OF PALATE UVULA
|
Facility
|
IP
|
$4,580.82
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
76101669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.51 |
| Max. Negotiated Rate |
$4,397.59 |
| Rate for Payer: Aetna Commercial |
$3,527.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,573.04
|
| Rate for Payer: Cash Price |
$2,290.41
|
| Rate for Payer: Cigna Commercial |
$3,802.08
|
| Rate for Payer: First Health Commercial |
$4,351.78
|
| Rate for Payer: Humana Commercial |
$3,893.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,756.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,031.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.05
|
| Rate for Payer: PHCS Commercial |
$4,397.59
|
| Rate for Payer: United Healthcare All Payer |
$4,031.12
|
|
|
EXC LESION OF PALATE UVULA
|
Facility
|
OP
|
$4,580.82
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
76101669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.51 |
| Max. Negotiated Rate |
$4,397.59 |
| Rate for Payer: Aetna Commercial |
$3,527.23
|
| Rate for Payer: Anthem Medicaid |
$1,575.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,573.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,290.41
|
| Rate for Payer: Cash Price |
$2,290.41
|
| Rate for Payer: Cigna Commercial |
$3,802.08
|
| Rate for Payer: First Health Commercial |
$4,351.78
|
| Rate for Payer: Humana Commercial |
$3,893.70
|
| Rate for Payer: Humana KY Medicaid |
$1,575.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,591.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,756.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,606.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,031.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.05
|
| Rate for Payer: PHCS Commercial |
$4,397.59
|
| Rate for Payer: United Healthcare All Payer |
$4,031.12
|
|
|
EXC LESION OF PALATE UVULA(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
761P1669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$195.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.97
|
| Rate for Payer: Anthem Medicaid |
$72.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$255.75
|
| Rate for Payer: Healthspan PPO |
$239.37
|
| Rate for Payer: Humana Medicaid |
$72.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.96
|
| Rate for Payer: Molina Healthcare Passport |
$72.51
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$99.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.24
|
|
|
EXC LESION OF PALATE UVULA(T
|
Facility
|
OP
|
$4,130.82
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
761T1669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.01 |
| Max. Negotiated Rate |
$3,965.59 |
| Rate for Payer: Aetna Commercial |
$3,180.73
|
| Rate for Payer: Anthem Medicaid |
$1,420.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,222.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,065.41
|
| Rate for Payer: Cash Price |
$2,065.41
|
| Rate for Payer: Cigna Commercial |
$3,428.58
|
| Rate for Payer: First Health Commercial |
$3,924.28
|
| Rate for Payer: Humana Commercial |
$3,511.20
|
| Rate for Payer: Humana KY Medicaid |
$1,420.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,387.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,048.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,635.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,098.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.55
|
| Rate for Payer: PHCS Commercial |
$3,965.59
|
| Rate for Payer: United Healthcare All Payer |
$3,635.12
|
|
|
EXC LESION OF PALATE UVULA(T
|
Facility
|
IP
|
$4,130.82
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
761T1669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.01 |
| Max. Negotiated Rate |
$3,965.59 |
| Rate for Payer: Aetna Commercial |
$3,180.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,222.04
|
| Rate for Payer: Cash Price |
$2,065.41
|
| Rate for Payer: Cigna Commercial |
$3,428.58
|
| Rate for Payer: First Health Commercial |
$3,924.28
|
| Rate for Payer: Humana Commercial |
$3,511.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,387.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,048.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,635.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,098.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.55
|
| Rate for Payer: PHCS Commercial |
$3,965.59
|
| Rate for Payer: United Healthcare All Payer |
$3,635.12
|
|
|
EXC LESION OF TONGUE
|
Professional
|
Both
|
$5,243.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
76101654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$5,243.00 |
| Rate for Payer: Aetna Commercial |
$185.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.06
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,243.00
|
| Rate for Payer: Cash Price |
$2,621.50
|
| Rate for Payer: Cash Price |
$2,621.50
|
| Rate for Payer: Cigna Commercial |
$266.57
|
| Rate for Payer: Healthspan PPO |
$238.46
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$3,145.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,670.10
|
| Rate for Payer: UHCCP Medicaid |
$105.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
EXC LESION OF TONGUE
|
Facility
|
IP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
76101654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.59 |
| Max. Negotiated Rate |
$5,033.28 |
| Rate for Payer: Aetna Commercial |
$4,037.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,089.54
|
| Rate for Payer: Cash Price |
$2,621.50
|
| Rate for Payer: Cigna Commercial |
$4,351.69
|
| Rate for Payer: First Health Commercial |
$4,980.85
|
| Rate for Payer: Humana Commercial |
$4,456.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,613.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,048.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,625.33
|
| Rate for Payer: PHCS Commercial |
$5,033.28
|
| Rate for Payer: United Healthcare All Payer |
$4,613.84
|
|
|
EXC LESION OF TONGUE
|
Facility
|
OP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
76101654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.59 |
| Max. Negotiated Rate |
$5,033.28 |
| Rate for Payer: Aetna Commercial |
$4,037.11
|
| Rate for Payer: Anthem Medicaid |
$1,803.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,089.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,621.50
|
| Rate for Payer: Cash Price |
$2,621.50
|
| Rate for Payer: Cigna Commercial |
$4,351.69
|
| Rate for Payer: First Health Commercial |
$4,980.85
|
| Rate for Payer: Humana Commercial |
$4,456.55
|
| Rate for Payer: Humana KY Medicaid |
$1,803.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,821.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,839.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,613.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,048.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,625.33
|
| Rate for Payer: PHCS Commercial |
$5,033.28
|
| Rate for Payer: United Healthcare All Payer |
$4,613.84
|
|
|
EXC LESION OF TONGUE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
761P1654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$185.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.06
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$266.57
|
| Rate for Payer: Healthspan PPO |
$238.46
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
EXC LESION OF TONGUE(T
|
Facility
|
OP
|
$4,943.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
761T1654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$642.59 |
| Max. Negotiated Rate |
$4,745.28 |
| Rate for Payer: Aetna Commercial |
$3,806.11
|
| Rate for Payer: Anthem Medicaid |
$1,699.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,855.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,471.50
|
| Rate for Payer: Cash Price |
$2,471.50
|
| Rate for Payer: Cigna Commercial |
$4,102.69
|
| Rate for Payer: First Health Commercial |
$4,695.85
|
| Rate for Payer: Humana Commercial |
$4,201.55
|
| Rate for Payer: Humana KY Medicaid |
$1,699.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,717.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,053.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,647.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,734.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,349.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,707.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,532.33
|
| Rate for Payer: PHCS Commercial |
$4,745.28
|
| Rate for Payer: United Healthcare All Payer |
$4,349.84
|
|
|
EXC LESION OF TONGUE(T
|
Facility
|
IP
|
$4,943.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
761T1654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$642.59 |
| Max. Negotiated Rate |
$4,745.28 |
| Rate for Payer: Aetna Commercial |
$3,806.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,855.54
|
| Rate for Payer: Cash Price |
$2,471.50
|
| Rate for Payer: Cigna Commercial |
$4,102.69
|
| Rate for Payer: First Health Commercial |
$4,695.85
|
| Rate for Payer: Humana Commercial |
$4,201.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,053.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,647.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,349.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,707.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,532.33
|
| Rate for Payer: PHCS Commercial |
$4,745.28
|
| Rate for Payer: United Healthcare All Payer |
$4,349.84
|
|
|
EXC LES/TUMOR DENTOALVEOLAR
|
Professional
|
Both
|
$4,862.75
|
|
|
Service Code
|
HCPCS 41825
|
| Hospital Charge Code |
76101666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.36 |
| Max. Negotiated Rate |
$4,862.75 |
| Rate for Payer: Aetna Commercial |
$178.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.05
|
| Rate for Payer: Anthem Medicaid |
$60.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,862.75
|
| Rate for Payer: Cash Price |
$2,431.38
|
| Rate for Payer: Cash Price |
$2,431.38
|
| Rate for Payer: Cigna Commercial |
$263.09
|
| Rate for Payer: Healthspan PPO |
$233.60
|
| Rate for Payer: Humana Medicaid |
$60.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$158.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.57
|
| Rate for Payer: Molina Healthcare Passport |
$60.36
|
| Rate for Payer: Multiplan PHCS |
$2,917.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,403.92
|
| Rate for Payer: UHCCP Medicaid |
$86.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.96
|
|
|
EXC LES/TUMOR DENTOALVEOLAR
|
Facility
|
IP
|
$4,862.75
|
|
|
Service Code
|
HCPCS 41825
|
| Hospital Charge Code |
76101666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$632.16 |
| Max. Negotiated Rate |
$4,668.24 |
| Rate for Payer: Aetna Commercial |
$3,744.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,792.94
|
| Rate for Payer: Cash Price |
$2,431.38
|
| Rate for Payer: Cigna Commercial |
$4,036.08
|
| Rate for Payer: First Health Commercial |
$4,619.61
|
| Rate for Payer: Humana Commercial |
$4,133.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,987.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,588.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,279.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,647.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.45
|
| Rate for Payer: PHCS Commercial |
$4,668.24
|
| Rate for Payer: United Healthcare All Payer |
$4,279.22
|
|
