|
EXC MALIGN INCL MARGINS
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$2,797.44 |
| Rate for Payer: Aetna Commercial |
$2,243.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,272.92
|
| Rate for Payer: Cash Price |
$1,457.00
|
| Rate for Payer: Cigna Commercial |
$2,418.62
|
| Rate for Payer: First Health Commercial |
$2,768.30
|
| Rate for Payer: Humana Commercial |
$2,476.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,389.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,150.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,564.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,185.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.34
|
| Rate for Payer: PHCS Commercial |
$2,797.44
|
| Rate for Payer: United Healthcare All Payer |
$2,564.32
|
|
|
EXC MALIGN INCL MARGINS
|
Facility
|
OP
|
$2,914.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$2,797.44 |
| Rate for Payer: Aetna Commercial |
$2,243.78
|
| Rate for Payer: Anthem Medicaid |
$1,002.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,272.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,457.00
|
| Rate for Payer: Cash Price |
$1,457.00
|
| Rate for Payer: Cigna Commercial |
$2,418.62
|
| Rate for Payer: First Health Commercial |
$2,768.30
|
| Rate for Payer: Humana Commercial |
$2,476.90
|
| Rate for Payer: Humana KY Medicaid |
$1,002.12
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,012.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,389.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,150.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,564.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,185.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.34
|
| Rate for Payer: PHCS Commercial |
$2,797.44
|
| Rate for Payer: United Healthcare All Payer |
$2,564.32
|
|
|
EXC MALIGN INCL MARGINS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
761P0083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.59
|
| Rate for Payer: Anthem Medicaid |
$101.32
|
| 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 |
$309.55
|
| Rate for Payer: Healthspan PPO |
$273.97
|
| Rate for Payer: Humana Medicaid |
$101.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.35
|
| Rate for Payer: Molina Healthcare Passport |
$101.32
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$98.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.33
|
|
|
EXC MALIGN INCL MARGINS(T
|
Facility
|
OP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
761T0083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem Medicaid |
$847.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Humana KY Medicaid |
$847.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$864.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.84
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIGN INCL MARGINS(T
|
Facility
|
IP
|
$2,464.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
761T0083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$2,365.44 |
| Rate for Payer: Aetna Commercial |
$1,897.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,921.92
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cigna Commercial |
$2,045.12
|
| Rate for Payer: First Health Commercial |
$2,340.80
|
| Rate for Payer: Humana Commercial |
$2,094.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,020.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,818.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$739.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,168.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,848.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.84
|
| Rate for Payer: PHCS Commercial |
$2,365.44
|
| Rate for Payer: United Healthcare All Payer |
$2,168.32
|
|
|
EXC MALIGN LESION HEAD AREA
|
Facility
|
OP
|
$4,204.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
76100090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.52 |
| Max. Negotiated Rate |
$4,035.84 |
| Rate for Payer: Aetna Commercial |
$3,237.08
|
| Rate for Payer: Anthem Medicaid |
$1,445.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.12
|
| 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 |
$2,102.00
|
| Rate for Payer: Cash Price |
$2,102.00
|
| Rate for Payer: Cigna Commercial |
$3,489.32
|
| Rate for Payer: First Health Commercial |
$3,993.80
|
| Rate for Payer: Humana Commercial |
$3,573.40
|
| Rate for Payer: Humana KY Medicaid |
$1,445.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,447.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,102.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,474.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,699.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.24
|
| Rate for Payer: PHCS Commercial |
$4,035.84
|
| Rate for Payer: United Healthcare All Payer |
$3,699.52
|
|
|
EXC MALIGN LESION HEAD AREA
|
Facility
|
IP
|
$4,204.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
76100090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.52 |
| Max. Negotiated Rate |
$4,035.84 |
| Rate for Payer: Aetna Commercial |
$3,237.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.12
|
| Rate for Payer: Cash Price |
$2,102.00
|
| Rate for Payer: Cigna Commercial |
$3,489.32
|
| Rate for Payer: First Health Commercial |
$3,993.80
|
| Rate for Payer: Humana Commercial |
$3,573.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,447.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,102.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,699.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.24
|
| Rate for Payer: PHCS Commercial |
$4,035.84
|
| Rate for Payer: United Healthcare All Payer |
$3,699.52
|
|
|
EXC MALIGN LESION HEAD AREA
|
Professional
|
Both
|
$4,204.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
76100090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.36 |
| Max. Negotiated Rate |
$4,204.00 |
| Rate for Payer: Aetna Commercial |
$327.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.36
|
| Rate for Payer: Anthem Medicaid |
$148.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,102.00
|
| Rate for Payer: Cash Price |
$2,102.00
|
| Rate for Payer: Cigna Commercial |
$409.78
|
| Rate for Payer: Healthspan PPO |
$348.83
|
| Rate for Payer: Humana Medicaid |
$148.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.38
|
| Rate for Payer: Molina Healthcare Passport |
$148.41
|
| Rate for Payer: Multiplan PHCS |
$2,522.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,942.80
|
| Rate for Payer: UHCCP Medicaid |
$140.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.89
|
|
|
EXC MALIGN LESION HEAD AREA(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
761P0090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.36 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$327.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.36
|
| Rate for Payer: Anthem Medicaid |
$148.41
|
| 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 |
$409.78
|
| Rate for Payer: Healthspan PPO |
$348.83
|
| Rate for Payer: Humana Medicaid |
$148.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.38
|
| Rate for Payer: Molina Healthcare Passport |
$148.41
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$140.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.89
|
|
|
EXC MALIGN LESION HEAD AREA(T
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
761T0090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.52 |
| Max. Negotiated Rate |
$3,363.84 |
| Rate for Payer: Aetna Commercial |
$2,698.08
|
| Rate for Payer: Anthem Medicaid |
$1,205.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.12
|
| 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 |
$1,752.00
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cigna Commercial |
$2,908.32
|
| Rate for Payer: First Health Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial |
$2,978.40
|
| Rate for Payer: Humana KY Medicaid |
$1,205.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.24
|
| Rate for Payer: PHCS Commercial |
$3,363.84
|
| Rate for Payer: United Healthcare All Payer |
$3,083.52
|
|
|
EXC MALIGN LESION HEAD AREA(T
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
761T0090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.52 |
| Max. Negotiated Rate |
$3,363.84 |
| Rate for Payer: Aetna Commercial |
$2,698.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.12
|
| Rate for Payer: Cash Price |
$1,752.00
|
| Rate for Payer: Cigna Commercial |
$2,908.32
|
| Rate for Payer: First Health Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial |
$2,978.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.24
|
| Rate for Payer: PHCS Commercial |
$3,363.84
|
| Rate for Payer: United Healthcare All Payer |
$3,083.52
|
|
|
EXC MAL LESION - FACE - EAR
|
Professional
|
Both
|
$4,551.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
76100091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.23 |
| Max. Negotiated Rate |
$4,551.00 |
| Rate for Payer: Aetna Commercial |
$409.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.23
|
| Rate for Payer: Anthem Medicaid |
$187.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,551.00
|
| Rate for Payer: Cash Price |
$2,275.50
|
| Rate for Payer: Cash Price |
$2,275.50
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Healthspan PPO |
$432.22
|
| Rate for Payer: Humana Medicaid |
$187.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$358.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.88
|
| Rate for Payer: Molina Healthcare Passport |
$187.14
|
| Rate for Payer: Multiplan PHCS |
$2,730.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,185.70
|
| Rate for Payer: UHCCP Medicaid |
$173.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.01
|
|
|
EXC MAL LESION - FACE - EAR
|
Facility
|
IP
|
$4,551.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
76100091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.63 |
| Max. Negotiated Rate |
$4,368.96 |
| Rate for Payer: Aetna Commercial |
$3,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.78
|
| Rate for Payer: Cash Price |
$2,275.50
|
| Rate for Payer: Cigna Commercial |
$3,777.33
|
| Rate for Payer: First Health Commercial |
$4,323.45
|
| Rate for Payer: Humana Commercial |
$3,868.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,358.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,365.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,413.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$910.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.81
|
| Rate for Payer: PHCS Commercial |
$4,368.96
|
| Rate for Payer: United Healthcare All Payer |
$4,004.88
|
|
|
EXC MAL LESION - FACE - EAR
|
Facility
|
OP
|
$4,551.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
76100091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.63 |
| Max. Negotiated Rate |
$4,368.96 |
| Rate for Payer: Aetna Commercial |
$3,504.27
|
| Rate for Payer: Anthem Medicaid |
$1,565.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.78
|
| 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 |
$2,275.50
|
| Rate for Payer: Cash Price |
$2,275.50
|
| Rate for Payer: Cigna Commercial |
$3,777.33
|
| Rate for Payer: First Health Commercial |
$4,323.45
|
| Rate for Payer: Humana Commercial |
$3,868.35
|
| Rate for Payer: Humana KY Medicaid |
$1,565.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,581.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,358.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,596.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,413.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$910.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.81
|
| Rate for Payer: PHCS Commercial |
$4,368.96
|
| Rate for Payer: United Healthcare All Payer |
$4,004.88
|
|
|
EXC MAL LESION - FACE - EAR(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
761P0091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.23 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$409.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.23
|
| Rate for Payer: Anthem Medicaid |
$187.14
|
| 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 |
$512.44
|
| Rate for Payer: Healthspan PPO |
$432.22
|
| Rate for Payer: Humana Medicaid |
$187.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$358.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.88
|
| Rate for Payer: Molina Healthcare Passport |
$187.14
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$173.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.01
|
|
|
EXC MAL LESION - FACE - EAR(T
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
761T0091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.13 |
| Max. Negotiated Rate |
$3,552.96 |
| Rate for Payer: Aetna Commercial |
$2,849.77
|
| Rate for Payer: Anthem Medicaid |
$1,272.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.78
|
| 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 |
$1,850.50
|
| Rate for Payer: Cash Price |
$1,850.50
|
| Rate for Payer: Cigna Commercial |
$3,071.83
|
| Rate for Payer: First Health Commercial |
$3,515.95
|
| Rate for Payer: Humana Commercial |
$3,145.85
|
| Rate for Payer: Humana KY Medicaid |
$1,272.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,731.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,298.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.31
|
| Rate for Payer: PHCS Commercial |
$3,552.96
|
| Rate for Payer: United Healthcare All Payer |
$3,256.88
|
|
|
EXC MAL LESION - FACE - EAR(T
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
761T0091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.13 |
| Max. Negotiated Rate |
$3,552.96 |
| Rate for Payer: Aetna Commercial |
$2,849.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.78
|
| Rate for Payer: Cash Price |
$1,850.50
|
| Rate for Payer: Cigna Commercial |
$3,071.83
|
| Rate for Payer: First Health Commercial |
$3,515.95
|
| Rate for Payer: Humana Commercial |
$3,145.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,731.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.31
|
| Rate for Payer: PHCS Commercial |
$3,552.96
|
| Rate for Payer: United Healthcare All Payer |
$3,256.88
|
|
|
EXC MUCOSA & SUBMUCOSA MOUTH
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
76101635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| 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 |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EXC MUCOSA & SUBMUCOSA MOUTH
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
76101635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EXC MUCOSA & SUBMUCOSA MOUTH
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
76101635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$177.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.45
|
| Rate for Payer: Anthem Medicaid |
$55.47
|
| 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 |
$252.83
|
| Rate for Payer: Healthspan PPO |
$228.73
|
| Rate for Payer: Humana Medicaid |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.58
|
| Rate for Payer: Molina Healthcare Passport |
$55.47
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$80.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.02
|
|
|
EXC MUCOSA & SUBMUCOSA MOUTH(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
761P1635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.47 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$177.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.45
|
| Rate for Payer: Anthem Medicaid |
$55.47
|
| 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 |
$252.83
|
| Rate for Payer: Healthspan PPO |
$228.73
|
| Rate for Payer: Humana Medicaid |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.58
|
| Rate for Payer: Molina Healthcare Passport |
$55.47
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$80.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.02
|
|
|
EXC NASAL POLYP
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
76101121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.37 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$599.43
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| 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 |
$585.04
|
| Rate for Payer: Healthspan PPO |
$505.51
|
| Rate for Payer: Humana Medicaid |
$207.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$539.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.52
|
| Rate for Payer: Molina Healthcare Passport |
$207.37
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.44
|
|
|
EXC NASAL POLYP
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
76101121
|
|
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
|
|
|
EXC NASAL POLYP
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
76101121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$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 |
$2,784.17
|
| 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 |
$3,341.00
|
| 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
|
|
|
EXC NASAL POLYP(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
761P1121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.37 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$599.43
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| 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 |
$585.04
|
| Rate for Payer: Healthspan PPO |
$505.51
|
| Rate for Payer: Humana Medicaid |
$207.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$539.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.52
|
| Rate for Payer: Molina Healthcare Passport |
$207.37
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.44
|
|
