|
EXCISION H/P/P/U COMPLEX RPR
|
Facility
|
IP
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,484.90 |
| Max. Negotiated Rate |
$7,951.68 |
| Rate for Payer: Aetna Commercial |
$6,377.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.74
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$6,874.89
|
| Rate for Payer: First Health Commercial |
$7,868.85
|
| Rate for Payer: Humana Commercial |
$7,040.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,206.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,715.27
|
| Rate for Payer: PHCS Commercial |
$7,951.68
|
| Rate for Payer: United Healthcare All Payer |
$7,289.04
|
|
|
EXCISION H/P/P/U COMPLEX RPR
|
Professional
|
Both
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.47 |
| Max. Negotiated Rate |
$4,969.80 |
| Rate for Payer: Aetna Commercial |
$477.92
|
| Rate for Payer: Ambetter Exchange |
$332.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.47
|
| Rate for Payer: Anthem Medicaid |
$202.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$399.26
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$444.02
|
| Rate for Payer: Healthspan PPO |
$531.49
|
| Rate for Payer: Humana Medicaid |
$202.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.70
|
| Rate for Payer: Molina Healthcare Passport |
$202.65
|
| Rate for Payer: Multiplan PHCS |
$4,969.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$432.54
|
| Rate for Payer: UHCCP Medicaid |
$189.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.72
|
|
|
EXCISION H/P/P/U COMPLEX RPR
|
Facility
|
OP
|
$8,283.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
76100074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$7,951.68 |
| Rate for Payer: Aetna Commercial |
$6,377.91
|
| Rate for Payer: Anthem Medicaid |
$2,848.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.74
|
| 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 |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cigna Commercial |
$6,874.89
|
| Rate for Payer: First Health Commercial |
$7,868.85
|
| Rate for Payer: Humana Commercial |
$7,040.55
|
| Rate for Payer: Humana KY Medicaid |
$2,848.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,206.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,715.27
|
| Rate for Payer: PHCS Commercial |
$7,951.68
|
| Rate for Payer: United Healthcare All Payer |
$7,289.04
|
|
|
EXCISION H/P/P/U COMPLEX RPR(P
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761P0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.47 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$477.92
|
| Rate for Payer: Ambetter Exchange |
$332.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.47
|
| Rate for Payer: Anthem Medicaid |
$202.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$399.26
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$444.02
|
| Rate for Payer: Healthspan PPO |
$531.49
|
| Rate for Payer: Humana Medicaid |
$202.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$420.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.70
|
| Rate for Payer: Molina Healthcare Passport |
$202.65
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$432.54
|
| Rate for Payer: UHCCP Medicaid |
$189.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.72
|
|
|
EXCISION H/P/P/U COMPLEX RPR(T
|
Facility
|
OP
|
$6,963.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761T0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,394.58 |
| Max. Negotiated Rate |
$6,684.48 |
| Rate for Payer: Aetna Commercial |
$5,361.51
|
| Rate for Payer: Anthem Medicaid |
$2,394.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,431.14
|
| 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 |
$3,481.50
|
| Rate for Payer: Cash Price |
$3,481.50
|
| Rate for Payer: Cigna Commercial |
$5,779.29
|
| Rate for Payer: First Health Commercial |
$6,614.85
|
| Rate for Payer: Humana Commercial |
$5,918.55
|
| Rate for Payer: Humana KY Medicaid |
$2,394.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,418.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,709.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,138.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,442.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,127.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,222.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,057.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,804.47
|
| Rate for Payer: PHCS Commercial |
$6,684.48
|
| Rate for Payer: United Healthcare All Payer |
$6,127.44
|
|
|
EXCISION H/P/P/U COMPLEX RPR(T
|
Facility
|
IP
|
$6,963.00
|
|
|
Service Code
|
HCPCS 11471
|
| Hospital Charge Code |
761T0074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,088.90 |
| Max. Negotiated Rate |
$6,684.48 |
| Rate for Payer: Aetna Commercial |
$5,361.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,431.14
|
| Rate for Payer: Cash Price |
$3,481.50
|
| Rate for Payer: Cigna Commercial |
$5,779.29
|
| Rate for Payer: First Health Commercial |
$6,614.85
|
| Rate for Payer: Humana Commercial |
$5,918.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,709.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,138.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,088.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,127.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,222.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,057.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,804.47
|
| Rate for Payer: PHCS Commercial |
$6,684.48
|
| Rate for Payer: United Healthcare All Payer |
$6,127.44
|
|
|
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.47 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
761P0821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$693.09
|
| Rate for Payer: Ambetter Exchange |
$467.35
|
| Rate for Payer: Anthem Medicaid |
$339.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.82
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$762.24
|
| Rate for Payer: Healthspan PPO |
$627.79
|
| Rate for Payer: Humana Medicaid |
$339.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.09
|
| Rate for Payer: Molina Healthcare Passport |
$339.30
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$607.55
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.35
|
|
|
EXCISION KNEE CYST(BAKER CYST)
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
76100821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$693.09
|
| Rate for Payer: Ambetter Exchange |
$467.35
|
| Rate for Payer: Anthem Medicaid |
$339.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.82
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$762.24
|
| Rate for Payer: Healthspan PPO |
$627.79
|
| Rate for Payer: Humana Medicaid |
$339.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.09
|
| Rate for Payer: Molina Healthcare Passport |
$339.30
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$607.55
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.35
|
|
|
EXCISION LESION MOUTH ROOF
|
Professional
|
Both
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$2,992.20 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Ambetter Exchange |
$151.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.85
|
| Rate for Payer: Anthem Medicaid |
$141.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.48
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$329.42
|
| Rate for Payer: Healthspan PPO |
$305.09
|
| Rate for Payer: Humana Medicaid |
$141.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.66
|
| Rate for Payer: Molina Healthcare Passport |
$141.82
|
| Rate for Payer: Multiplan PHCS |
$2,992.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.60
|
| Rate for Payer: UHCCP Medicaid |
$127.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.23
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
OP
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,715.03 |
| Max. Negotiated Rate |
$4,787.52 |
| Rate for Payer: Aetna Commercial |
$3,839.99
|
| Rate for Payer: Anthem Medicaid |
$1,715.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,889.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$4,139.21
|
| Rate for Payer: First Health Commercial |
$4,737.65
|
| Rate for Payer: Humana Commercial |
$4,238.95
|
| Rate for Payer: Humana KY Medicaid |
$1,715.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,732.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,089.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,680.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,749.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,388.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,740.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,338.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,441.03
|
| Rate for Payer: PHCS Commercial |
$4,787.52
|
| Rate for Payer: United Healthcare All Payer |
$4,388.56
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
IP
|
$4,987.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
76101670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.10 |
| Max. Negotiated Rate |
$4,787.52 |
| Rate for Payer: Aetna Commercial |
$3,839.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,889.86
|
| Rate for Payer: Cash Price |
$2,493.50
|
| Rate for Payer: Cigna Commercial |
$4,139.21
|
| Rate for Payer: First Health Commercial |
$4,737.65
|
| Rate for Payer: Humana Commercial |
$4,238.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,089.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,680.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,388.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,740.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,338.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,441.03
|
| Rate for Payer: PHCS Commercial |
$4,787.52
|
| Rate for Payer: United Healthcare All Payer |
$4,388.56
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
IP
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,247.60 |
| Max. Negotiated Rate |
$7,192.32 |
| Rate for Payer: Aetna Commercial |
$5,768.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,843.76
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$6,218.36
|
| Rate for Payer: First Health Commercial |
$7,117.40
|
| Rate for Payer: Humana Commercial |
$6,368.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,143.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,592.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,518.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,169.48
|
| Rate for Payer: PHCS Commercial |
$7,192.32
|
| Rate for Payer: United Healthcare All Payer |
$6,592.96
|
|
|
EXCISION LESION MOUTH ROOF
|
Facility
|
OP
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,576.50 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$5,768.84
|
| Rate for Payer: Anthem Medicaid |
$2,576.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,843.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$6,218.36
|
| Rate for Payer: First Health Commercial |
$7,117.40
|
| Rate for Payer: Humana Commercial |
$6,368.20
|
| Rate for Payer: Humana KY Medicaid |
$2,576.50
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,143.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,592.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,518.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,169.48
|
| Rate for Payer: PHCS Commercial |
$7,192.32
|
| Rate for Payer: United Healthcare All Payer |
$6,592.96
|
|
|
EXCISION LESION MOUTH ROOF
|
Professional
|
Both
|
$7,492.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
76101671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.92 |
| Max. Negotiated Rate |
$4,495.20 |
| Rate for Payer: Aetna Commercial |
$495.47
|
| Rate for Payer: Ambetter Exchange |
$306.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.92
|
| Rate for Payer: Anthem Medicaid |
$267.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$367.90
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cash Price |
$3,746.00
|
| Rate for Payer: Cigna Commercial |
$488.13
|
| Rate for Payer: Healthspan PPO |
$532.49
|
| Rate for Payer: Humana Medicaid |
$267.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$306.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.43
|
| Rate for Payer: Molina Healthcare Passport |
$267.09
|
| Rate for Payer: Multiplan PHCS |
$4,495.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.55
|
| Rate for Payer: UHCCP Medicaid |
$268.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.58
|
|
|
EXCISION LESION MOUTH ROOF(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761P1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Ambetter Exchange |
$151.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.85
|
| Rate for Payer: Anthem Medicaid |
$141.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$181.48
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$329.42
|
| Rate for Payer: Healthspan PPO |
$305.09
|
| Rate for Payer: Humana Medicaid |
$141.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.66
|
| Rate for Payer: Molina Healthcare Passport |
$141.82
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.60
|
| Rate for Payer: UHCCP Medicaid |
$127.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.23
|
|
|
EXCISION LESION MOUTH ROOF(P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761P1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.92 |
| Max. Negotiated Rate |
$532.49 |
| Rate for Payer: Aetna Commercial |
$495.47
|
| Rate for Payer: Ambetter Exchange |
$306.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.92
|
| Rate for Payer: Anthem Medicaid |
$267.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$367.90
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$488.13
|
| Rate for Payer: Healthspan PPO |
$532.49
|
| Rate for Payer: Humana Medicaid |
$267.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$306.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.43
|
| Rate for Payer: Molina Healthcare Passport |
$267.09
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.55
|
| Rate for Payer: UHCCP Medicaid |
$268.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.58
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761T1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,389.07 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem Medicaid |
$2,389.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Humana KY Medicaid |
$2,389.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.43
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
OP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761T1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,457.10 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem Medicaid |
$1,457.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Humana KY Medicaid |
$1,457.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,471.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,486.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,686.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.53
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42107
|
| Hospital Charge Code |
761T1671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,084.10 |
| Max. Negotiated Rate |
$6,669.12 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.43
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXCISION LESION MOUTH ROOF(T
|
Facility
|
IP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
761T1670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,271.10 |
| Max. Negotiated Rate |
$4,067.52 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,686.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.53
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 42104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 42106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
