|
EXCISION - PRESSURE ULCER
|
Facility
|
OP
|
$5,435.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,218.01 |
| Rate for Payer: Aetna Commercial |
$4,185.28
|
| Rate for Payer: Anthem Medicaid |
$1,869.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,239.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cash Price |
$2,717.72
|
| Rate for Payer: Cigna Commercial |
$4,511.41
|
| Rate for Payer: First Health Commercial |
$5,163.66
|
| Rate for Payer: Humana Commercial |
$4,620.12
|
| Rate for Payer: Humana KY Medicaid |
$1,869.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,888.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,457.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,011.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,906.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,783.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,076.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,348.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,728.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,750.45
|
| Rate for Payer: PHCS Commercial |
$5,218.01
|
| Rate for Payer: United Healthcare All Payer |
$4,783.18
|
|
|
EXCISION - PRESSURE ULCER(P
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761P0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.95 |
| Max. Negotiated Rate |
$820.76 |
| Rate for Payer: Aetna Commercial |
$820.76
|
| Rate for Payer: Ambetter Exchange |
$599.71
|
| Rate for Payer: Anthem Medicaid |
$294.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$599.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$719.65
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$777.59
|
| Rate for Payer: Healthspan PPO |
$656.27
|
| Rate for Payer: Humana Medicaid |
$294.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$709.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$599.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.95
|
| Rate for Payer: Molina Healthcare Passport |
$294.07
|
| Rate for Payer: Multiplan PHCS |
$466.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$779.62
|
| Rate for Payer: UHCCP Medicaid |
$271.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$599.71
|
|
|
EXCISION - PRESSURE ULCER(T
|
Facility
|
OP
|
$4,658.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761T0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,472.09 |
| Rate for Payer: Aetna Commercial |
$3,586.99
|
| Rate for Payer: Anthem Medicaid |
$1,602.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cigna Commercial |
$3,866.50
|
| Rate for Payer: First Health Commercial |
$4,425.51
|
| Rate for Payer: Humana Commercial |
$3,959.67
|
| Rate for Payer: Humana KY Medicaid |
$1,602.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,618.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,819.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,437.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,634.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,493.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,726.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,052.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,214.32
|
| Rate for Payer: PHCS Commercial |
$4,472.09
|
| Rate for Payer: United Healthcare All Payer |
$4,099.42
|
|
|
EXCISION - PRESSURE ULCER(T
|
Facility
|
IP
|
$4,658.43
|
|
|
Service Code
|
HCPCS 15950
|
| Hospital Charge Code |
761T0239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,397.53 |
| Max. Negotiated Rate |
$4,472.09 |
| Rate for Payer: Aetna Commercial |
$3,586.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.58
|
| Rate for Payer: Cash Price |
$2,329.22
|
| Rate for Payer: Cigna Commercial |
$3,866.50
|
| Rate for Payer: First Health Commercial |
$4,425.51
|
| Rate for Payer: Humana Commercial |
$3,959.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,819.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,437.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,493.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,726.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,052.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,214.32
|
| Rate for Payer: PHCS Commercial |
$4,472.09
|
| Rate for Payer: United Healthcare All Payer |
$4,099.42
|
|
|
EXCISION, RADIAL HEAD
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
EXCISION, RADIAL HEAD
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$807.26 |
| Rate for Payer: Aetna Commercial |
$729.45
|
| Rate for Payer: Ambetter Exchange |
$491.40
|
| Rate for Payer: Anthem Medicaid |
$381.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$491.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$589.68
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$807.26
|
| Rate for Payer: Healthspan PPO |
$660.72
|
| Rate for Payer: Humana Medicaid |
$381.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$491.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Molina Healthcare Passport |
$381.37
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$638.82
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$491.40
|
|
|
EXCISION, RADIAL HEAD
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.56 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| 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 |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
EXCISION, RADIAL HEAD(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 24130
|
| Hospital Charge Code |
761P0510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$807.26 |
| Rate for Payer: Aetna Commercial |
$729.45
|
| Rate for Payer: Ambetter Exchange |
$491.40
|
| Rate for Payer: Anthem Medicaid |
$381.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$491.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$589.68
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$807.26
|
| Rate for Payer: Healthspan PPO |
$660.72
|
| Rate for Payer: Humana Medicaid |
$381.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$491.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Molina Healthcare Passport |
$381.37
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$638.82
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$491.40
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Professional
|
Both
|
$5,022.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$3,013.20 |
| Rate for Payer: Aetna Commercial |
$502.39
|
| Rate for Payer: Ambetter Exchange |
$299.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.31
|
| Rate for Payer: Anthem Medicaid |
$197.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$299.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.65
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cigna Commercial |
$545.16
|
| Rate for Payer: Healthspan PPO |
$569.46
|
| Rate for Payer: Humana Medicaid |
$197.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$299.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.87
|
| Rate for Payer: Molina Healthcare Passport |
$197.91
|
| Rate for Payer: Multiplan PHCS |
$3,013.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$389.62
|
| Rate for Payer: UHCCP Medicaid |
$170.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$299.71
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Facility
|
OP
|
$5,022.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,821.12 |
| Rate for Payer: Aetna Commercial |
$3,866.94
|
| Rate for Payer: Anthem Medicaid |
$1,727.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cigna Commercial |
$4,168.26
|
| Rate for Payer: First Health Commercial |
$4,770.90
|
| Rate for Payer: Humana Commercial |
$4,268.70
|
| Rate for Payer: Humana KY Medicaid |
$1,727.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,744.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,761.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,017.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,369.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,465.18
|
| Rate for Payer: PHCS Commercial |
$4,821.12
|
| Rate for Payer: United Healthcare All Payer |
$4,419.36
|
|
|
EXCISION - SKIN - SUBCUTANEO
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
76100813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.60 |
| Max. Negotiated Rate |
$4,821.12 |
| Rate for Payer: Aetna Commercial |
$3,866.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,917.16
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cigna Commercial |
$4,168.26
|
| Rate for Payer: First Health Commercial |
$4,770.90
|
| Rate for Payer: Humana Commercial |
$4,268.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,118.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,706.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,419.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,766.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,017.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,369.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,465.18
|
| Rate for Payer: PHCS Commercial |
$4,821.12
|
| Rate for Payer: United Healthcare All Payer |
$4,419.36
|
|
|
EXCISION - SKIN - SUBCUTANEO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
761P0813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$569.46 |
| Rate for Payer: Aetna Commercial |
$502.39
|
| Rate for Payer: Ambetter Exchange |
$299.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.31
|
| Rate for Payer: Anthem Medicaid |
$197.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$299.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.65
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$545.16
|
| Rate for Payer: Healthspan PPO |
$569.46
|
| Rate for Payer: Humana Medicaid |
$197.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$299.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.87
|
| Rate for Payer: Molina Healthcare Passport |
$197.91
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$389.62
|
| Rate for Payer: UHCCP Medicaid |
$170.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$299.71
|
|
|
EXCISION - SKIN - SUBCUTANEO(T
|
Facility
|
IP
|
$4,272.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
761T0813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$4,101.12 |
| Rate for Payer: Aetna Commercial |
$3,289.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.16
|
| Rate for Payer: Cash Price |
$2,136.00
|
| Rate for Payer: Cigna Commercial |
$3,545.76
|
| Rate for Payer: First Health Commercial |
$4,058.40
|
| Rate for Payer: Humana Commercial |
$3,631.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.68
|
| Rate for Payer: PHCS Commercial |
$4,101.12
|
| Rate for Payer: United Healthcare All Payer |
$3,759.36
|
|
|
EXCISION - SKIN - SUBCUTANEO(T
|
Facility
|
OP
|
$4,272.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
761T0813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,469.14 |
| Max. Negotiated Rate |
$4,101.12 |
| Rate for Payer: Aetna Commercial |
$3,289.44
|
| Rate for Payer: Anthem Medicaid |
$1,469.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,136.00
|
| Rate for Payer: Cash Price |
$2,136.00
|
| Rate for Payer: Cigna Commercial |
$3,545.76
|
| Rate for Payer: First Health Commercial |
$4,058.40
|
| Rate for Payer: Humana Commercial |
$3,631.20
|
| Rate for Payer: Humana KY Medicaid |
$1,469.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,498.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.68
|
| Rate for Payer: PHCS Commercial |
$4,101.12
|
| Rate for Payer: United Healthcare All Payer |
$3,759.36
|
|
|
EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 27062
|
|
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 TUMOR NECK
|
Facility
|
OP
|
$5,889.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,653.44 |
| Rate for Payer: Aetna Commercial |
$4,534.53
|
| Rate for Payer: Anthem Medicaid |
$2,025.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,593.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,944.50
|
| Rate for Payer: Cash Price |
$2,944.50
|
| Rate for Payer: Cigna Commercial |
$4,887.87
|
| Rate for Payer: First Health Commercial |
$5,594.55
|
| Rate for Payer: Humana Commercial |
$5,005.65
|
| Rate for Payer: Humana KY Medicaid |
$2,025.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,045.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,828.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,346.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,065.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,182.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,711.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,123.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,063.41
|
| Rate for Payer: PHCS Commercial |
$5,653.44
|
| Rate for Payer: United Healthcare All Payer |
$5,182.32
|
|
|
EXCISION TUMOR NECK
|
Professional
|
Both
|
$5,889.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$3,533.40 |
| Rate for Payer: Aetna Commercial |
$476.92
|
| Rate for Payer: Ambetter Exchange |
$292.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.81
|
| Rate for Payer: Anthem Medicaid |
$169.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$292.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$292.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$350.62
|
| Rate for Payer: Cash Price |
$2,944.50
|
| Rate for Payer: Cash Price |
$2,944.50
|
| Rate for Payer: Cigna Commercial |
$502.77
|
| Rate for Payer: Healthspan PPO |
$543.97
|
| Rate for Payer: Humana Medicaid |
$169.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.39
|
| Rate for Payer: Molina Healthcare Passport |
$169.01
|
| Rate for Payer: Multiplan PHCS |
$3,533.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$379.83
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$292.18
|
|
|
EXCISION TUMOR NECK
|
Facility
|
IP
|
$5,889.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,766.70 |
| Max. Negotiated Rate |
$5,653.44 |
| Rate for Payer: Aetna Commercial |
$4,534.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,593.42
|
| Rate for Payer: Cash Price |
$2,944.50
|
| Rate for Payer: Cigna Commercial |
$4,887.87
|
| Rate for Payer: First Health Commercial |
$5,594.55
|
| Rate for Payer: Humana Commercial |
$5,005.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,828.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,346.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,766.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,182.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,711.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,123.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,063.41
|
| Rate for Payer: PHCS Commercial |
$5,653.44
|
| Rate for Payer: United Healthcare All Payer |
$5,182.32
|
|
|
EXCISION TUMOR NECK
|
Professional
|
Both
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.41 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$595.01
|
| Rate for Payer: Ambetter Exchange |
$503.17
|
| Rate for Payer: Anthem Medicaid |
$272.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$603.80
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$633.67
|
| Rate for Payer: Healthspan PPO |
$538.95
|
| Rate for Payer: Humana Medicaid |
$272.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.86
|
| Rate for Payer: Molina Healthcare Passport |
$272.41
|
| Rate for Payer: Multiplan PHCS |
$4,267.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.12
|
| Rate for Payer: UHCCP Medicaid |
$2,489.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.17
|
|
|
EXCISION TUMOR NECK
|
Facility
|
OP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,445.82 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem Medicaid |
$2,445.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| 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 |
$3,556.00
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Humana KY Medicaid |
$2,445.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,187.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,907.28
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
EXCISION TUMOR NECK
|
Facility
|
IP
|
$7,112.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
76100396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,133.60 |
| Max. Negotiated Rate |
$6,827.52 |
| Rate for Payer: Aetna Commercial |
$5,476.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,547.36
|
| Rate for Payer: Cash Price |
$3,556.00
|
| Rate for Payer: Cigna Commercial |
$5,902.96
|
| Rate for Payer: First Health Commercial |
$6,756.40
|
| Rate for Payer: Humana Commercial |
$6,045.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,831.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,248.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,258.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,334.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,187.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,907.28
|
| Rate for Payer: PHCS Commercial |
$6,827.52
|
| Rate for Payer: United Healthcare All Payer |
$6,258.56
|
|
|
EXCISION TUMOR NECK(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761P0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.41 |
| Max. Negotiated Rate |
$654.12 |
| Rate for Payer: Aetna Commercial |
$595.01
|
| Rate for Payer: Ambetter Exchange |
$503.17
|
| Rate for Payer: Anthem Medicaid |
$272.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$603.80
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$633.67
|
| Rate for Payer: Healthspan PPO |
$538.95
|
| Rate for Payer: Humana Medicaid |
$272.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.86
|
| Rate for Payer: Molina Healthcare Passport |
$272.41
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.12
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.17
|
|
|
EXCISION TUMOR NECK(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761P0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$543.97 |
| Rate for Payer: Aetna Commercial |
$476.92
|
| Rate for Payer: Ambetter Exchange |
$292.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.81
|
| Rate for Payer: Anthem Medicaid |
$169.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$292.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$292.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$350.62
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$502.77
|
| Rate for Payer: Healthspan PPO |
$543.97
|
| Rate for Payer: Humana Medicaid |
$169.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.39
|
| Rate for Payer: Molina Healthcare Passport |
$169.01
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$379.83
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$292.18
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
IP
|
$6,262.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761T0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,878.60 |
| Max. Negotiated Rate |
$6,011.52 |
| Rate for Payer: Aetna Commercial |
$4,821.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,884.36
|
| Rate for Payer: Cash Price |
$3,131.00
|
| Rate for Payer: Cigna Commercial |
$5,197.46
|
| Rate for Payer: First Health Commercial |
$5,948.90
|
| Rate for Payer: Humana Commercial |
$5,322.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,134.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,621.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,878.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,510.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,696.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,447.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,320.78
|
| Rate for Payer: PHCS Commercial |
$6,011.52
|
| Rate for Payer: United Healthcare All Payer |
$5,510.56
|
|
|
EXCISION TUMOR NECK(T
|
Facility
|
IP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761T0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.70 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$4,306.87
|
| Rate for Payer: First Health Commercial |
$4,929.55
|
| Rate for Payer: Humana Commercial |
$4,410.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,254.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,829.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,566.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,514.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,580.41
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
