|
EXCISION OF PENIS LESION(S)(P
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761P2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$357.00 |
| 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 |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| 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 |
$357.00
|
| 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)(T
|
Facility
|
OP
|
$4,176.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761T2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,436.37 |
| Max. Negotiated Rate |
$4,009.63 |
| Rate for Payer: Aetna Commercial |
$3,216.06
|
| Rate for Payer: Anthem Medicaid |
$1,436.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,257.83
|
| 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 |
$2,088.35
|
| Rate for Payer: Cash Price |
$2,088.35
|
| Rate for Payer: Cigna Commercial |
$3,466.66
|
| Rate for Payer: First Health Commercial |
$3,967.86
|
| Rate for Payer: Humana Commercial |
$3,550.20
|
| Rate for Payer: Humana KY Medicaid |
$1,436.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,450.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,424.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,341.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,633.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,881.92
|
| Rate for Payer: PHCS Commercial |
$4,009.63
|
| Rate for Payer: United Healthcare All Payer |
$3,675.50
|
|
|
EXCISION OF PENIS LESION(S)(T
|
Facility
|
IP
|
$4,176.70
|
|
|
Service Code
|
HCPCS 54060
|
| Hospital Charge Code |
761T2127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,253.01 |
| Max. Negotiated Rate |
$4,009.63 |
| Rate for Payer: Aetna Commercial |
$3,216.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,257.83
|
| Rate for Payer: Cash Price |
$2,088.35
|
| Rate for Payer: Cigna Commercial |
$3,466.66
|
| Rate for Payer: First Health Commercial |
$3,967.86
|
| Rate for Payer: Humana Commercial |
$3,550.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,424.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,341.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,633.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,881.92
|
| Rate for Payer: PHCS Commercial |
$4,009.63
|
| Rate for Payer: United Healthcare All Payer |
$3,675.50
|
|
|
EXCISION OF PILONDIAL CYST
|
Professional
|
Both
|
$7,302.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$4,381.20 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Ambetter Exchange |
$175.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.84
|
| Rate for Payer: Anthem Medicaid |
$157.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.05
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$330.63
|
| Rate for Payer: Healthspan PPO |
$287.82
|
| Rate for Payer: Humana Medicaid |
$157.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.58
|
| Rate for Payer: Molina Healthcare Passport |
$157.43
|
| Rate for Payer: Multiplan PHCS |
$4,381.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.55
|
| Rate for Payer: UHCCP Medicaid |
$118.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.04
|
|
|
EXCISION OF PILONDIAL CYST
|
Facility
|
IP
|
$7,302.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,190.60 |
| Max. Negotiated Rate |
$7,009.92 |
| Rate for Payer: Aetna Commercial |
$5,622.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.56
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$6,060.66
|
| Rate for Payer: First Health Commercial |
$6,936.90
|
| Rate for Payer: Humana Commercial |
$6,206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,190.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,038.38
|
| Rate for Payer: PHCS Commercial |
$7,009.92
|
| Rate for Payer: United Healthcare All Payer |
$6,425.76
|
|
|
EXCISION OF PILONDIAL CYST
|
Facility
|
OP
|
$7,302.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
76100104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,511.16 |
| Max. Negotiated Rate |
$7,009.92 |
| Rate for Payer: Aetna Commercial |
$5,622.54
|
| Rate for Payer: Anthem Medicaid |
$2,511.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$6,060.66
|
| Rate for Payer: First Health Commercial |
$6,936.90
|
| Rate for Payer: Humana Commercial |
$6,206.70
|
| Rate for Payer: Humana KY Medicaid |
$2,511.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,561.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,038.38
|
| Rate for Payer: PHCS Commercial |
$7,009.92
|
| Rate for Payer: United Healthcare All Payer |
$6,425.76
|
|
|
EXCISION OF PILONDIAL CYST(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761P0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$257.20
|
| Rate for Payer: Ambetter Exchange |
$175.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.84
|
| Rate for Payer: Anthem Medicaid |
$157.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.05
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$330.63
|
| Rate for Payer: Healthspan PPO |
$287.82
|
| Rate for Payer: Humana Medicaid |
$157.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.58
|
| Rate for Payer: Molina Healthcare Passport |
$157.43
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.55
|
| Rate for Payer: UHCCP Medicaid |
$118.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.04
|
|
|
EXCISION OF PILONDIAL CYST(T
|
Facility
|
IP
|
$6,652.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761T0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,995.60 |
| Max. Negotiated Rate |
$6,385.92 |
| Rate for Payer: Aetna Commercial |
$5,122.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,188.56
|
| Rate for Payer: Cash Price |
$3,326.00
|
| Rate for Payer: Cigna Commercial |
$5,521.16
|
| Rate for Payer: First Health Commercial |
$6,319.40
|
| Rate for Payer: Humana Commercial |
$5,654.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,454.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,853.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,787.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,589.88
|
| Rate for Payer: PHCS Commercial |
$6,385.92
|
| Rate for Payer: United Healthcare All Payer |
$5,853.76
|
|
|
EXCISION OF PILONDIAL CYST(T
|
Facility
|
OP
|
$6,652.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
761T0104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,287.62 |
| Max. Negotiated Rate |
$6,385.92 |
| Rate for Payer: Aetna Commercial |
$5,122.04
|
| Rate for Payer: Anthem Medicaid |
$2,287.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,188.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,326.00
|
| Rate for Payer: Cash Price |
$3,326.00
|
| Rate for Payer: Cigna Commercial |
$5,521.16
|
| Rate for Payer: First Health Commercial |
$6,319.40
|
| Rate for Payer: Humana Commercial |
$5,654.20
|
| Rate for Payer: Humana KY Medicaid |
$2,287.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,454.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,333.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,853.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,787.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,589.88
|
| Rate for Payer: PHCS Commercial |
$6,385.92
|
| Rate for Payer: United Healthcare All Payer |
$5,853.76
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 11772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 11771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 11770
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION OF RIB, PARTIAL
|
Facility
|
OP
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,324.83 |
| Max. Negotiated Rate |
$9,281.28 |
| Rate for Payer: Aetna Commercial |
$7,444.36
|
| Rate for Payer: Anthem Medicaid |
$3,324.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,541.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$8,024.44
|
| Rate for Payer: First Health Commercial |
$9,184.60
|
| Rate for Payer: Humana Commercial |
$8,217.80
|
| Rate for Payer: Humana KY Medicaid |
$3,324.83
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,358.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,927.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,134.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,391.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,507.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,734.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,411.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,670.92
|
| Rate for Payer: PHCS Commercial |
$9,281.28
|
| Rate for Payer: United Healthcare All Payer |
$8,507.84
|
|
|
EXCISION OF RIB, PARTIAL
|
Facility
|
IP
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,900.40 |
| Max. Negotiated Rate |
$9,281.28 |
| Rate for Payer: Aetna Commercial |
$7,444.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,541.04
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$8,024.44
|
| Rate for Payer: First Health Commercial |
$9,184.60
|
| Rate for Payer: Humana Commercial |
$8,217.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,927.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,134.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,507.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,734.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,411.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,670.92
|
| Rate for Payer: PHCS Commercial |
$9,281.28
|
| Rate for Payer: United Healthcare All Payer |
$8,507.84
|
|
|
EXCISION OF RIB, PARTIAL
|
Professional
|
Both
|
$9,668.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.07 |
| Max. Negotiated Rate |
$5,800.80 |
| Rate for Payer: Aetna Commercial |
$799.50
|
| Rate for Payer: Ambetter Exchange |
$543.00
|
| Rate for Payer: Anthem Medicaid |
$326.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$543.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$543.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$651.60
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cash Price |
$4,834.00
|
| Rate for Payer: Cigna Commercial |
$850.33
|
| Rate for Payer: Healthspan PPO |
$724.17
|
| Rate for Payer: Humana Medicaid |
$326.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$702.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$543.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Molina Healthcare Passport |
$326.07
|
| Rate for Payer: Multiplan PHCS |
$5,800.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$705.90
|
| Rate for Payer: UHCCP Medicaid |
$3,383.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$543.00
|
|
|
EXCISION OF RIB, PARTIAL(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761P0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.07 |
| Max. Negotiated Rate |
$850.33 |
| Rate for Payer: Aetna Commercial |
$799.50
|
| Rate for Payer: Ambetter Exchange |
$543.00
|
| Rate for Payer: Anthem Medicaid |
$326.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$543.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$543.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$651.60
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$850.33
|
| Rate for Payer: Healthspan PPO |
$724.17
|
| Rate for Payer: Humana Medicaid |
$326.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$702.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$543.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.59
|
| Rate for Payer: Molina Healthcare Passport |
$326.07
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$705.90
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$543.00
|
|
|
EXCISION OF RIB, PARTIAL(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761T0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
EXCISION OF RIB, PARTIAL(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 21600
|
| Hospital Charge Code |
761T0399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
EXCISION OF SALIVARY CYST
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
76101686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.88 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$478.95
|
| Rate for Payer: Ambetter Exchange |
$328.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$223.88
|
| Rate for Payer: Anthem Medicaid |
$225.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$393.96
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Healthspan PPO |
$533.90
|
| Rate for Payer: Humana Medicaid |
$225.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$423.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.05
|
| Rate for Payer: Molina Healthcare Passport |
$225.54
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$426.79
|
| Rate for Payer: UHCCP Medicaid |
$235.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.30
|
|
|
EXCISION OF SALIVARY CYST
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
76101686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
EXCISION OF SALIVARY CYST
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
76101686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
EXCISION OF SALIVARY CYST(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42408
|
| Hospital Charge Code |
761P1686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.88 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$478.95
|
| Rate for Payer: Ambetter Exchange |
$328.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$223.88
|
| Rate for Payer: Anthem Medicaid |
$225.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$328.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$328.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$393.96
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Healthspan PPO |
$533.90
|
| Rate for Payer: Humana Medicaid |
$225.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$423.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$328.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.05
|
| Rate for Payer: Molina Healthcare Passport |
$225.54
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$426.79
|
| Rate for Payer: UHCCP Medicaid |
$235.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$328.30
|
|
|
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 11450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR INTERMEDIATE REPAIR
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 11462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION OF STOMACH LESION
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 43610
|
| Hospital Charge Code |
76101783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.35 |
| Max. Negotiated Rate |
$1,411.83 |
| Rate for Payer: Aetna Commercial |
$1,411.83
|
| Rate for Payer: Ambetter Exchange |
$930.53
|
| Rate for Payer: Anthem Medicaid |
$557.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$930.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$930.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,116.64
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,311.13
|
| Rate for Payer: Healthspan PPO |
$1,190.62
|
| Rate for Payer: Humana Medicaid |
$557.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,251.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$930.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.50
|
| Rate for Payer: Molina Healthcare Passport |
$557.35
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,209.69
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$930.53
|
|
