|
EXCISION OF HIP JOINT/MUSCLE
|
Facility
|
OP
|
$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 Medicaid |
$417.84
|
| 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: Humana KY Medicaid |
$417.84
|
| Rate for Payer: Kentucky WC Medicaid |
$422.09
|
| 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: Molina Healthcare Medicaid |
$426.22
|
| 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/MUSCL(P
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 27036
|
| Hospital Charge Code |
761P0765
|
|
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
|
|
|
EXCISION OF HYDROCELE; UNI
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.37 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Ambetter Exchange |
$321.05
|
| Rate for Payer: Anthem Medicaid |
$295.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$385.26
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$485.50
|
| Rate for Payer: Healthspan PPO |
$527.85
|
| Rate for Payer: Humana Medicaid |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$321.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.28
|
| Rate for Payer: Molina Healthcare Passport |
$295.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$417.37
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.05
|
|
|
EXCISION OF HYDROCELE; UNI
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EXCISION OF HYDROCELE; UNI
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
76102143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EXCISION OF HYDROCELE; UNILATERAL
|
Facility
|
OP
|
$4,565.09
|
|
|
Service Code
|
CPT 55040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,260.78 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
|
|
EXCISION OF HYDROCELE; UNI(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
761P2143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.37 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$545.16
|
| Rate for Payer: Ambetter Exchange |
$321.05
|
| Rate for Payer: Anthem Medicaid |
$295.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$385.26
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$485.50
|
| Rate for Payer: Healthspan PPO |
$527.85
|
| Rate for Payer: Humana Medicaid |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$321.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.28
|
| Rate for Payer: Molina Healthcare Passport |
$295.37
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$417.37
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.05
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.29 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$982.24
|
| Rate for Payer: Ambetter Exchange |
$525.79
|
| Rate for Payer: Anthem Medicaid |
$481.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$525.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.95
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$971.95
|
| Rate for Payer: Healthspan PPO |
$965.74
|
| Rate for Payer: Humana Medicaid |
$481.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$525.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.92
|
| Rate for Payer: Molina Healthcare Passport |
$481.29
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$683.53
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$525.79
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
76101427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXCISION OF INFECTED GRAFT; EX
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35903
|
| Hospital Charge Code |
761P1427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.29 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$982.24
|
| Rate for Payer: Ambetter Exchange |
$525.79
|
| Rate for Payer: Anthem Medicaid |
$481.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$525.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.95
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$971.95
|
| Rate for Payer: Healthspan PPO |
$965.74
|
| Rate for Payer: Humana Medicaid |
$481.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$525.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.92
|
| Rate for Payer: Molina Healthcare Passport |
$481.29
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$683.53
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$525.79
|
|
|
EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
|
Facility
|
OP
|
$3,017.85
|
|
|
Service Code
|
CPT 68115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,155.61 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
|
|
EXCISION OF LESION OF MUCOSA
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| 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 |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
EXCISION OF LESION OF MUCOSA
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.67 |
| Max. Negotiated Rate |
$526.57 |
| Rate for Payer: Aetna Commercial |
$449.73
|
| Rate for Payer: Ambetter Exchange |
$284.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.53
|
| Rate for Payer: Anthem Medicaid |
$197.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$284.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$284.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$341.72
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$526.57
|
| Rate for Payer: Healthspan PPO |
$463.67
|
| Rate for Payer: Humana Medicaid |
$197.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$402.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$284.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.62
|
| Rate for Payer: Molina Healthcare Passport |
$197.67
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$370.20
|
| Rate for Payer: UHCCP Medicaid |
$217.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$284.77
|
|
|
EXCISION OF LESION OF MUCOSA
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
76101638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
EXCISION OF LESION OF MUCOSA(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 40816
|
| Hospital Charge Code |
761P1638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.67 |
| Max. Negotiated Rate |
$526.57 |
| Rate for Payer: Aetna Commercial |
$449.73
|
| Rate for Payer: Ambetter Exchange |
$284.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.53
|
| Rate for Payer: Anthem Medicaid |
$197.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$284.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$284.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$341.72
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$526.57
|
| Rate for Payer: Healthspan PPO |
$463.67
|
| Rate for Payer: Humana Medicaid |
$197.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$402.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$284.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.62
|
| Rate for Payer: Molina Healthcare Passport |
$197.67
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$370.20
|
| Rate for Payer: UHCCP Medicaid |
$217.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$284.77
|
|
|
EXCISION OF LESION OF SPERMATI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.92 |
| Max. Negotiated Rate |
$632.26 |
| Rate for Payer: Aetna Commercial |
$632.26
|
| Rate for Payer: Ambetter Exchange |
$438.07
|
| Rate for Payer: Anthem Medicaid |
$263.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$438.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$438.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$525.68
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$577.79
|
| Rate for Payer: Healthspan PPO |
$612.19
|
| Rate for Payer: Humana Medicaid |
$263.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$438.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.20
|
| Rate for Payer: Molina Healthcare Passport |
$263.92
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$569.49
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$438.07
|
|
|
EXCISION OF LESION OF SPERMATI
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| 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 |
$3,186.78
|
| 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 |
$3,824.14
|
| 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 OF LESION OF SPERMATI
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
761P2151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.92 |
| Max. Negotiated Rate |
$632.26 |
| Rate for Payer: Aetna Commercial |
$632.26
|
| Rate for Payer: Ambetter Exchange |
$438.07
|
| Rate for Payer: Anthem Medicaid |
$263.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$438.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$438.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$525.68
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$577.79
|
| Rate for Payer: Healthspan PPO |
$612.19
|
| Rate for Payer: Humana Medicaid |
$263.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$438.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.20
|
| Rate for Payer: Molina Healthcare Passport |
$263.92
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$569.49
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$438.07
|
|
|
EXCISION OF LESION OF SPERMATI
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
76102151
|
|
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 OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26160
|
|
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 LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 41112
|
|
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 OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); FOOT
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28090
|
|
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 LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); TOE(S), EACH
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28092
|
|
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 LINGUAL FRENUM (FRENECTOMY)
|
Facility
|
OP
|
$1,916.14
|
|
|
Service Code
|
CPT 41115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
|
