|
EXC NECK LES SC = 3 CM
|
Facility
|
IP
|
$6,629.62
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.85 |
| Max. Negotiated Rate |
$6,364.44 |
| Rate for Payer: Aetna Commercial |
$5,104.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,171.10
|
| Rate for Payer: Cash Price |
$3,314.81
|
| Rate for Payer: Cigna Commercial |
$5,502.58
|
| Rate for Payer: First Health Commercial |
$6,298.14
|
| Rate for Payer: Humana Commercial |
$5,635.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,436.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,892.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,988.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,834.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,972.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.18
|
| Rate for Payer: PHCS Commercial |
$6,364.44
|
| Rate for Payer: United Healthcare All Payer |
$5,834.07
|
|
|
EXC NECK LES SC = 3 CM
|
Facility
|
OP
|
$6,629.62
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.85 |
| Max. Negotiated Rate |
$6,364.44 |
| Rate for Payer: Aetna Commercial |
$5,104.81
|
| Rate for Payer: Anthem Medicaid |
$2,279.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,171.10
|
| 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 |
$3,314.81
|
| Rate for Payer: Cash Price |
$3,314.81
|
| Rate for Payer: Cigna Commercial |
$5,502.58
|
| Rate for Payer: First Health Commercial |
$6,298.14
|
| Rate for Payer: Humana Commercial |
$5,635.18
|
| Rate for Payer: Humana KY Medicaid |
$2,279.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,303.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,436.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,892.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,325.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,834.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,972.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.18
|
| Rate for Payer: PHCS Commercial |
$6,364.44
|
| Rate for Payer: United Healthcare All Payer |
$5,834.07
|
|
|
EXC NECK LES SC = 3 CM
|
Professional
|
Both
|
$6,629.62
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.14 |
| Max. Negotiated Rate |
$6,629.62 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Anthem Medicaid |
$325.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,629.62
|
| Rate for Payer: Cash Price |
$3,314.81
|
| Rate for Payer: Cash Price |
$3,314.81
|
| Rate for Payer: Cigna Commercial |
$786.92
|
| Rate for Payer: Healthspan PPO |
$492.32
|
| Rate for Payer: Humana Medicaid |
$325.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.64
|
| Rate for Payer: Molina Healthcare Passport |
$325.14
|
| Rate for Payer: Multiplan PHCS |
$3,977.77
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,640.73
|
| Rate for Payer: UHCCP Medicaid |
$2,320.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.39
|
|
|
EXC NECK LES SC = 3 CM(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761P0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$786.92 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Anthem Medicaid |
$325.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$786.92
|
| Rate for Payer: Healthspan PPO |
$492.32
|
| Rate for Payer: Humana Medicaid |
$325.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.64
|
| Rate for Payer: Molina Healthcare Passport |
$325.14
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.39
|
|
|
EXC NECK LES SC = 3 CM(T
|
Facility
|
OP
|
$5,849.62
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761T0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$760.45 |
| Max. Negotiated Rate |
$5,615.64 |
| Rate for Payer: Aetna Commercial |
$4,504.21
|
| Rate for Payer: Anthem Medicaid |
$2,011.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,562.70
|
| 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 |
$2,924.81
|
| Rate for Payer: Cash Price |
$2,924.81
|
| Rate for Payer: Cigna Commercial |
$4,855.18
|
| Rate for Payer: First Health Commercial |
$5,557.14
|
| Rate for Payer: Humana Commercial |
$4,972.18
|
| Rate for Payer: Humana KY Medicaid |
$2,011.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,032.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,796.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,317.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,052.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,147.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,387.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,169.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,813.38
|
| Rate for Payer: PHCS Commercial |
$5,615.64
|
| Rate for Payer: United Healthcare All Payer |
$5,147.67
|
|
|
EXC NECK LES SC = 3 CM(T
|
Facility
|
IP
|
$5,849.62
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761T0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$760.45 |
| Max. Negotiated Rate |
$5,615.64 |
| Rate for Payer: Aetna Commercial |
$4,504.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,562.70
|
| Rate for Payer: Cash Price |
$2,924.81
|
| Rate for Payer: Cigna Commercial |
$4,855.18
|
| Rate for Payer: First Health Commercial |
$5,557.14
|
| Rate for Payer: Humana Commercial |
$4,972.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,796.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,317.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,754.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,147.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,387.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,169.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,813.38
|
| Rate for Payer: PHCS Commercial |
$5,615.64
|
| Rate for Payer: United Healthcare All Payer |
$5,147.67
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$8,602.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,118.26 |
| Max. Negotiated Rate |
$8,257.92 |
| Rate for Payer: Aetna Commercial |
$6,623.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.56
|
| Rate for Payer: Cash Price |
$4,301.00
|
| Rate for Payer: Cigna Commercial |
$7,139.66
|
| Rate for Payer: First Health Commercial |
$8,171.90
|
| Rate for Payer: Humana Commercial |
$7,311.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.62
|
| Rate for Payer: PHCS Commercial |
$8,257.92
|
| Rate for Payer: United Healthcare All Payer |
$7,569.76
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$8,602.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,118.26 |
| Max. Negotiated Rate |
$8,257.92 |
| Rate for Payer: Aetna Commercial |
$6,623.54
|
| Rate for Payer: Anthem Medicaid |
$2,958.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,709.56
|
| 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 |
$4,301.00
|
| Rate for Payer: Cash Price |
$4,301.00
|
| Rate for Payer: Cigna Commercial |
$7,139.66
|
| Rate for Payer: First Health Commercial |
$8,171.90
|
| Rate for Payer: Humana Commercial |
$7,311.70
|
| Rate for Payer: Humana KY Medicaid |
$2,958.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,053.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,348.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,569.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.62
|
| Rate for Payer: PHCS Commercial |
$8,257.92
|
| Rate for Payer: United Healthcare All Payer |
$7,569.76
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Professional
|
Both
|
$8,602.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.14 |
| Max. Negotiated Rate |
$8,602.00 |
| Rate for Payer: Aetna Commercial |
$1,135.19
|
| Rate for Payer: Anthem Medicaid |
$535.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,602.00
|
| Rate for Payer: Cash Price |
$4,301.00
|
| Rate for Payer: Cash Price |
$4,301.00
|
| Rate for Payer: Cigna Commercial |
$1,293.32
|
| Rate for Payer: Healthspan PPO |
$809.97
|
| Rate for Payer: Humana Medicaid |
$535.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$936.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.84
|
| Rate for Payer: Molina Healthcare Passport |
$535.14
|
| Rate for Payer: Multiplan PHCS |
$5,161.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,021.40
|
| Rate for Payer: UHCCP Medicaid |
$3,010.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.49
|
|
|
EXC NECK TUM DEEP 5 CM/>(P
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761P0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.25 |
| Max. Negotiated Rate |
$1,293.32 |
| Rate for Payer: Aetna Commercial |
$1,135.19
|
| Rate for Payer: Anthem Medicaid |
$535.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,175.00
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$1,293.32
|
| Rate for Payer: Healthspan PPO |
$809.97
|
| Rate for Payer: Humana Medicaid |
$535.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$936.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.84
|
| Rate for Payer: Molina Healthcare Passport |
$535.14
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$822.50
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.49
|
|
|
EXC NECK TUM DEEP 5 CM/>(T
|
Facility
|
IP
|
$7,427.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761T0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$965.51 |
| Max. Negotiated Rate |
$7,129.92 |
| Rate for Payer: Aetna Commercial |
$5,718.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,793.06
|
| Rate for Payer: Cash Price |
$3,713.50
|
| Rate for Payer: Cigna Commercial |
$6,164.41
|
| Rate for Payer: First Health Commercial |
$7,055.65
|
| Rate for Payer: Humana Commercial |
$6,312.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,090.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,481.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,535.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,570.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.37
|
| Rate for Payer: PHCS Commercial |
$7,129.92
|
| Rate for Payer: United Healthcare All Payer |
$6,535.76
|
|
|
EXC NECK TUM DEEP 5 CM/>(T
|
Facility
|
OP
|
$7,427.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761T0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$965.51 |
| Max. Negotiated Rate |
$7,129.92 |
| Rate for Payer: Aetna Commercial |
$5,718.79
|
| Rate for Payer: Anthem Medicaid |
$2,554.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,793.06
|
| 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 |
$3,713.50
|
| Rate for Payer: Cash Price |
$3,713.50
|
| Rate for Payer: Cigna Commercial |
$6,164.41
|
| Rate for Payer: First Health Commercial |
$7,055.65
|
| Rate for Payer: Humana Commercial |
$6,312.95
|
| Rate for Payer: Humana KY Medicaid |
$2,554.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,090.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,481.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,535.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,570.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.37
|
| Rate for Payer: PHCS Commercial |
$7,129.92
|
| Rate for Payer: United Healthcare All Payer |
$6,535.76
|
|
|
EXC OF CHALAZION; SINGLE
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.21
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
EXC OF CHALAZION; SINGLE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$1,191.00 |
| Rate for Payer: Aetna Commercial |
$137.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.52
|
| Rate for Payer: Anthem Medicaid |
$53.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,191.00
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$164.88
|
| Rate for Payer: Healthspan PPO |
$145.86
|
| Rate for Payer: Humana Medicaid |
$53.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.51
|
| Rate for Payer: Molina Healthcare Passport |
$53.44
|
| Rate for Payer: Multiplan PHCS |
$714.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.70
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.97
|
|
|
EXC OF CHALAZION; SINGLE
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem Medicaid |
$409.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Humana KY Medicaid |
$409.58
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$413.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.21
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
EXC OF CHALAZION; SINGLE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761P2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$137.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.52
|
| Rate for Payer: Anthem Medicaid |
$53.44
|
| 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 |
$164.88
|
| Rate for Payer: Healthspan PPO |
$145.86
|
| Rate for Payer: Humana Medicaid |
$53.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.51
|
| Rate for Payer: Molina Healthcare Passport |
$53.44
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.97
|
|
|
EXC OF CHALAZION; SINGLE(T
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761T2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.83 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.21
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
EXC OF CHALAZION; SINGLE(T
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761T2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.83 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem Medicaid |
$306.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Humana KY Medicaid |
$306.41
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$309.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.21
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
EXC OF CHEST WALL TUMOR
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
76100291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
EXC OF CHEST WALL TUMOR
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
76100291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
EXC OF CYST OR ADENOMA
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXC OF CYST OR ADENOMA
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXC OF CYST OR ADENOMA
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna Commercial |
$951.75
|
| Rate for Payer: Anthem Medicaid |
$445.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$903.12
|
| Rate for Payer: Healthspan PPO |
$802.63
|
| Rate for Payer: Humana Medicaid |
$445.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.76
|
| Rate for Payer: Molina Healthcare Passport |
$445.84
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.30
|
|
|
EXC OF CYST OR ADENOMA(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
761P2270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna Commercial |
$951.75
|
| Rate for Payer: Anthem Medicaid |
$445.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$903.12
|
| Rate for Payer: Healthspan PPO |
$802.63
|
| Rate for Payer: Humana Medicaid |
$445.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.76
|
| Rate for Payer: Molina Healthcare Passport |
$445.84
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.30
|
|
|
EXC OF LESION OF TONGUE
|
Facility
|
IP
|
$5,418.33
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
76101655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.38 |
| Max. Negotiated Rate |
$5,201.60 |
| Rate for Payer: Aetna Commercial |
$4,172.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.30
|
| Rate for Payer: Cash Price |
$2,709.16
|
| Rate for Payer: Cigna Commercial |
$4,497.21
|
| Rate for Payer: First Health Commercial |
$5,147.41
|
| Rate for Payer: Humana Commercial |
$4,605.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,443.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,998.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,768.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,063.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,083.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,679.68
|
| Rate for Payer: PHCS Commercial |
$5,201.60
|
| Rate for Payer: United Healthcare All Payer |
$4,768.13
|
|
