|
EXCISION LESION PHARYNX
|
Professional
|
Both
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$2,968.80 |
| Rate for Payer: Aetna Commercial |
$239.51
|
| Rate for Payer: Ambetter Exchange |
$157.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.66
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.06
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$240.65
|
| Rate for Payer: Healthspan PPO |
$268.34
|
| Rate for Payer: Humana Medicaid |
$140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.47
|
| Rate for Payer: Molina Healthcare Passport |
$140.66
|
| Rate for Payer: Multiplan PHCS |
$2,968.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.81
|
| Rate for Payer: UHCCP Medicaid |
$141.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.55
|
|
|
EXCISION LESION PHARYNX
|
Facility
|
OP
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,701.62 |
| Max. Negotiated Rate |
$4,750.08 |
| Rate for Payer: Aetna Commercial |
$3,809.96
|
| Rate for Payer: Anthem Medicaid |
$1,701.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,859.44
|
| 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 |
$2,474.00
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$4,106.84
|
| Rate for Payer: First Health Commercial |
$4,700.60
|
| Rate for Payer: Humana Commercial |
$4,205.80
|
| Rate for Payer: Humana KY Medicaid |
$1,701.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,057.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,651.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,735.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,304.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.12
|
| Rate for Payer: PHCS Commercial |
$4,750.08
|
| Rate for Payer: United Healthcare All Payer |
$4,354.24
|
|
|
EXCISION LESION PHARYNX
|
Facility
|
IP
|
$4,948.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
76101702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,484.40 |
| Max. Negotiated Rate |
$4,750.08 |
| Rate for Payer: Aetna Commercial |
$3,809.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,859.44
|
| Rate for Payer: Cash Price |
$2,474.00
|
| Rate for Payer: Cigna Commercial |
$4,106.84
|
| Rate for Payer: First Health Commercial |
$4,700.60
|
| Rate for Payer: Humana Commercial |
$4,205.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,057.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,651.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,354.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,304.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.12
|
| Rate for Payer: PHCS Commercial |
$4,750.08
|
| Rate for Payer: United Healthcare All Payer |
$4,354.24
|
|
|
EXCISION LESION PHARYNX(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761P1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$239.51
|
| Rate for Payer: Ambetter Exchange |
$157.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.66
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.06
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$240.65
|
| Rate for Payer: Healthspan PPO |
$268.34
|
| Rate for Payer: Humana Medicaid |
$140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.47
|
| Rate for Payer: Molina Healthcare Passport |
$140.66
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.81
|
| Rate for Payer: UHCCP Medicaid |
$141.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.55
|
|
|
EXCISION LESION PHARYNX(T
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761T1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,349.40 |
| Max. Negotiated Rate |
$4,318.08 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,913.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.62
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
EXCISION LESION PHARYNX(T
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
HCPCS 42808
|
| Hospital Charge Code |
761T1702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,546.86 |
| Max. Negotiated Rate |
$4,318.08 |
| Rate for Payer: Aetna Commercial |
$3,463.46
|
| Rate for Payer: Anthem Medicaid |
$1,546.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.44
|
| 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 |
$2,249.00
|
| Rate for Payer: Cash Price |
$2,249.00
|
| Rate for Payer: Cigna Commercial |
$3,733.34
|
| Rate for Payer: First Health Commercial |
$4,273.10
|
| Rate for Payer: Humana Commercial |
$3,823.30
|
| Rate for Payer: Humana KY Medicaid |
$1,546.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,913.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.62
|
| Rate for Payer: PHCS Commercial |
$4,318.08
|
| Rate for Payer: United Healthcare All Payer |
$3,958.24
|
|
|
EXCISION LIPOMA SPERMATIC CORD
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
76102956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXCISION LIPOMA SPERMATIC CORD
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
76102956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXCISION LIPOMA SPERMATIC CORD
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55559
|
| Hospital Charge Code |
76102956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
EXCISION - LOCAL; MALIGNANT (P
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
761P1784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$2,002.80 |
| Rate for Payer: Aetna Commercial |
$1,755.03
|
| Rate for Payer: Ambetter Exchange |
$1,170.32
|
| Rate for Payer: Anthem Medicaid |
$625.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.38
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$1,625.76
|
| Rate for Payer: Healthspan PPO |
$1,480.05
|
| Rate for Payer: Humana Medicaid |
$625.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.94
|
| Rate for Payer: Molina Healthcare Passport |
$625.43
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,521.42
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.32
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$2,002.80 |
| Rate for Payer: Aetna Commercial |
$1,755.03
|
| Rate for Payer: Ambetter Exchange |
$1,170.32
|
| Rate for Payer: Anthem Medicaid |
$625.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.38
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$1,625.76
|
| Rate for Payer: Healthspan PPO |
$1,480.05
|
| Rate for Payer: Humana Medicaid |
$625.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.94
|
| Rate for Payer: Molina Healthcare Passport |
$625.43
|
| Rate for Payer: Multiplan PHCS |
$2,002.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,521.42
|
| Rate for Payer: UHCCP Medicaid |
$1,168.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.32
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,001.40 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem Medicaid |
$1,147.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Humana KY Medicaid |
$1,147.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,904.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,303.22
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
EXCISION - LOCAL; MALIGNANT T
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
HCPCS 43611
|
| Hospital Charge Code |
76101784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,001.40 |
| Max. Negotiated Rate |
$3,204.48 |
| Rate for Payer: Aetna Commercial |
$2,570.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.64
|
| Rate for Payer: Cash Price |
$1,669.00
|
| Rate for Payer: Cigna Commercial |
$2,770.54
|
| Rate for Payer: First Health Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial |
$2,837.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,737.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,904.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,303.22
|
| Rate for Payer: PHCS Commercial |
$3,204.48
|
| Rate for Payer: United Healthcare All Payer |
$2,937.44
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Professional
|
Both
|
$8,711.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.35 |
| Max. Negotiated Rate |
$5,226.60 |
| Rate for Payer: Aetna Commercial |
$736.22
|
| Rate for Payer: Ambetter Exchange |
$495.65
|
| Rate for Payer: Anthem Medicaid |
$287.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.78
|
| Rate for Payer: Cash Price |
$4,355.50
|
| Rate for Payer: Cash Price |
$4,355.50
|
| Rate for Payer: Cigna Commercial |
$594.05
|
| Rate for Payer: Healthspan PPO |
$588.67
|
| Rate for Payer: Humana Medicaid |
$287.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$665.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.10
|
| Rate for Payer: Molina Healthcare Passport |
$287.35
|
| Rate for Payer: Multiplan PHCS |
$5,226.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.35
|
| Rate for Payer: UHCCP Medicaid |
$3,048.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.65
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
IP
|
$2,267.00
|
|
| Hospital Charge Code |
76102566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.10 |
| Max. Negotiated Rate |
$2,176.32 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,813.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,972.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.23
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
OP
|
$8,711.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,995.71 |
| Max. Negotiated Rate |
$8,362.56 |
| Rate for Payer: Aetna Commercial |
$6,707.47
|
| Rate for Payer: Anthem Medicaid |
$2,995.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$4,355.50
|
| Rate for Payer: Cash Price |
$4,355.50
|
| Rate for Payer: Cigna Commercial |
$7,230.13
|
| Rate for Payer: First Health Commercial |
$8,275.45
|
| Rate for Payer: Humana Commercial |
$7,404.35
|
| Rate for Payer: Humana KY Medicaid |
$2,995.71
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,143.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,533.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,968.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,578.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,010.59
|
| Rate for Payer: PHCS Commercial |
$8,362.56
|
| Rate for Payer: United Healthcare All Payer |
$7,665.68
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
IP
|
$8,711.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
76101600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,613.30 |
| Max. Negotiated Rate |
$8,362.56 |
| Rate for Payer: Aetna Commercial |
$6,707.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.58
|
| Rate for Payer: Cash Price |
$4,355.50
|
| Rate for Payer: Cigna Commercial |
$7,230.13
|
| Rate for Payer: First Health Commercial |
$8,275.45
|
| Rate for Payer: Humana Commercial |
$7,404.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,143.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,533.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,968.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,578.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,010.59
|
| Rate for Payer: PHCS Commercial |
$8,362.56
|
| Rate for Payer: United Healthcare All Payer |
$7,665.68
|
|
|
EXCISION LYMPHATIC SYSTEM
|
Facility
|
OP
|
$2,267.00
|
|
| Hospital Charge Code |
76102566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.10 |
| Max. Negotiated Rate |
$2,176.32 |
| Rate for Payer: Aetna Commercial |
$1,745.59
|
| Rate for Payer: Anthem Medicaid |
$779.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,768.26
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,881.61
|
| Rate for Payer: First Health Commercial |
$2,153.65
|
| Rate for Payer: Humana Commercial |
$1,926.95
|
| Rate for Payer: Humana KY Medicaid |
$779.62
|
| Rate for Payer: Kentucky WC Medicaid |
$787.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,858.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,673.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$795.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,700.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,813.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,972.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.23
|
| Rate for Payer: PHCS Commercial |
$2,176.32
|
| Rate for Payer: United Healthcare All Payer |
$1,994.96
|
|
|
EXCISION LYMPHATIC SYSTEM(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
761P1600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.35 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$736.22
|
| Rate for Payer: Ambetter Exchange |
$495.65
|
| Rate for Payer: Anthem Medicaid |
$287.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.78
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$594.05
|
| Rate for Payer: Healthspan PPO |
$588.67
|
| Rate for Payer: Humana Medicaid |
$287.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$665.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.10
|
| Rate for Payer: Molina Healthcare Passport |
$287.35
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.35
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.65
|
|
|
EXCISION LYMPHATIC SYSTEM(T
|
Facility
|
IP
|
$7,461.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
761T1600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,238.30 |
| Max. Negotiated Rate |
$7,162.56 |
| Rate for Payer: Aetna Commercial |
$5,744.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,819.58
|
| Rate for Payer: Cash Price |
$3,730.50
|
| Rate for Payer: Cigna Commercial |
$6,192.63
|
| Rate for Payer: First Health Commercial |
$7,087.95
|
| Rate for Payer: Humana Commercial |
$6,341.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,118.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,506.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,565.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,595.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,968.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,491.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,148.09
|
| Rate for Payer: PHCS Commercial |
$7,162.56
|
| Rate for Payer: United Healthcare All Payer |
$6,565.68
|
|
|
EXCISION LYMPHATIC SYSTEM(T
|
Facility
|
OP
|
$7,461.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
761T1600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,565.84 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$5,744.97
|
| Rate for Payer: Anthem Medicaid |
$2,565.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,819.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$3,730.50
|
| Rate for Payer: Cash Price |
$3,730.50
|
| Rate for Payer: Cigna Commercial |
$6,192.63
|
| Rate for Payer: First Health Commercial |
$7,087.95
|
| Rate for Payer: Humana Commercial |
$6,341.85
|
| Rate for Payer: Humana KY Medicaid |
$2,565.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,591.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,118.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,506.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,565.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,595.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,968.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,491.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,148.09
|
| Rate for Payer: PHCS Commercial |
$7,162.56
|
| Rate for Payer: United Healthcare All Payer |
$6,565.68
|
|
|
EXCISION LYMPH NODE BREAST
|
Facility
|
IP
|
$6,075.00
|
|
|
Service Code
|
HCPCS 38530
|
| Hospital Charge Code |
76101598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.50 |
| Max. Negotiated Rate |
$5,832.00 |
| Rate for Payer: Aetna Commercial |
$4,677.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,738.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna Commercial |
$5,042.25
|
| Rate for Payer: First Health Commercial |
$5,771.25
|
| Rate for Payer: Humana Commercial |
$5,163.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,981.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,483.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,822.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,346.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.75
|
| Rate for Payer: PHCS Commercial |
$5,832.00
|
| Rate for Payer: United Healthcare All Payer |
$5,346.00
|
|
|
EXCISION LYMPH NODE BREAST
|
Facility
|
OP
|
$6,075.00
|
|
|
Service Code
|
HCPCS 38530
|
| Hospital Charge Code |
76101598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,089.19 |
| Max. Negotiated Rate |
$5,832.00 |
| Rate for Payer: Aetna Commercial |
$4,677.75
|
| Rate for Payer: Anthem Medicaid |
$2,089.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,738.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna Commercial |
$5,042.25
|
| Rate for Payer: First Health Commercial |
$5,771.25
|
| Rate for Payer: Humana Commercial |
$5,163.75
|
| Rate for Payer: Humana KY Medicaid |
$2,089.19
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,110.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,981.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,483.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,131.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,346.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.75
|
| Rate for Payer: PHCS Commercial |
$5,832.00
|
| Rate for Payer: United Healthcare All Payer |
$5,346.00
|
|
|
EXCISION LYMPH NODE BREAST
|
Professional
|
Both
|
$6,075.00
|
|
|
Service Code
|
HCPCS 38530
|
| Hospital Charge Code |
76101598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna Commercial |
$787.78
|
| Rate for Payer: Ambetter Exchange |
$540.96
|
| Rate for Payer: Anthem Medicaid |
$271.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$649.15
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: Healthspan PPO |
$629.90
|
| Rate for Payer: Humana Medicaid |
$271.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$540.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.03
|
| Rate for Payer: Molina Healthcare Passport |
$271.60
|
| Rate for Payer: Multiplan PHCS |
$3,645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.25
|
| Rate for Payer: UHCCP Medicaid |
$2,126.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.96
|
|
|
EXCISION LYMPH NODE BREAST(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 38530
|
| Hospital Charge Code |
761P1598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$787.78 |
| Rate for Payer: Aetna Commercial |
$787.78
|
| Rate for Payer: Ambetter Exchange |
$540.96
|
| Rate for Payer: Anthem Medicaid |
$271.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$649.15
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: Healthspan PPO |
$629.90
|
| Rate for Payer: Humana Medicaid |
$271.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$540.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.03
|
| Rate for Payer: Molina Healthcare Passport |
$271.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.25
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.96
|
|
