|
EXCISION OF STOMACH LESION
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 43610
|
| Hospital Charge Code |
76101783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXCISION OF STOMACH LESION
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 43610
|
| Hospital Charge Code |
76101783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXCISION OF STOMACH LESION(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 43610
|
| Hospital Charge Code |
761P1783
|
|
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
|
|
|
EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
|
Facility
|
OP
|
$7,652.33
|
|
|
Service Code
|
CPT 42440
|
|
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 THROMBOSED HEMORRHOID, EXTERNAL
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 46320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 60280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
OP
|
$6,592.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
76101656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,266.99 |
| Max. Negotiated Rate |
$6,328.32 |
| Rate for Payer: Aetna Commercial |
$5,075.84
|
| Rate for Payer: Anthem Medicaid |
$2,266.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,141.76
|
| 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 |
$3,296.00
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cigna Commercial |
$5,471.36
|
| Rate for Payer: First Health Commercial |
$6,262.40
|
| Rate for Payer: Humana Commercial |
$5,603.20
|
| Rate for Payer: Humana KY Medicaid |
$2,266.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,290.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,405.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,864.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,312.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,800.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,735.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,548.48
|
| Rate for Payer: PHCS Commercial |
$6,328.32
|
| Rate for Payer: United Healthcare All Payer |
$5,800.96
|
|
|
EXCISION OF TONGUE LESION
|
Professional
|
Both
|
$6,592.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
76101656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.72 |
| Max. Negotiated Rate |
$3,955.20 |
| Rate for Payer: Aetna Commercial |
$394.78
|
| Rate for Payer: Ambetter Exchange |
$247.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.72
|
| Rate for Payer: Anthem Medicaid |
$191.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.46
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cigna Commercial |
$473.89
|
| Rate for Payer: Healthspan PPO |
$417.78
|
| Rate for Payer: Humana Medicaid |
$191.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.94
|
| Rate for Payer: Molina Healthcare Passport |
$191.12
|
| Rate for Payer: Multiplan PHCS |
$3,955.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.17
|
| Rate for Payer: UHCCP Medicaid |
$193.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.05
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
IP
|
$6,592.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
76101656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,977.60 |
| Max. Negotiated Rate |
$6,328.32 |
| Rate for Payer: Aetna Commercial |
$5,075.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,141.76
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cigna Commercial |
$5,471.36
|
| Rate for Payer: First Health Commercial |
$6,262.40
|
| Rate for Payer: Humana Commercial |
$5,603.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,405.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,864.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,800.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,735.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,548.48
|
| Rate for Payer: PHCS Commercial |
$6,328.32
|
| Rate for Payer: United Healthcare All Payer |
$5,800.96
|
|
|
EXCISION OF TONGUE LESION(P
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
761P1656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.72 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna Commercial |
$394.78
|
| Rate for Payer: Ambetter Exchange |
$247.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.72
|
| Rate for Payer: Anthem Medicaid |
$191.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.46
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$473.89
|
| Rate for Payer: Healthspan PPO |
$417.78
|
| Rate for Payer: Humana Medicaid |
$191.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.94
|
| Rate for Payer: Molina Healthcare Passport |
$191.12
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.17
|
| Rate for Payer: UHCCP Medicaid |
$193.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.05
|
|
|
EXCISION OF TONGUE LESION(T
|
Facility
|
OP
|
$5,762.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
761T1656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,981.55 |
| Max. Negotiated Rate |
$5,531.52 |
| Rate for Payer: Aetna Commercial |
$4,436.74
|
| Rate for Payer: Anthem Medicaid |
$1,981.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,494.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,881.00
|
| Rate for Payer: Cash Price |
$2,881.00
|
| Rate for Payer: Cigna Commercial |
$4,782.46
|
| Rate for Payer: First Health Commercial |
$5,473.90
|
| Rate for Payer: Humana Commercial |
$4,897.70
|
| Rate for Payer: Humana KY Medicaid |
$1,981.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,001.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,724.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,252.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,021.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,070.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,321.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,012.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,975.78
|
| Rate for Payer: PHCS Commercial |
$5,531.52
|
| Rate for Payer: United Healthcare All Payer |
$5,070.56
|
|
|
EXCISION OF TONGUE LESION(T
|
Facility
|
IP
|
$5,762.00
|
|
|
Service Code
|
HCPCS 41113
|
| Hospital Charge Code |
761T1656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,728.60 |
| Max. Negotiated Rate |
$5,531.52 |
| Rate for Payer: Aetna Commercial |
$4,436.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,494.36
|
| Rate for Payer: Cash Price |
$2,881.00
|
| Rate for Payer: Cigna Commercial |
$4,782.46
|
| Rate for Payer: First Health Commercial |
$5,473.90
|
| Rate for Payer: Humana Commercial |
$4,897.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,724.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,252.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,728.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,070.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,321.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,012.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,975.78
|
| Rate for Payer: PHCS Commercial |
$5,531.52
|
| Rate for Payer: United Healthcare All Payer |
$5,070.56
|
|
|
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE
|
Facility
|
OP
|
$6,576.02
|
|
|
Service Code
|
CPT 53230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,697.16 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
|
|
EXCISION OF UVULA
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
76101673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,479.46 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,312.54
|
| Rate for Payer: Anthem Medicaid |
$1,479.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,355.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna Commercial |
$3,570.66
|
| Rate for Payer: First Health Commercial |
$4,086.90
|
| Rate for Payer: Humana Commercial |
$3,656.70
|
| Rate for Payer: Humana KY Medicaid |
$1,479.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,494.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,527.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,174.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,785.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,742.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,968.38
|
| Rate for Payer: PHCS Commercial |
$4,129.92
|
| Rate for Payer: United Healthcare All Payer |
$3,785.76
|
|
|
EXCISION OF UVULA
|
Professional
|
Both
|
$4,302.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
76101673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$2,581.20 |
| Rate for Payer: Aetna Commercial |
$217.44
|
| Rate for Payer: Ambetter Exchange |
$152.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.90
|
| Rate for Payer: Anthem Medicaid |
$85.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.11
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna Commercial |
$213.77
|
| Rate for Payer: Healthspan PPO |
$283.12
|
| Rate for Payer: Humana Medicaid |
$85.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$199.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.74
|
| Rate for Payer: Molina Healthcare Passport |
$85.04
|
| Rate for Payer: Multiplan PHCS |
$2,581.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.37
|
| Rate for Payer: UHCCP Medicaid |
$98.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.59
|
|
|
EXCISION OF UVULA
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
76101673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.60 |
| Max. Negotiated Rate |
$4,129.92 |
| Rate for Payer: Aetna Commercial |
$3,312.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,355.56
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna Commercial |
$3,570.66
|
| Rate for Payer: First Health Commercial |
$4,086.90
|
| Rate for Payer: Humana Commercial |
$3,656.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,527.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,174.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,785.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,742.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,968.38
|
| Rate for Payer: PHCS Commercial |
$4,129.92
|
| Rate for Payer: United Healthcare All Payer |
$3,785.76
|
|
|
EXCISION OF UVULA(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
761P1673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$217.44
|
| Rate for Payer: Ambetter Exchange |
$152.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.90
|
| Rate for Payer: Anthem Medicaid |
$85.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.11
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$213.77
|
| Rate for Payer: Healthspan PPO |
$283.12
|
| Rate for Payer: Humana Medicaid |
$85.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$199.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.74
|
| Rate for Payer: Molina Healthcare Passport |
$85.04
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.37
|
| Rate for Payer: UHCCP Medicaid |
$98.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.59
|
|
|
EXCISION OF UVULA(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
761T1673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| 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 |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
EXCISION OF UVULA(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
761T1673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
EXCISION OF VAGINAL CYST OR TUMOR
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 57135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 55530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
EXCISION, OLECRANON BURSA
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 24105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
EXCISION, OLECRANON BURSA
|
Facility
|
OP
|
$7,291.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
76100508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,507.37 |
| Max. Negotiated Rate |
$6,999.36 |
| Rate for Payer: Aetna Commercial |
$5,614.07
|
| Rate for Payer: Anthem Medicaid |
$2,507.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$3,645.50
|
| Rate for Payer: Cash Price |
$3,645.50
|
| Rate for Payer: Cigna Commercial |
$6,051.53
|
| Rate for Payer: First Health Commercial |
$6,926.45
|
| Rate for Payer: Humana Commercial |
$6,197.35
|
| Rate for Payer: Humana KY Medicaid |
$2,507.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,416.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,468.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,343.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.79
|
| Rate for Payer: PHCS Commercial |
$6,999.36
|
| Rate for Payer: United Healthcare All Payer |
$6,416.08
|
|
|
EXCISION, OLECRANON BURSA
|
Professional
|
Both
|
$7,291.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
76100508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.08 |
| Max. Negotiated Rate |
$4,374.60 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Ambetter Exchange |
$344.72
|
| Rate for Payer: Anthem Medicaid |
$217.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.66
|
| Rate for Payer: Cash Price |
$3,645.50
|
| Rate for Payer: Cash Price |
$3,645.50
|
| Rate for Payer: Cigna Commercial |
$527.38
|
| Rate for Payer: Healthspan PPO |
$432.42
|
| Rate for Payer: Humana Medicaid |
$217.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$418.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.42
|
| Rate for Payer: Molina Healthcare Passport |
$217.08
|
| Rate for Payer: Multiplan PHCS |
$4,374.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.14
|
| Rate for Payer: UHCCP Medicaid |
$2,551.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.72
|
|
|
EXCISION, OLECRANON BURSA
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
76100508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
