|
EXCISE SACRAL SPINE TUMOR
|
Professional
|
Both
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.30 |
| Max. Negotiated Rate |
$3,212.19 |
| Rate for Payer: Aetna Commercial |
$3,212.19
|
| Rate for Payer: Ambetter Exchange |
$2,096.50
|
| Rate for Payer: Anthem Medicaid |
$884.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,096.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,096.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,515.80
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$3,004.47
|
| Rate for Payer: Healthspan PPO |
$2,708.90
|
| Rate for Payer: Humana Medicaid |
$884.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,820.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,096.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$901.99
|
| Rate for Payer: Molina Healthcare Passport |
$884.30
|
| Rate for Payer: Multiplan PHCS |
$3,171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,725.45
|
| Rate for Payer: UHCCP Medicaid |
$1,849.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$893.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,096.50
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
EXCISE SACRAL SPINE TUMOR
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
76101984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem Medicaid |
$1,817.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Humana KY Medicaid |
$1,817.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
EXCISE SACRAL SPINE TUMOR(P
|
Professional
|
Both
|
$5,285.00
|
|
|
Service Code
|
HCPCS 49215
|
| Hospital Charge Code |
761P1984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.30 |
| Max. Negotiated Rate |
$3,212.19 |
| Rate for Payer: Aetna Commercial |
$3,212.19
|
| Rate for Payer: Ambetter Exchange |
$2,096.50
|
| Rate for Payer: Anthem Medicaid |
$884.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,096.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,096.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,515.80
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$3,004.47
|
| Rate for Payer: Healthspan PPO |
$2,708.90
|
| Rate for Payer: Humana Medicaid |
$884.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,820.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,096.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$901.99
|
| Rate for Payer: Molina Healthcare Passport |
$884.30
|
| Rate for Payer: Multiplan PHCS |
$3,171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,725.45
|
| Rate for Payer: UHCCP Medicaid |
$1,849.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$893.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,096.50
|
|
|
EXCISE TENDON FOREARM/WRIST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 25109
|
| Hospital Charge Code |
76102669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$801.58 |
| Rate for Payer: Aetna Commercial |
$753.15
|
| Rate for Payer: Ambetter Exchange |
$514.19
|
| Rate for Payer: Anthem Medicaid |
$355.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$514.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$514.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$617.03
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$801.58
|
| Rate for Payer: Healthspan PPO |
$682.20
|
| Rate for Payer: Humana Medicaid |
$355.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$514.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.53
|
| Rate for Payer: Molina Healthcare Passport |
$355.42
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.45
|
| Rate for Payer: UHCCP Medicaid |
$257.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$514.19
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
EXCISE WRIST TENDON SHEATH
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
EXCISE WRIST TENDON SHEATH
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
76100585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.47 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$548.70
|
| Rate for Payer: Ambetter Exchange |
$367.81
|
| Rate for Payer: Anthem Medicaid |
$286.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.37
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$650.18
|
| Rate for Payer: Healthspan PPO |
$497.00
|
| Rate for Payer: Humana Medicaid |
$286.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.20
|
| Rate for Payer: Molina Healthcare Passport |
$286.47
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.15
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.81
|
|
|
EXCISE WRIST TENDON SHEATH(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
761P0585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.47 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$548.70
|
| Rate for Payer: Ambetter Exchange |
$367.81
|
| Rate for Payer: Anthem Medicaid |
$286.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.37
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$650.18
|
| Rate for Payer: Healthspan PPO |
$497.00
|
| Rate for Payer: Humana Medicaid |
$286.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.20
|
| Rate for Payer: Molina Healthcare Passport |
$286.47
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.15
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.81
|
|
|
EXCISIE MOUTH LESION
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXCISIE MOUTH LESION
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXCISIE MOUTH LESION
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
76101636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$365.31 |
| Rate for Payer: Aetna Commercial |
$279.68
|
| Rate for Payer: Ambetter Exchange |
$170.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.46
|
| Rate for Payer: Anthem Medicaid |
$109.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.22
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$365.31
|
| Rate for Payer: Healthspan PPO |
$326.13
|
| Rate for Payer: Humana Medicaid |
$109.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$248.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.15
|
| Rate for Payer: Molina Healthcare Passport |
$109.95
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.23
|
| Rate for Payer: UHCCP Medicaid |
$118.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.18
|
|
|
EXCISIE MOUTH LESION(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
761P1636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$365.31 |
| Rate for Payer: Aetna Commercial |
$279.68
|
| Rate for Payer: Ambetter Exchange |
$170.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.46
|
| Rate for Payer: Anthem Medicaid |
$109.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.22
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$365.31
|
| Rate for Payer: Healthspan PPO |
$326.13
|
| Rate for Payer: Humana Medicaid |
$109.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$248.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.15
|
| Rate for Payer: Molina Healthcare Passport |
$109.95
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.23
|
| Rate for Payer: UHCCP Medicaid |
$118.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.18
|
|
|
EXCISION ABDOMINAL WALL TUMO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
761P0427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$703.66 |
| Rate for Payer: Aetna Commercial |
$596.96
|
| Rate for Payer: Ambetter Exchange |
$541.28
|
| Rate for Payer: Anthem Medicaid |
$288.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$541.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$649.54
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.81
|
| Rate for Payer: Healthspan PPO |
$540.72
|
| Rate for Payer: Humana Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$664.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$541.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.11
|
| Rate for Payer: Molina Healthcare Passport |
$288.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.66
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$541.28
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
EXCISION ABDOMINAL WALL TUMOR
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
76100427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$703.66 |
| Rate for Payer: Aetna Commercial |
$596.96
|
| Rate for Payer: Ambetter Exchange |
$541.28
|
| Rate for Payer: Anthem Medicaid |
$288.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$541.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$649.54
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.81
|
| Rate for Payer: Healthspan PPO |
$540.72
|
| Rate for Payer: Humana Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$664.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$541.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.11
|
| Rate for Payer: Molina Healthcare Passport |
$288.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.66
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$541.28
|
|
|
EXCISION AURAL POLYP
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$249.68 |
| Rate for Payer: Aetna Commercial |
$178.17
|
| Rate for Payer: Ambetter Exchange |
$119.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$71.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.44
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$180.53
|
| Rate for Payer: Healthspan PPO |
$249.68
|
| Rate for Payer: Humana Medicaid |
$71.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.63
|
| Rate for Payer: Molina Healthcare Passport |
$71.21
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.39
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.53
|
|
|
EXCISION AURAL POLYP
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXCISION AURAL POLYP
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
76102424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXCISION AURAL POLYP(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
761P2424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$249.68 |
| Rate for Payer: Aetna Commercial |
$178.17
|
| Rate for Payer: Ambetter Exchange |
$119.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$71.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.44
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$180.53
|
| Rate for Payer: Healthspan PPO |
$249.68
|
| Rate for Payer: Humana Medicaid |
$71.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.63
|
| Rate for Payer: Molina Healthcare Passport |
$71.21
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.39
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.53
|
|
|
EXCISION BARTHOLIN GLAND/CYS(P
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761P2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$448.76
|
| Rate for Payer: Ambetter Exchange |
$296.34
|
| Rate for Payer: Anthem Medicaid |
$195.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$296.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$296.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$355.61
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$436.93
|
| Rate for Payer: Healthspan PPO |
$434.51
|
| Rate for Payer: Humana Medicaid |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$296.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.90
|
| Rate for Payer: Molina Healthcare Passport |
$195.98
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.24
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.34
|
|
|
EXCISION BARTHOLIN GLAND/CYS(T
|
Facility
|
OP
|
$6,999.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761T2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,406.96 |
| Max. Negotiated Rate |
$6,719.04 |
| Rate for Payer: Aetna Commercial |
$5,389.23
|
| Rate for Payer: Anthem Medicaid |
$2,406.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,459.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$5,809.17
|
| Rate for Payer: First Health Commercial |
$6,649.05
|
| Rate for Payer: Humana Commercial |
$5,949.15
|
| Rate for Payer: Humana KY Medicaid |
$2,406.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,431.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,739.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,165.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,455.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,159.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,249.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,599.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,089.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,829.31
|
| Rate for Payer: PHCS Commercial |
$6,719.04
|
| Rate for Payer: United Healthcare All Payer |
$6,159.12
|
|
|
EXCISION BARTHOLIN GLAND/CYS(T
|
Facility
|
IP
|
$6,999.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
761T2164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,099.70 |
| Max. Negotiated Rate |
$6,719.04 |
| Rate for Payer: Aetna Commercial |
$5,389.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,459.22
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$5,809.17
|
| Rate for Payer: First Health Commercial |
$6,649.05
|
| Rate for Payer: Humana Commercial |
$5,949.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,739.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,165.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,159.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,249.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,599.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,089.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,829.31
|
| Rate for Payer: PHCS Commercial |
$6,719.04
|
| Rate for Payer: United Healthcare All Payer |
$6,159.12
|
|
|
EXCISION BARTHOLIN GLAND/CYST
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,670.04 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,754.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,357.16
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
