|
EXCISION NASAL POLYP
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
76101120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$286.78 |
| Rate for Payer: Aetna Commercial |
$185.50
|
| Rate for Payer: Ambetter Exchange |
$125.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.46
|
| Rate for Payer: Anthem Medicaid |
$84.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.16
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$286.78
|
| Rate for Payer: Healthspan PPO |
$256.19
|
| Rate for Payer: Humana Medicaid |
$84.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.05
|
| Rate for Payer: Molina Healthcare Passport |
$84.36
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.67
|
| Rate for Payer: UHCCP Medicaid |
$92.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.13
|
|
|
EXCISION NASAL POLYP(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
761P1120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$286.78 |
| Rate for Payer: Aetna Commercial |
$185.50
|
| Rate for Payer: Ambetter Exchange |
$125.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.46
|
| Rate for Payer: Anthem Medicaid |
$84.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.16
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$286.78
|
| Rate for Payer: Healthspan PPO |
$256.19
|
| Rate for Payer: Humana Medicaid |
$84.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.05
|
| Rate for Payer: Molina Healthcare Passport |
$84.36
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.67
|
| Rate for Payer: UHCCP Medicaid |
$92.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.13
|
|
|
EXCISION OF BARTHOLIN'S GLAND OR CYST
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 56740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
EX CISION OF BENIGN LESION
|
Facility
|
IP
|
$4,849.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,454.70 |
| Max. Negotiated Rate |
$4,655.04 |
| Rate for Payer: Aetna Commercial |
$3,733.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,782.22
|
| Rate for Payer: Cash Price |
$2,424.50
|
| Rate for Payer: Cigna Commercial |
$4,024.67
|
| Rate for Payer: First Health Commercial |
$4,606.55
|
| Rate for Payer: Humana Commercial |
$4,121.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,976.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,578.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,454.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,267.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,879.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,345.81
|
| Rate for Payer: PHCS Commercial |
$4,655.04
|
| Rate for Payer: United Healthcare All Payer |
$4,267.12
|
|
|
EX CISION OF BENIGN LESION
|
Facility
|
OP
|
$4,849.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,667.57 |
| Max. Negotiated Rate |
$4,655.04 |
| Rate for Payer: Aetna Commercial |
$3,733.73
|
| Rate for Payer: Anthem Medicaid |
$1,667.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,782.22
|
| 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 |
$2,424.50
|
| Rate for Payer: Cash Price |
$2,424.50
|
| Rate for Payer: Cigna Commercial |
$4,024.67
|
| Rate for Payer: First Health Commercial |
$4,606.55
|
| Rate for Payer: Humana Commercial |
$4,121.65
|
| Rate for Payer: Humana KY Medicaid |
$1,667.57
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,976.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,578.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,267.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,879.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,345.81
|
| Rate for Payer: PHCS Commercial |
$4,655.04
|
| Rate for Payer: United Healthcare All Payer |
$4,267.12
|
|
|
EX CISION OF BENIGN LESION
|
Professional
|
Both
|
$4,849.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.48 |
| Max. Negotiated Rate |
$2,909.40 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Ambetter Exchange |
$300.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.48
|
| Rate for Payer: Anthem Medicaid |
$182.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$361.08
|
| Rate for Payer: Cash Price |
$2,424.50
|
| Rate for Payer: Cash Price |
$2,424.50
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: Healthspan PPO |
$420.48
|
| Rate for Payer: Humana Medicaid |
$182.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.05
|
| Rate for Payer: Molina Healthcare Passport |
$182.40
|
| Rate for Payer: Multiplan PHCS |
$2,909.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$391.17
|
| Rate for Payer: UHCCP Medicaid |
$170.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.90
|
|
|
EX CISION OF BENIGN LESION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761P0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.48 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$453.62
|
| Rate for Payer: Ambetter Exchange |
$300.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.48
|
| Rate for Payer: Anthem Medicaid |
$182.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$361.08
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: Healthspan PPO |
$420.48
|
| Rate for Payer: Humana Medicaid |
$182.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.05
|
| Rate for Payer: Molina Healthcare Passport |
$182.40
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$391.17
|
| Rate for Payer: UHCCP Medicaid |
$170.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.90
|
|
|
EX CISION OF BENIGN LESION(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761T0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,375.26 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| 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 |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,199.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,479.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.31
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
EX CISION OF BENIGN LESION(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 11446
|
| Hospital Charge Code |
761T0068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,199.70 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,199.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,479.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.31
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; SINGLE LESION
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
Excision of carotid body tumor
|
Professional
|
Both
|
$1,614.29
|
|
|
Service Code
|
HCPCS 60600
|
| Hospital Charge Code |
761P2643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,123.82 |
| Rate for Payer: Aetna Commercial |
$2,123.82
|
| Rate for Payer: Ambetter Exchange |
$1,283.59
|
| Rate for Payer: Anthem Medicaid |
$826.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,283.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,283.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,540.31
|
| Rate for Payer: Cash Price |
$807.14
|
| Rate for Payer: Cash Price |
$807.14
|
| Rate for Payer: Cigna Commercial |
$2,025.93
|
| Rate for Payer: Healthspan PPO |
$1,791.06
|
| Rate for Payer: Humana Medicaid |
$826.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,889.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,283.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$842.90
|
| Rate for Payer: Molina Healthcare Passport |
$826.37
|
| Rate for Payer: Multiplan PHCS |
$968.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,668.67
|
| Rate for Payer: UHCCP Medicaid |
$565.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,283.59
|
|
|
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
OP
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,111.26 |
| Max. Negotiated Rate |
$8,685.12 |
| Rate for Payer: Aetna Commercial |
$6,966.19
|
| Rate for Payer: Anthem Medicaid |
$3,111.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,056.66
|
| 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 |
$4,523.50
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$7,509.01
|
| Rate for Payer: First Health Commercial |
$8,594.65
|
| Rate for Payer: Humana Commercial |
$7,689.95
|
| Rate for Payer: Humana KY Medicaid |
$3,111.26
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,142.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,418.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,676.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,173.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,961.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,870.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,242.43
|
| Rate for Payer: PHCS Commercial |
$8,685.12
|
| Rate for Payer: United Healthcare All Payer |
$7,961.36
|
|
|
EXCISION OF FACIAL BONE(S)
|
Facility
|
IP
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,714.10 |
| Max. Negotiated Rate |
$8,685.12 |
| Rate for Payer: Aetna Commercial |
$6,966.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,056.66
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$7,509.01
|
| Rate for Payer: First Health Commercial |
$8,594.65
|
| Rate for Payer: Humana Commercial |
$7,689.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,418.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,676.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,961.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,870.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,242.43
|
| Rate for Payer: PHCS Commercial |
$8,685.12
|
| Rate for Payer: United Healthcare All Payer |
$7,961.36
|
|
|
EXCISION OF FACIAL BONE(S)
|
Professional
|
Both
|
$9,047.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$5,428.20 |
| Rate for Payer: Aetna Commercial |
$686.34
|
| Rate for Payer: Ambetter Exchange |
$411.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.85
|
| Rate for Payer: Anthem Medicaid |
$223.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$411.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$411.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$493.24
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cash Price |
$4,523.50
|
| Rate for Payer: Cigna Commercial |
$874.47
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$223.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.43
|
| Rate for Payer: Molina Healthcare Passport |
$223.95
|
| Rate for Payer: Multiplan PHCS |
$5,428.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.34
|
| Rate for Payer: UHCCP Medicaid |
$228.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$411.03
|
|
|
EXCISION OF FACIAL BONE(S)(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761P0368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.85 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$686.34
|
| Rate for Payer: Ambetter Exchange |
$411.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.85
|
| Rate for Payer: Anthem Medicaid |
$223.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$411.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$411.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$493.24
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$874.47
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$223.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.43
|
| Rate for Payer: Molina Healthcare Passport |
$223.95
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.34
|
| Rate for Payer: UHCCP Medicaid |
$228.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$411.03
|
|
|
EXCISION OF FACIAL BONE(S)(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761T0368
|
|
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 OF FACIAL BONE(S)(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 21026
|
| Hospital Charge Code |
761T0368
|
|
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 OF FRENUM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$392.32 |
| Rate for Payer: Aetna Commercial |
$329.06
|
| Rate for Payer: Ambetter Exchange |
$188.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.08
|
| Rate for Payer: Anthem Medicaid |
$102.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$226.52
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$392.32
|
| Rate for Payer: Healthspan PPO |
$348.83
|
| Rate for Payer: Humana Medicaid |
$102.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$294.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.76
|
| Rate for Payer: Molina Healthcare Passport |
$102.71
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.40
|
| Rate for Payer: UHCCP Medicaid |
$134.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.77
|
|
|
EXCISION OF FRENUM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
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
|
|
|
EXCISION OF FRENUM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
76101640
|
|
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
|
|
|
EXCISION OF FRENUM(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
761P1640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$392.32 |
| Rate for Payer: Aetna Commercial |
$329.06
|
| Rate for Payer: Ambetter Exchange |
$188.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$128.08
|
| Rate for Payer: Anthem Medicaid |
$102.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$226.52
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$392.32
|
| Rate for Payer: Healthspan PPO |
$348.83
|
| Rate for Payer: Humana Medicaid |
$102.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$294.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.76
|
| Rate for Payer: Molina Healthcare Passport |
$102.71
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.40
|
| Rate for Payer: UHCCP Medicaid |
$134.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.77
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 25111
|
|
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 OF HIP JOINT/MUSCLE
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
76100765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
EXCISION OF HIP JOINT/MUSCLE
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
76100765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$1,604.15 |
| Rate for Payer: Aetna Commercial |
$1,485.94
|
| Rate for Payer: Ambetter Exchange |
$968.40
|
| Rate for Payer: Anthem Medicaid |
$686.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$968.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$968.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,162.08
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,604.15
|
| Rate for Payer: Healthspan PPO |
$1,345.95
|
| Rate for Payer: Humana Medicaid |
$686.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,253.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$968.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$699.84
|
| Rate for Payer: Molina Healthcare Passport |
$686.12
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,258.92
|
| Rate for Payer: UHCCP Medicaid |
$425.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$692.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$968.40
|
|
