|
EXCISION OF LINGUAL TONSIL
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 42870
|
| Hospital Charge Code |
76101713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXCISION OF LINGUAL TONSIL
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 42870
|
| Hospital Charge Code |
76101713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXCISION OF LINGUAL TONSIL
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 42870
|
| Hospital Charge Code |
76101713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$809.41 |
| Rate for Payer: Aetna Commercial |
$809.41
|
| Rate for Payer: Ambetter Exchange |
$540.63
|
| Rate for Payer: Anthem Medicaid |
$219.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$648.76
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$798.79
|
| Rate for Payer: Healthspan PPO |
$682.59
|
| Rate for Payer: Humana Medicaid |
$219.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$736.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$540.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.36
|
| Rate for Payer: Molina Healthcare Passport |
$219.96
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$702.82
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.63
|
|
|
EXCISION OF LINGUAL TONSIL(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 42870
|
| Hospital Charge Code |
761P1713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$809.41 |
| Rate for Payer: Aetna Commercial |
$809.41
|
| Rate for Payer: Ambetter Exchange |
$540.63
|
| Rate for Payer: Anthem Medicaid |
$219.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$540.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$648.76
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$798.79
|
| Rate for Payer: Healthspan PPO |
$682.59
|
| Rate for Payer: Humana Medicaid |
$219.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$736.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$540.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.36
|
| Rate for Payer: Molina Healthcare Passport |
$219.96
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$702.82
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$540.63
|
|
|
EXCISION OF LIP
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 40510
|
| Hospital Charge Code |
76101626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXCISION OF LIP
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 40510
|
| Hospital Charge Code |
76101626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXCISION OF LIP
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 40510
|
| Hospital Charge Code |
76101626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$511.91
|
| Rate for Payer: Ambetter Exchange |
$329.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$273.73
|
| Rate for Payer: Anthem Medicaid |
$310.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$329.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$329.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.66
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$660.01
|
| Rate for Payer: Healthspan PPO |
$563.95
|
| Rate for Payer: Humana Medicaid |
$310.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$456.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$329.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.13
|
| Rate for Payer: Molina Healthcare Passport |
$310.91
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$428.64
|
| Rate for Payer: UHCCP Medicaid |
$287.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$329.72
|
|
|
EXCISION OF LIP(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 40510
|
| Hospital Charge Code |
761P1626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$511.91
|
| Rate for Payer: Ambetter Exchange |
$329.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$273.73
|
| Rate for Payer: Anthem Medicaid |
$310.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$329.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$329.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.66
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$660.01
|
| Rate for Payer: Healthspan PPO |
$563.95
|
| Rate for Payer: Humana Medicaid |
$310.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$456.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$329.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.13
|
| Rate for Payer: Molina Healthcare Passport |
$310.91
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$428.64
|
| Rate for Payer: UHCCP Medicaid |
$287.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$314.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$329.72
|
|
|
EXCISION OF MESENTERY LESION
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44820
|
| Hospital Charge Code |
76101866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXCISION OF MESENTERY LESION
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44820
|
| Hospital Charge Code |
76101866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.16 |
| Max. Negotiated Rate |
$1,206.71 |
| Rate for Payer: Aetna Commercial |
$1,206.71
|
| Rate for Payer: Ambetter Exchange |
$813.27
|
| Rate for Payer: Anthem Medicaid |
$458.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$813.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$813.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$975.92
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,118.32
|
| Rate for Payer: Healthspan PPO |
$1,017.64
|
| Rate for Payer: Humana Medicaid |
$458.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,069.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$813.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$467.32
|
| Rate for Payer: Molina Healthcare Passport |
$458.16
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,057.25
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$462.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$813.27
|
|
|
EXCISION OF MESENTERY LESION
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44820
|
| Hospital Charge Code |
76101866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXCISION OF MESENTERY LESIO(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44820
|
| Hospital Charge Code |
761P1866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.16 |
| Max. Negotiated Rate |
$1,206.71 |
| Rate for Payer: Aetna Commercial |
$1,206.71
|
| Rate for Payer: Ambetter Exchange |
$813.27
|
| Rate for Payer: Anthem Medicaid |
$458.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$813.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$813.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$975.92
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,118.32
|
| Rate for Payer: Healthspan PPO |
$1,017.64
|
| Rate for Payer: Humana Medicaid |
$458.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,069.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$813.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$467.32
|
| Rate for Payer: Molina Healthcare Passport |
$458.16
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,057.25
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$462.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$813.27
|
|
|
EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS
|
Facility
|
OP
|
$3,547.47
|
|
|
Service Code
|
CPT 46230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,533.91 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
|
|
EXCISION OF NECK CYST
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
76101705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.46 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$801.21
|
| Rate for Payer: Ambetter Exchange |
$505.49
|
| Rate for Payer: Anthem Medicaid |
$452.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.59
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$782.86
|
| Rate for Payer: Healthspan PPO |
$675.67
|
| Rate for Payer: Humana Medicaid |
$452.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.51
|
| Rate for Payer: Molina Healthcare Passport |
$452.46
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$657.14
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.49
|
|
|
EXCISION OF NECK CYST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
76101705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
EXCISION OF NECK CYST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
76101705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
EXCISION OF NECK CYST(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
761P1705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.46 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$801.21
|
| Rate for Payer: Ambetter Exchange |
$505.49
|
| Rate for Payer: Anthem Medicaid |
$452.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.59
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$782.86
|
| Rate for Payer: Healthspan PPO |
$675.67
|
| Rate for Payer: Humana Medicaid |
$452.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.51
|
| Rate for Payer: Molina Healthcare Passport |
$452.46
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$657.14
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.49
|
|
|
EXCISION OF PAROTID TUMOR OR P
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
76101688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$967.68 |
| Rate for Payer: Aetna Commercial |
$776.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$786.24
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$836.64
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Humana Commercial |
$856.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$826.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$887.04
|
| Rate for Payer: Ohio Health Group HMO |
$756.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.52
|
| Rate for Payer: PHCS Commercial |
$967.68
|
| Rate for Payer: United Healthcare All Payer |
$887.04
|
|
|
EXCISION OF PAROTID TUMOR OR P
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
76101688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.65 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$776.16
|
| Rate for Payer: Anthem Medicaid |
$346.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$786.24
|
| 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 |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$836.64
|
| Rate for Payer: First Health Commercial |
$957.60
|
| Rate for Payer: Humana Commercial |
$856.80
|
| Rate for Payer: Humana KY Medicaid |
$346.65
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$350.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$826.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$353.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$887.04
|
| Rate for Payer: Ohio Health Group HMO |
$756.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.52
|
| Rate for Payer: PHCS Commercial |
$967.68
|
| Rate for Payer: United Healthcare All Payer |
$887.04
|
|
|
EXCISION OF PAROTID TUMOR OR P
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
76101688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$915.99 |
| Rate for Payer: Aetna Commercial |
$915.99
|
| Rate for Payer: Ambetter Exchange |
$595.30
|
| Rate for Payer: Anthem Medicaid |
$442.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$714.36
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$902.85
|
| Rate for Payer: Healthspan PPO |
$772.47
|
| Rate for Payer: Humana Medicaid |
$442.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.10
|
| Rate for Payer: Molina Healthcare Passport |
$442.25
|
| Rate for Payer: Multiplan PHCS |
$604.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$773.89
|
| Rate for Payer: UHCCP Medicaid |
$352.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.30
|
|
|
EXCISION OF PAROTID TUMOR OR P
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
761P1688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$915.99 |
| Rate for Payer: Aetna Commercial |
$915.99
|
| Rate for Payer: Ambetter Exchange |
$595.30
|
| Rate for Payer: Anthem Medicaid |
$442.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$714.36
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$902.85
|
| Rate for Payer: Healthspan PPO |
$772.47
|
| Rate for Payer: Humana Medicaid |
$442.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$451.10
|
| Rate for Payer: Molina Healthcare Passport |
$442.25
|
| Rate for Payer: Multiplan PHCS |
$604.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$773.89
|
| Rate for Payer: UHCCP Medicaid |
$352.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.30
|
|
|
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF FACIAL NERVE
|
Facility
|
OP
|
$7,652.33
|
|
|
Service Code
|
CPT 42415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.95 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
|
|
EXCISION OF PENIS LESION(S)
|
Professional
|
Both
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$2,863.02 |
| Rate for Payer: Aetna Commercial |
$203.72
|
| Rate for Payer: Ambetter Exchange |
$124.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.92
|
| Rate for Payer: Anthem Medicaid |
$89.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.77
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$281.63
|
| Rate for Payer: Healthspan PPO |
$279.65
|
| Rate for Payer: Humana Medicaid |
$89.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.25
|
| Rate for Payer: Molina Healthcare Passport |
$89.46
|
| Rate for Payer: Multiplan PHCS |
$2,863.02
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.25
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.81
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
IP
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.51 |
| Max. Negotiated Rate |
$4,580.83 |
| Rate for Payer: Aetna Commercial |
$3,674.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,721.93
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$3,960.51
|
| Rate for Payer: First Health Commercial |
$4,533.11
|
| Rate for Payer: Humana Commercial |
$4,055.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,912.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,521.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,578.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,817.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.47
|
| Rate for Payer: PHCS Commercial |
$4,580.83
|
| Rate for Payer: United Healthcare All Payer |
$4,199.10
|
|
|
EXCISION OF PENIS LESION(S)
|
Facility
|
OP
|
$4,771.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
76102127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,640.99 |
| Max. Negotiated Rate |
$4,580.83 |
| Rate for Payer: Aetna Commercial |
$3,674.21
|
| Rate for Payer: Anthem Medicaid |
$1,640.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,721.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cash Price |
$2,385.85
|
| Rate for Payer: Cigna Commercial |
$3,960.51
|
| Rate for Payer: First Health Commercial |
$4,533.11
|
| Rate for Payer: Humana Commercial |
$4,055.95
|
| Rate for Payer: Humana KY Medicaid |
$1,640.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,657.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,912.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,521.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,673.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,578.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,817.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.47
|
| Rate for Payer: PHCS Commercial |
$4,580.83
|
| Rate for Payer: United Healthcare All Payer |
$4,199.10
|
|
