|
EXC OF LESION OF TONGUE
|
Professional
|
Both
|
$5,418.33
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
76101655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$5,418.33 |
| Rate for Payer: Aetna Commercial |
$353.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.53
|
| Rate for Payer: Anthem Medicaid |
$114.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,418.33
|
| Rate for Payer: Cash Price |
$2,709.16
|
| Rate for Payer: Cash Price |
$2,709.16
|
| Rate for Payer: Cigna Commercial |
$429.10
|
| Rate for Payer: Healthspan PPO |
$379.61
|
| Rate for Payer: Humana Medicaid |
$114.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.11
|
| Rate for Payer: Molina Healthcare Passport |
$114.81
|
| Rate for Payer: Multiplan PHCS |
$3,251.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,792.83
|
| Rate for Payer: UHCCP Medicaid |
$154.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.96
|
|
|
EXC OF LESION OF TONGUE
|
Facility
|
OP
|
$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 Medicaid |
$1,863.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.30
|
| 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 |
$2,709.16
|
| 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: Humana KY Medicaid |
$1,863.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,882.33
|
| 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 |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,900.75
|
| 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
|
|
|
EXC OF LESION OF TONGUE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761P1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$353.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.53
|
| Rate for Payer: Anthem Medicaid |
$114.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$429.10
|
| Rate for Payer: Healthspan PPO |
$379.61
|
| Rate for Payer: Humana Medicaid |
$114.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.11
|
| Rate for Payer: Molina Healthcare Passport |
$114.81
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$154.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.96
|
|
|
EXC OF LESION OF TONGUE(T
|
Facility
|
OP
|
$4,918.33
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761T1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.38 |
| Max. Negotiated Rate |
$4,721.60 |
| Rate for Payer: Aetna Commercial |
$3,787.11
|
| Rate for Payer: Anthem Medicaid |
$1,691.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,836.30
|
| 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 |
$2,459.16
|
| Rate for Payer: Cash Price |
$2,459.16
|
| Rate for Payer: Cigna Commercial |
$4,082.21
|
| Rate for Payer: First Health Commercial |
$4,672.41
|
| Rate for Payer: Humana Commercial |
$4,180.58
|
| Rate for Payer: Humana KY Medicaid |
$1,691.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,708.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,629.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,725.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,328.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,524.68
|
| Rate for Payer: PHCS Commercial |
$4,721.60
|
| Rate for Payer: United Healthcare All Payer |
$4,328.13
|
|
|
EXC OF LESION OF TONGUE(T
|
Facility
|
IP
|
$4,918.33
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761T1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.38 |
| Max. Negotiated Rate |
$4,721.60 |
| Rate for Payer: Aetna Commercial |
$3,787.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,836.30
|
| Rate for Payer: Cash Price |
$2,459.16
|
| Rate for Payer: Cigna Commercial |
$4,082.21
|
| Rate for Payer: First Health Commercial |
$4,672.41
|
| Rate for Payer: Humana Commercial |
$4,180.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,629.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,475.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,328.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,524.68
|
| Rate for Payer: PHCS Commercial |
$4,721.60
|
| Rate for Payer: United Healthcare All Payer |
$4,328.13
|
|
|
EXC OF SM OR LG INTESTINE
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.50 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$1,214.37
|
| Rate for Payer: Anthem Medicaid |
$508.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,122.20
|
| Rate for Payer: Healthspan PPO |
$1,024.10
|
| Rate for Payer: Humana Medicaid |
$508.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,080.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.67
|
| Rate for Payer: Molina Healthcare Passport |
$508.50
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.58
|
|
|
EXC OF SM OR LG INTESTINE
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXC OF SM OR LG INTESTINE
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.60
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXC OF SM OR LG INTESTINE(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
761P1809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.50 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$1,214.37
|
| Rate for Payer: Anthem Medicaid |
$508.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,122.20
|
| Rate for Payer: Healthspan PPO |
$1,024.10
|
| Rate for Payer: Humana Medicaid |
$508.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,080.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.67
|
| Rate for Payer: Molina Healthcare Passport |
$508.50
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.58
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.06 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$685.57
|
| Rate for Payer: Anthem Medicaid |
$432.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$671.89
|
| Rate for Payer: Healthspan PPO |
$578.15
|
| Rate for Payer: Humana Medicaid |
$432.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$604.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$440.70
|
| Rate for Payer: Molina Healthcare Passport |
$432.06
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$436.38
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
EXC OF SUBMANDIBULAR GLAND(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
761P1691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.06 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$685.57
|
| Rate for Payer: Anthem Medicaid |
$432.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$671.89
|
| Rate for Payer: Healthspan PPO |
$578.15
|
| Rate for Payer: Humana Medicaid |
$432.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$604.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$440.70
|
| Rate for Payer: Molina Healthcare Passport |
$432.06
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$436.38
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Facility
|
IP
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$775.00 |
| Max. Negotiated Rate |
$5,723.04 |
| Rate for Payer: Aetna Commercial |
$4,590.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,649.97
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$4,948.04
|
| Rate for Payer: First Health Commercial |
$5,663.42
|
| Rate for Payer: Humana Commercial |
$5,067.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,788.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,848.06
|
| Rate for Payer: PHCS Commercial |
$5,723.04
|
| Rate for Payer: United Healthcare All Payer |
$5,246.12
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Professional
|
Both
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$5,961.50 |
| Rate for Payer: Aetna Commercial |
$261.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.19
|
| Rate for Payer: Anthem Medicaid |
$138.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,961.50
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$255.67
|
| Rate for Payer: Healthspan PPO |
$280.52
|
| Rate for Payer: Humana Medicaid |
$138.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.24
|
| Rate for Payer: Molina Healthcare Passport |
$138.47
|
| Rate for Payer: Multiplan PHCS |
$3,576.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,173.05
|
| Rate for Payer: UHCCP Medicaid |
$120.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.85
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Facility
|
OP
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$775.00 |
| Max. Negotiated Rate |
$5,723.04 |
| Rate for Payer: Aetna Commercial |
$4,590.36
|
| Rate for Payer: Anthem Medicaid |
$2,050.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,649.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$4,948.04
|
| Rate for Payer: First Health Commercial |
$5,663.42
|
| Rate for Payer: Humana Commercial |
$5,067.28
|
| Rate for Payer: Humana KY Medicaid |
$2,050.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,071.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,091.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,848.06
|
| Rate for Payer: PHCS Commercial |
$5,723.04
|
| Rate for Payer: United Healthcare All Payer |
$5,246.12
|
|
|
EXC OF VAGINAL CYST OR TUMOR(P
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761P2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$695.00 |
| Rate for Payer: Aetna Commercial |
$261.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.19
|
| Rate for Payer: Anthem Medicaid |
$138.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$695.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$255.67
|
| Rate for Payer: Healthspan PPO |
$280.52
|
| Rate for Payer: Humana Medicaid |
$138.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.24
|
| Rate for Payer: Molina Healthcare Passport |
$138.47
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$486.50
|
| Rate for Payer: UHCCP Medicaid |
$120.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.85
|
|
|
EXC OF VAGINAL CYST OR TUMOR(T
|
Facility
|
IP
|
$5,266.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761T2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.64 |
| Max. Negotiated Rate |
$5,055.84 |
| Rate for Payer: Aetna Commercial |
$4,055.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.87
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cigna Commercial |
$4,371.20
|
| Rate for Payer: First Health Commercial |
$5,003.18
|
| Rate for Payer: Humana Commercial |
$4,476.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.62
|
| Rate for Payer: PHCS Commercial |
$5,055.84
|
| Rate for Payer: United Healthcare All Payer |
$4,634.52
|
|
|
EXC OF VAGINAL CYST OR TUMOR(T
|
Facility
|
OP
|
$5,266.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761T2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.64 |
| Max. Negotiated Rate |
$5,055.84 |
| Rate for Payer: Aetna Commercial |
$4,055.20
|
| Rate for Payer: Anthem Medicaid |
$1,811.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cigna Commercial |
$4,371.20
|
| Rate for Payer: First Health Commercial |
$5,003.18
|
| Rate for Payer: Humana Commercial |
$4,476.52
|
| Rate for Payer: Humana KY Medicaid |
$1,811.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.62
|
| Rate for Payer: PHCS Commercial |
$5,055.84
|
| Rate for Payer: United Healthcare All Payer |
$4,634.52
|
|
|
EXC OR DESTR TUMOR 5CM >
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
76101982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.55 |
| Max. Negotiated Rate |
$1,569.60 |
| Rate for Payer: Aetna Commercial |
$1,258.95
|
| Rate for Payer: Anthem Medicaid |
$562.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,275.30
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cigna Commercial |
$1,357.05
|
| Rate for Payer: First Health Commercial |
$1,553.25
|
| Rate for Payer: Humana Commercial |
$1,389.75
|
| Rate for Payer: Humana KY Medicaid |
$562.28
|
| Rate for Payer: Kentucky WC Medicaid |
$568.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,340.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,206.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$490.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$573.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,438.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,226.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.85
|
| Rate for Payer: PHCS Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
|
EXC OR DESTR TUMOR 5CM >
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
76101982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.55 |
| Max. Negotiated Rate |
$1,569.60 |
| Rate for Payer: Aetna Commercial |
$1,258.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,275.30
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cigna Commercial |
$1,357.05
|
| Rate for Payer: First Health Commercial |
$1,553.25
|
| Rate for Payer: Humana Commercial |
$1,389.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,340.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,206.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$490.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,438.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,226.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.85
|
| Rate for Payer: PHCS Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
|
EXC OR DESTR TUMOR 5CM >
|
Professional
|
Both
|
$1,635.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
76101982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.25 |
| Max. Negotiated Rate |
$1,745.97 |
| Rate for Payer: Aetna Commercial |
$1,745.97
|
| Rate for Payer: Anthem Medicaid |
$888.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,635.00
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cigna Commercial |
$1,590.74
|
| Rate for Payer: Healthspan PPO |
$1,472.40
|
| Rate for Payer: Humana Medicaid |
$888.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,528.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$905.78
|
| Rate for Payer: Molina Healthcare Passport |
$888.02
|
| Rate for Payer: Multiplan PHCS |
$981.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,144.50
|
| Rate for Payer: UHCCP Medicaid |
$572.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$896.90
|
|
|
EXC OR DESTR TUMOR 5CM >(P
|
Professional
|
Both
|
$1,635.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
761P1982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.25 |
| Max. Negotiated Rate |
$1,745.97 |
| Rate for Payer: Aetna Commercial |
$1,745.97
|
| Rate for Payer: Anthem Medicaid |
$888.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,635.00
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cash Price |
$817.50
|
| Rate for Payer: Cigna Commercial |
$1,590.74
|
| Rate for Payer: Healthspan PPO |
$1,472.40
|
| Rate for Payer: Humana Medicaid |
$888.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,528.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$905.78
|
| Rate for Payer: Molina Healthcare Passport |
$888.02
|
| Rate for Payer: Multiplan PHCS |
$981.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,144.50
|
| Rate for Payer: UHCCP Medicaid |
$572.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$896.90
|
|
|
EXC - OTHER BENIGN INCL MARGI
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.98 |
| Max. Negotiated Rate |
$2,924.16 |
| Rate for Payer: Aetna Commercial |
$2,345.42
|
| Rate for Payer: Anthem Medicaid |
$1,047.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,375.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,523.00
|
| Rate for Payer: Cash Price |
$1,523.00
|
| Rate for Payer: Cigna Commercial |
$2,528.18
|
| Rate for Payer: First Health Commercial |
$2,893.70
|
| Rate for Payer: Humana Commercial |
$2,589.10
|
| Rate for Payer: Humana KY Medicaid |
$1,047.52
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,058.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,497.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,247.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,068.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,680.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,284.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.26
|
| Rate for Payer: PHCS Commercial |
$2,924.16
|
| Rate for Payer: United Healthcare All Payer |
$2,680.48
|
|
|
EXC - OTHER BENIGN INCL MARGI
|
Professional
|
Both
|
$3,046.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$3,046.00 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.23
|
| Rate for Payer: Anthem Medicaid |
$71.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,046.00
|
| Rate for Payer: Cash Price |
$1,523.00
|
| Rate for Payer: Cash Price |
$1,523.00
|
| Rate for Payer: Cigna Commercial |
$242.33
|
| Rate for Payer: Healthspan PPO |
$201.13
|
| Rate for Payer: Humana Medicaid |
$71.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.52
|
| Rate for Payer: Molina Healthcare Passport |
$71.10
|
| Rate for Payer: Multiplan PHCS |
$1,827.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,132.20
|
| Rate for Payer: UHCCP Medicaid |
$77.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.81
|
|
