|
EXC NASAL POLYP
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
76101121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.37 |
| Max. Negotiated Rate |
$599.43 |
| Rate for Payer: Aetna Commercial |
$599.43
|
| Rate for Payer: Ambetter Exchange |
$428.11
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$428.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.73
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$585.04
|
| Rate for Payer: Healthspan PPO |
$505.51
|
| Rate for Payer: Humana Medicaid |
$207.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$539.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$428.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$428.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.52
|
| Rate for Payer: Molina Healthcare Passport |
$207.37
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$556.54
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.11
|
|
|
EXC NASAL POLYP(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
761P1121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.37 |
| Max. Negotiated Rate |
$599.43 |
| Rate for Payer: Aetna Commercial |
$599.43
|
| Rate for Payer: Ambetter Exchange |
$428.11
|
| Rate for Payer: Anthem Medicaid |
$207.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$428.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.73
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$585.04
|
| Rate for Payer: Healthspan PPO |
$505.51
|
| Rate for Payer: Humana Medicaid |
$207.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$539.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$428.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$428.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.52
|
| Rate for Payer: Molina Healthcare Passport |
$207.37
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$556.54
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.11
|
|
|
EXC NECK LES SC = 3 CM
|
Facility
|
IP
|
$6,834.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,050.20 |
| Max. Negotiated Rate |
$6,560.64 |
| Rate for Payer: Aetna Commercial |
$5,262.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,330.52
|
| Rate for Payer: Cash Price |
$3,417.00
|
| Rate for Payer: Cigna Commercial |
$5,672.22
|
| Rate for Payer: First Health Commercial |
$6,492.30
|
| Rate for Payer: Humana Commercial |
$5,808.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,603.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,043.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,050.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,013.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,125.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,945.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,715.46
|
| Rate for Payer: PHCS Commercial |
$6,560.64
|
| Rate for Payer: United Healthcare All Payer |
$6,013.92
|
|
|
EXC NECK LES SC = 3 CM
|
Facility
|
OP
|
$6,834.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,350.21 |
| Max. Negotiated Rate |
$6,560.64 |
| Rate for Payer: Aetna Commercial |
$5,262.18
|
| Rate for Payer: Anthem Medicaid |
$2,350.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,330.52
|
| 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 |
$3,417.00
|
| Rate for Payer: Cash Price |
$3,417.00
|
| Rate for Payer: Cigna Commercial |
$5,672.22
|
| Rate for Payer: First Health Commercial |
$6,492.30
|
| Rate for Payer: Humana Commercial |
$5,808.90
|
| Rate for Payer: Humana KY Medicaid |
$2,350.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,374.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,603.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,043.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,397.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,013.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,125.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,945.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,715.46
|
| Rate for Payer: PHCS Commercial |
$6,560.64
|
| Rate for Payer: United Healthcare All Payer |
$6,013.92
|
|
|
EXC NECK LES SC = 3 CM
|
Professional
|
Both
|
$6,834.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.14 |
| Max. Negotiated Rate |
$4,100.40 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Ambetter Exchange |
$427.13
|
| Rate for Payer: Anthem Medicaid |
$325.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.56
|
| Rate for Payer: Cash Price |
$3,417.00
|
| Rate for Payer: Cash Price |
$3,417.00
|
| Rate for Payer: Cigna Commercial |
$786.92
|
| Rate for Payer: Healthspan PPO |
$492.32
|
| Rate for Payer: Humana Medicaid |
$325.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.64
|
| Rate for Payer: Molina Healthcare Passport |
$325.14
|
| Rate for Payer: Multiplan PHCS |
$4,100.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.27
|
| Rate for Payer: UHCCP Medicaid |
$2,391.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.13
|
|
|
EXC NECK LES SC = 3 CM(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761P0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$786.92 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Ambetter Exchange |
$427.13
|
| Rate for Payer: Anthem Medicaid |
$325.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.56
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$786.92
|
| Rate for Payer: Healthspan PPO |
$492.32
|
| Rate for Payer: Humana Medicaid |
$325.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.64
|
| Rate for Payer: Molina Healthcare Passport |
$325.14
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.27
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.13
|
|
|
EXC NECK LES SC = 3 CM(T
|
Facility
|
OP
|
$6,054.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761T0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,081.97 |
| Max. Negotiated Rate |
$5,811.84 |
| Rate for Payer: Aetna Commercial |
$4,661.58
|
| Rate for Payer: Anthem Medicaid |
$2,081.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,722.12
|
| 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 |
$3,027.00
|
| Rate for Payer: Cash Price |
$3,027.00
|
| Rate for Payer: Cigna Commercial |
$5,024.82
|
| Rate for Payer: First Health Commercial |
$5,751.30
|
| Rate for Payer: Humana Commercial |
$5,145.90
|
| Rate for Payer: Humana KY Medicaid |
$2,081.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,103.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,467.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,123.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,327.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,540.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,266.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,177.26
|
| Rate for Payer: PHCS Commercial |
$5,811.84
|
| Rate for Payer: United Healthcare All Payer |
$5,327.52
|
|
|
EXC NECK LES SC = 3 CM(T
|
Facility
|
IP
|
$6,054.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
761T0393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,816.20 |
| Max. Negotiated Rate |
$5,811.84 |
| Rate for Payer: Aetna Commercial |
$4,661.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,722.12
|
| Rate for Payer: Cash Price |
$3,027.00
|
| Rate for Payer: Cigna Commercial |
$5,024.82
|
| Rate for Payer: First Health Commercial |
$5,751.30
|
| Rate for Payer: Humana Commercial |
$5,145.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,467.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,816.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,327.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,540.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,266.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,177.26
|
| Rate for Payer: PHCS Commercial |
$5,811.84
|
| Rate for Payer: United Healthcare All Payer |
$5,327.52
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Professional
|
Both
|
$8,817.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.14 |
| Max. Negotiated Rate |
$5,290.20 |
| Rate for Payer: Aetna Commercial |
$1,135.19
|
| Rate for Payer: Ambetter Exchange |
$696.79
|
| Rate for Payer: Anthem Medicaid |
$535.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$696.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$696.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$836.15
|
| Rate for Payer: Cash Price |
$4,408.50
|
| Rate for Payer: Cash Price |
$4,408.50
|
| Rate for Payer: Cigna Commercial |
$1,293.32
|
| Rate for Payer: Healthspan PPO |
$809.97
|
| Rate for Payer: Humana Medicaid |
$535.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$936.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$696.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$696.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.84
|
| Rate for Payer: Molina Healthcare Passport |
$535.14
|
| Rate for Payer: Multiplan PHCS |
$5,290.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$905.83
|
| Rate for Payer: UHCCP Medicaid |
$3,085.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$696.79
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
IP
|
$8,817.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,645.10 |
| Max. Negotiated Rate |
$8,464.32 |
| Rate for Payer: Aetna Commercial |
$6,789.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,877.26
|
| Rate for Payer: Cash Price |
$4,408.50
|
| Rate for Payer: Cigna Commercial |
$7,318.11
|
| Rate for Payer: First Health Commercial |
$8,376.15
|
| Rate for Payer: Humana Commercial |
$7,494.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,645.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.73
|
| Rate for Payer: PHCS Commercial |
$8,464.32
|
| Rate for Payer: United Healthcare All Payer |
$7,758.96
|
|
|
EXC NECK TUM DEEP 5 CM/>
|
Facility
|
OP
|
$8,817.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$8,464.32 |
| Rate for Payer: Aetna Commercial |
$6,789.09
|
| Rate for Payer: Anthem Medicaid |
$3,032.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,877.26
|
| 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 |
$4,408.50
|
| Rate for Payer: Cash Price |
$4,408.50
|
| Rate for Payer: Cigna Commercial |
$7,318.11
|
| Rate for Payer: First Health Commercial |
$8,376.15
|
| Rate for Payer: Humana Commercial |
$7,494.45
|
| Rate for Payer: Humana KY Medicaid |
$3,032.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,063.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,229.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,093.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,758.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,612.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,670.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,083.73
|
| Rate for Payer: PHCS Commercial |
$8,464.32
|
| Rate for Payer: United Healthcare All Payer |
$7,758.96
|
|
|
EXC NECK TUM DEEP 5 CM/>(P
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761P0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.25 |
| Max. Negotiated Rate |
$1,293.32 |
| Rate for Payer: Aetna Commercial |
$1,135.19
|
| Rate for Payer: Ambetter Exchange |
$696.79
|
| Rate for Payer: Anthem Medicaid |
$535.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$696.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$696.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$836.15
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$1,293.32
|
| Rate for Payer: Healthspan PPO |
$809.97
|
| Rate for Payer: Humana Medicaid |
$535.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$936.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$696.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$696.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.84
|
| Rate for Payer: Molina Healthcare Passport |
$535.14
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$905.83
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$696.79
|
|
|
EXC NECK TUM DEEP 5 CM/>(T
|
Facility
|
OP
|
$7,642.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761T0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,628.08 |
| Max. Negotiated Rate |
$7,336.32 |
| Rate for Payer: Aetna Commercial |
$5,884.34
|
| Rate for Payer: Anthem Medicaid |
$2,628.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,960.76
|
| 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 |
$3,821.00
|
| Rate for Payer: Cash Price |
$3,821.00
|
| Rate for Payer: Cigna Commercial |
$6,342.86
|
| Rate for Payer: First Health Commercial |
$7,259.90
|
| Rate for Payer: Humana Commercial |
$6,495.70
|
| Rate for Payer: Humana KY Medicaid |
$2,628.08
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,654.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,266.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,639.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,680.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,724.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,731.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,648.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,272.98
|
| Rate for Payer: PHCS Commercial |
$7,336.32
|
| Rate for Payer: United Healthcare All Payer |
$6,724.96
|
|
|
EXC NECK TUM DEEP 5 CM/>(T
|
Facility
|
IP
|
$7,642.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
761T0394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,292.60 |
| Max. Negotiated Rate |
$7,336.32 |
| Rate for Payer: Aetna Commercial |
$5,884.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,960.76
|
| Rate for Payer: Cash Price |
$3,821.00
|
| Rate for Payer: Cigna Commercial |
$6,342.86
|
| Rate for Payer: First Health Commercial |
$7,259.90
|
| Rate for Payer: Humana Commercial |
$6,495.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,266.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,639.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,292.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,724.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,731.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,648.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,272.98
|
| Rate for Payer: PHCS Commercial |
$7,336.32
|
| Rate for Payer: United Healthcare All Payer |
$6,724.96
|
|
|
EXC OF CHALAZION; SINGLE
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.21 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem Medicaid |
$409.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Humana KY Medicaid |
$409.58
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$413.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.79
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
EXC OF CHALAZION; SINGLE
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$714.60 |
| Rate for Payer: Aetna Commercial |
$137.14
|
| Rate for Payer: Ambetter Exchange |
$94.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.52
|
| Rate for Payer: Anthem Medicaid |
$66.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.64
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$164.88
|
| Rate for Payer: Healthspan PPO |
$145.86
|
| Rate for Payer: Humana Medicaid |
$66.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.36
|
| Rate for Payer: Molina Healthcare Passport |
$66.04
|
| Rate for Payer: Multiplan PHCS |
$714.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.11
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.70
|
|
|
EXC OF CHALAZION; SINGLE
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
76102389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.79
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
EXC OF CHALAZION; SINGLE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761P2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$137.14
|
| Rate for Payer: Ambetter Exchange |
$94.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.52
|
| Rate for Payer: Anthem Medicaid |
$66.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.64
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$164.88
|
| Rate for Payer: Healthspan PPO |
$145.86
|
| Rate for Payer: Humana Medicaid |
$66.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.36
|
| Rate for Payer: Molina Healthcare Passport |
$66.04
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.11
|
| Rate for Payer: UHCCP Medicaid |
$54.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.70
|
|
|
EXC OF CHALAZION; SINGLE(T
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761T2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.21 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem Medicaid |
$306.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Humana KY Medicaid |
$306.41
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$309.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.79
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
EXC OF CHALAZION; SINGLE(T
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
HCPCS 67800
|
| Hospital Charge Code |
761T2389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$855.36 |
| Rate for Payer: Aetna Commercial |
$686.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.98
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$739.53
|
| Rate for Payer: First Health Commercial |
$846.45
|
| Rate for Payer: Humana Commercial |
$757.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$730.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$657.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$784.08
|
| Rate for Payer: Ohio Health Group HMO |
$668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$775.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.79
|
| Rate for Payer: PHCS Commercial |
$855.36
|
| Rate for Payer: United Healthcare All Payer |
$784.08
|
|
|
EXC OF CHEST WALL TUMOR
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
76100291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
EXC OF CHEST WALL TUMOR
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 21601
|
| Hospital Charge Code |
76100291
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
EXC OF CYST OR ADENOMA
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXC OF CYST OR ADENOMA
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$951.75 |
| Rate for Payer: Aetna Commercial |
$951.75
|
| Rate for Payer: Ambetter Exchange |
$634.42
|
| Rate for Payer: Anthem Medicaid |
$445.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$761.30
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$903.12
|
| Rate for Payer: Healthspan PPO |
$802.63
|
| Rate for Payer: Humana Medicaid |
$445.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$634.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.76
|
| Rate for Payer: Molina Healthcare Passport |
$445.84
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$824.75
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.42
|
|
|
EXC OF CYST OR ADENOMA
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
76102270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
