|
EXCISION TUMOR NECK(T
|
Facility
|
OP
|
$6,262.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
761T0396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,153.50 |
| Max. Negotiated Rate |
$6,011.52 |
| Rate for Payer: Aetna Commercial |
$4,821.74
|
| Rate for Payer: Anthem Medicaid |
$2,153.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,884.36
|
| 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 |
$3,131.00
|
| 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: Humana KY Medicaid |
$2,153.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,175.42
|
| 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 |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,196.71
|
| 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
|
OP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
761T0395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem Medicaid |
$1,784.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| 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 |
$2,594.50
|
| 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: Humana KY Medicaid |
$1,784.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.66
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.30
|
| 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
|
|
|
EXCISION - TUMOR - PELVIS AN
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
EXCISION - TUMOR - PELVIS AN
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
EXCISION - TUMOR - PELVIS AN
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
76100769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Ambetter Exchange |
$586.28
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$586.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$586.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$703.54
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$742.08
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$303.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$740.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$586.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.39
|
| Rate for Payer: Molina Healthcare Passport |
$303.32
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$762.16
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$306.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$586.28
|
|
|
EXCISION - TUMOR - PELVIS AN(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27048
|
| Hospital Charge Code |
761P0769
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Ambetter Exchange |
$586.28
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$586.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$586.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$703.54
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$742.08
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$303.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$740.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$586.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.39
|
| Rate for Payer: Molina Healthcare Passport |
$303.32
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$762.16
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$306.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$586.28
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Professional
|
Both
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.67 |
| Max. Negotiated Rate |
$3,765.00 |
| Rate for Payer: Aetna Commercial |
$819.60
|
| Rate for Payer: Ambetter Exchange |
$520.38
|
| Rate for Payer: Anthem Medicaid |
$319.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$520.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$624.46
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$881.75
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$319.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$670.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$520.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.06
|
| Rate for Payer: Molina Healthcare Passport |
$319.67
|
| Rate for Payer: Multiplan PHCS |
$3,765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$676.49
|
| Rate for Payer: UHCCP Medicaid |
$2,196.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$322.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$520.38
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Facility
|
IP
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$6,024.00 |
| Rate for Payer: Aetna Commercial |
$4,831.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,894.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$5,208.25
|
| Rate for Payer: First Health Commercial |
$5,961.25
|
| Rate for Payer: Humana Commercial |
$5,333.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,145.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,630.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,882.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,522.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,459.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,329.75
|
| Rate for Payer: PHCS Commercial |
$6,024.00
|
| Rate for Payer: United Healthcare All Payer |
$5,522.00
|
|
|
EXCISION TUMOR SHOULDER DEEP
|
Facility
|
OP
|
$6,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,157.97 |
| Max. Negotiated Rate |
$6,024.00 |
| Rate for Payer: Aetna Commercial |
$4,831.75
|
| Rate for Payer: Anthem Medicaid |
$2,157.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,894.50
|
| 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 |
$3,137.50
|
| Rate for Payer: Cash Price |
$3,137.50
|
| Rate for Payer: Cigna Commercial |
$5,208.25
|
| Rate for Payer: First Health Commercial |
$5,961.25
|
| Rate for Payer: Humana Commercial |
$5,333.75
|
| Rate for Payer: Humana KY Medicaid |
$2,157.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,179.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,145.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,630.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,201.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,522.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,459.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,329.75
|
| Rate for Payer: PHCS Commercial |
$6,024.00
|
| Rate for Payer: United Healthcare All Payer |
$5,522.00
|
|
|
EXCISION TUMOR SHOULDER DEEP(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761P0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.67 |
| Max. Negotiated Rate |
$881.75 |
| Rate for Payer: Aetna Commercial |
$819.60
|
| Rate for Payer: Ambetter Exchange |
$520.38
|
| Rate for Payer: Anthem Medicaid |
$319.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$520.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$624.46
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$881.75
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$319.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$670.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$520.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.06
|
| Rate for Payer: Molina Healthcare Passport |
$319.67
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$676.49
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$322.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$520.38
|
|
|
EXCISION TUMOR SHOULDER DEEP(T
|
Facility
|
IP
|
$5,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761T0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,582.50 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$4,061.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.50
|
| Rate for Payer: Cash Price |
$2,637.50
|
| Rate for Payer: Cigna Commercial |
$4,378.25
|
| Rate for Payer: First Health Commercial |
$5,011.25
|
| Rate for Payer: Humana Commercial |
$4,483.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,589.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,639.75
|
| Rate for Payer: PHCS Commercial |
$5,064.00
|
| Rate for Payer: United Healthcare All Payer |
$4,642.00
|
|
|
EXCISION TUMOR SHOULDER DEEP(T
|
Facility
|
OP
|
$5,275.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
761T0440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,814.07 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$4,061.75
|
| Rate for Payer: Anthem Medicaid |
$1,814.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.50
|
| 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 |
$2,637.50
|
| Rate for Payer: Cash Price |
$2,637.50
|
| Rate for Payer: Cigna Commercial |
$4,378.25
|
| Rate for Payer: First Health Commercial |
$5,011.25
|
| Rate for Payer: Humana Commercial |
$4,483.75
|
| Rate for Payer: Humana KY Medicaid |
$1,814.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,589.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,639.75
|
| Rate for Payer: PHCS Commercial |
$5,064.00
|
| Rate for Payer: United Healthcare All Payer |
$4,642.00
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Professional
|
Both
|
$4,495.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$2,697.00 |
| Rate for Payer: Aetna Commercial |
$447.24
|
| Rate for Payer: Ambetter Exchange |
$314.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.09
|
| Rate for Payer: Anthem Medicaid |
$172.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.74
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cigna Commercial |
$602.85
|
| Rate for Payer: Healthspan PPO |
$591.75
|
| Rate for Payer: Humana Medicaid |
$172.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.28
|
| Rate for Payer: Molina Healthcare Passport |
$172.82
|
| Rate for Payer: Multiplan PHCS |
$2,697.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.21
|
| Rate for Payer: UHCCP Medicaid |
$178.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.78
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Facility
|
OP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$3,461.15
|
| Rate for Payer: Anthem Medicaid |
$1,545.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.10
|
| 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 |
$2,247.50
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cigna Commercial |
$3,730.85
|
| Rate for Payer: First Health Commercial |
$4,270.25
|
| Rate for Payer: Humana Commercial |
$3,820.75
|
| Rate for Payer: Humana KY Medicaid |
$1,545.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,561.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,685.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.55
|
| Rate for Payer: PHCS Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Payer |
$3,955.60
|
|
|
EXCISION TUMOR SOFT TIS ARM
|
Facility
|
IP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.50 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$3,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.10
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cigna Commercial |
$3,730.85
|
| Rate for Payer: First Health Commercial |
$4,270.25
|
| Rate for Payer: Humana Commercial |
$3,820.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,685.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.55
|
| Rate for Payer: PHCS Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Payer |
$3,955.60
|
|
|
EXCISION TUMOR SOFT TIS ARM(P
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761P0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$602.85 |
| Rate for Payer: Aetna Commercial |
$447.24
|
| Rate for Payer: Ambetter Exchange |
$314.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.09
|
| Rate for Payer: Anthem Medicaid |
$172.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.74
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cigna Commercial |
$602.85
|
| Rate for Payer: Healthspan PPO |
$591.75
|
| Rate for Payer: Humana Medicaid |
$172.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$401.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.28
|
| Rate for Payer: Molina Healthcare Passport |
$172.82
|
| Rate for Payer: Multiplan PHCS |
$386.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.21
|
| Rate for Payer: UHCCP Medicaid |
$178.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.78
|
|
|
EXCISION TUMOR SOFT TIS ARM(T
|
Facility
|
IP
|
$3,851.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761T0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,155.30 |
| Max. Negotiated Rate |
$3,696.96 |
| Rate for Payer: Aetna Commercial |
$2,965.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.78
|
| Rate for Payer: Cash Price |
$1,925.50
|
| Rate for Payer: Cigna Commercial |
$3,196.33
|
| Rate for Payer: First Health Commercial |
$3,658.45
|
| Rate for Payer: Humana Commercial |
$3,273.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,888.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,350.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,657.19
|
| Rate for Payer: PHCS Commercial |
$3,696.96
|
| Rate for Payer: United Healthcare All Payer |
$3,388.88
|
|
|
EXCISION TUMOR SOFT TIS ARM(T
|
Facility
|
OP
|
$3,851.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
761T0502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,324.36 |
| Max. Negotiated Rate |
$3,696.96 |
| Rate for Payer: Aetna Commercial |
$2,965.27
|
| Rate for Payer: Anthem Medicaid |
$1,324.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.78
|
| 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 |
$1,925.50
|
| Rate for Payer: Cash Price |
$1,925.50
|
| Rate for Payer: Cigna Commercial |
$3,196.33
|
| Rate for Payer: First Health Commercial |
$3,658.45
|
| Rate for Payer: Humana Commercial |
$3,273.35
|
| Rate for Payer: Humana KY Medicaid |
$1,324.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,337.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,350.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,888.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,350.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,657.19
|
| Rate for Payer: PHCS Commercial |
$3,696.96
|
| Rate for Payer: United Healthcare All Payer |
$3,388.88
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 22903
|
|
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 22902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 22901
|
|
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 22900
|
|
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, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 21931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 21930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 21933
|
|
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
|
|
