|
EXC OF CYST OR ADENOMA(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 60200
|
| Hospital Charge Code |
761P2270
|
|
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 LESION OF TONGUE
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
76101655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.87 |
| Max. Negotiated Rate |
$3,251.40 |
| Rate for Payer: Aetna Commercial |
$353.80
|
| Rate for Payer: Ambetter Exchange |
$227.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.53
|
| Rate for Payer: Anthem Medicaid |
$146.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$227.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$227.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$272.40
|
| Rate for Payer: Cash Price |
$2,709.50
|
| Rate for Payer: Cash Price |
$2,709.50
|
| Rate for Payer: Cigna Commercial |
$429.10
|
| Rate for Payer: Healthspan PPO |
$379.61
|
| Rate for Payer: Humana Medicaid |
$146.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$227.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.81
|
| Rate for Payer: Molina Healthcare Passport |
$146.87
|
| Rate for Payer: Multiplan PHCS |
$3,251.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$295.10
|
| Rate for Payer: UHCCP Medicaid |
$154.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$227.00
|
|
|
EXC OF LESION OF TONGUE
|
Facility
|
OP
|
$5,419.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
76101655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,863.59 |
| Max. Negotiated Rate |
$5,202.24 |
| Rate for Payer: Aetna Commercial |
$4,172.63
|
| Rate for Payer: Anthem Medicaid |
$1,863.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,709.50
|
| Rate for Payer: Cash Price |
$2,709.50
|
| Rate for Payer: Cigna Commercial |
$4,497.77
|
| Rate for Payer: First Health Commercial |
$5,148.05
|
| Rate for Payer: Humana Commercial |
$4,606.15
|
| Rate for Payer: Humana KY Medicaid |
$1,863.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,882.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,443.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,900.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,768.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,064.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,714.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,739.11
|
| Rate for Payer: PHCS Commercial |
$5,202.24
|
| Rate for Payer: United Healthcare All Payer |
$4,768.72
|
|
|
EXC OF LESION OF TONGUE
|
Facility
|
IP
|
$5,419.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
76101655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,625.70 |
| Max. Negotiated Rate |
$5,202.24 |
| Rate for Payer: Aetna Commercial |
$4,172.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,226.82
|
| Rate for Payer: Cash Price |
$2,709.50
|
| Rate for Payer: Cigna Commercial |
$4,497.77
|
| Rate for Payer: First Health Commercial |
$5,148.05
|
| Rate for Payer: Humana Commercial |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,443.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,768.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,064.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,714.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,739.11
|
| Rate for Payer: PHCS Commercial |
$5,202.24
|
| Rate for Payer: United Healthcare All Payer |
$4,768.72
|
|
|
EXC OF LESION OF TONGUE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761P1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.87 |
| Max. Negotiated Rate |
$429.10 |
| Rate for Payer: Aetna Commercial |
$353.80
|
| Rate for Payer: Ambetter Exchange |
$227.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.53
|
| Rate for Payer: Anthem Medicaid |
$146.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$227.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$227.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$272.40
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$429.10
|
| Rate for Payer: Healthspan PPO |
$379.61
|
| Rate for Payer: Humana Medicaid |
$146.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$227.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.81
|
| Rate for Payer: Molina Healthcare Passport |
$146.87
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$295.10
|
| Rate for Payer: UHCCP Medicaid |
$154.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$148.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$227.00
|
|
|
EXC OF LESION OF TONGUE(T
|
Facility
|
IP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761T1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,475.70 |
| Max. Negotiated Rate |
$4,722.24 |
| Rate for Payer: Aetna Commercial |
$3,787.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,836.82
|
| Rate for Payer: Cash Price |
$2,459.50
|
| Rate for Payer: Cigna Commercial |
$4,082.77
|
| Rate for Payer: First Health Commercial |
$4,673.05
|
| Rate for Payer: Humana Commercial |
$4,181.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,630.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,475.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,328.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,689.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,935.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,279.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.11
|
| Rate for Payer: PHCS Commercial |
$4,722.24
|
| Rate for Payer: United Healthcare All Payer |
$4,328.72
|
|
|
EXC OF LESION OF TONGUE(T
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 41112
|
| Hospital Charge Code |
761T1655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,691.64 |
| Max. Negotiated Rate |
$4,722.24 |
| Rate for Payer: Aetna Commercial |
$3,787.63
|
| Rate for Payer: Anthem Medicaid |
$1,691.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,836.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,459.50
|
| Rate for Payer: Cash Price |
$2,459.50
|
| Rate for Payer: Cigna Commercial |
$4,082.77
|
| Rate for Payer: First Health Commercial |
$4,673.05
|
| Rate for Payer: Humana Commercial |
$4,181.15
|
| Rate for Payer: Humana KY Medicaid |
$1,691.64
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,708.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,630.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,328.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,689.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,935.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,279.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.11
|
| Rate for Payer: PHCS Commercial |
$4,722.24
|
| Rate for Payer: United Healthcare All Payer |
$4,328.72
|
|
|
EXC OF SM OR LG INTESTINE
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.50 |
| Max. Negotiated Rate |
$1,214.37 |
| Rate for Payer: Aetna Commercial |
$1,214.37
|
| Rate for Payer: Ambetter Exchange |
$807.42
|
| Rate for Payer: Anthem Medicaid |
$508.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$807.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$807.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$968.90
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,122.20
|
| Rate for Payer: Healthspan PPO |
$1,024.10
|
| Rate for Payer: Humana Medicaid |
$508.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,080.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$807.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.67
|
| Rate for Payer: Molina Healthcare Passport |
$508.50
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,049.65
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$807.42
|
|
|
EXC OF SM OR LG INTESTINE
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXC OF SM OR LG INTESTINE
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
76101809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
EXC OF SM OR LG INTESTINE(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44110
|
| Hospital Charge Code |
761P1809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.50 |
| Max. Negotiated Rate |
$1,214.37 |
| Rate for Payer: Aetna Commercial |
$1,214.37
|
| Rate for Payer: Ambetter Exchange |
$807.42
|
| Rate for Payer: Anthem Medicaid |
$508.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$807.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$807.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$968.90
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,122.20
|
| Rate for Payer: Healthspan PPO |
$1,024.10
|
| Rate for Payer: Humana Medicaid |
$508.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,080.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$807.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.67
|
| Rate for Payer: Molina Healthcare Passport |
$508.50
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,049.65
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$807.42
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.33 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$685.57
|
| Rate for Payer: Ambetter Exchange |
$393.33
|
| Rate for Payer: Anthem Medicaid |
$432.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$671.89
|
| Rate for Payer: Healthspan PPO |
$578.15
|
| Rate for Payer: Humana Medicaid |
$432.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$604.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$440.70
|
| Rate for Payer: Molina Healthcare Passport |
$432.06
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.33
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$436.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.33
|
|
|
EXC OF SUBMANDIBULAR GLAND
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
76101691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
EXC OF SUBMANDIBULAR GLAND(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
761P1691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.33 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$685.57
|
| Rate for Payer: Ambetter Exchange |
$393.33
|
| Rate for Payer: Anthem Medicaid |
$432.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$671.89
|
| Rate for Payer: Healthspan PPO |
$578.15
|
| Rate for Payer: Humana Medicaid |
$432.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$604.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$440.70
|
| Rate for Payer: Molina Healthcare Passport |
$432.06
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.33
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$436.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.33
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Professional
|
Both
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$3,576.90 |
| Rate for Payer: Aetna Commercial |
$261.88
|
| Rate for Payer: Ambetter Exchange |
$177.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.19
|
| Rate for Payer: Anthem Medicaid |
$138.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.76
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$255.67
|
| Rate for Payer: Healthspan PPO |
$280.52
|
| Rate for Payer: Humana Medicaid |
$138.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.24
|
| Rate for Payer: Molina Healthcare Passport |
$138.47
|
| Rate for Payer: Multiplan PHCS |
$3,576.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.49
|
| Rate for Payer: UHCCP Medicaid |
$120.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.30
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Facility
|
IP
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,788.45 |
| Max. Negotiated Rate |
$5,723.04 |
| Rate for Payer: Aetna Commercial |
$4,590.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,649.97
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$4,948.05
|
| Rate for Payer: First Health Commercial |
$5,663.43
|
| Rate for Payer: Humana Commercial |
$5,067.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,788.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,769.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,186.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,113.44
|
| Rate for Payer: PHCS Commercial |
$5,723.04
|
| Rate for Payer: United Healthcare All Payer |
$5,246.12
|
|
|
EXC OF VAGINAL CYST OR TUMOR
|
Facility
|
OP
|
$5,961.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
76102173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,050.16 |
| Max. Negotiated Rate |
$5,723.04 |
| Rate for Payer: Aetna Commercial |
$4,590.35
|
| Rate for Payer: Anthem Medicaid |
$2,050.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,649.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cash Price |
$2,980.75
|
| Rate for Payer: Cigna Commercial |
$4,948.05
|
| Rate for Payer: First Health Commercial |
$5,663.43
|
| Rate for Payer: Humana Commercial |
$5,067.27
|
| Rate for Payer: Humana KY Medicaid |
$2,050.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,071.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,888.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,399.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,091.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,246.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,471.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,769.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,186.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,113.44
|
| Rate for Payer: PHCS Commercial |
$5,723.04
|
| Rate for Payer: United Healthcare All Payer |
$5,246.12
|
|
|
EXC OF VAGINAL CYST OR TUMOR(P
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761P2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna Commercial |
$261.88
|
| Rate for Payer: Ambetter Exchange |
$177.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$115.19
|
| Rate for Payer: Anthem Medicaid |
$138.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.76
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$255.67
|
| Rate for Payer: Healthspan PPO |
$280.52
|
| Rate for Payer: Humana Medicaid |
$138.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.24
|
| Rate for Payer: Molina Healthcare Passport |
$138.47
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.49
|
| Rate for Payer: UHCCP Medicaid |
$120.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.30
|
|
|
EXC OF VAGINAL CYST OR TUMOR(T
|
Facility
|
IP
|
$5,266.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761T2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,579.95 |
| Max. Negotiated Rate |
$5,055.84 |
| Rate for Payer: Aetna Commercial |
$4,055.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.87
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cigna Commercial |
$4,371.19
|
| Rate for Payer: First Health Commercial |
$5,003.18
|
| Rate for Payer: Humana Commercial |
$4,476.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,213.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,581.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.89
|
| Rate for Payer: PHCS Commercial |
$5,055.84
|
| Rate for Payer: United Healthcare All Payer |
$4,634.52
|
|
|
EXC OF VAGINAL CYST OR TUMOR(T
|
Facility
|
OP
|
$5,266.50
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
761T2173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,811.15 |
| Max. Negotiated Rate |
$5,055.84 |
| Rate for Payer: Aetna Commercial |
$4,055.20
|
| Rate for Payer: Anthem Medicaid |
$1,811.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cash Price |
$2,633.25
|
| Rate for Payer: Cigna Commercial |
$4,371.19
|
| Rate for Payer: First Health Commercial |
$5,003.18
|
| Rate for Payer: Humana Commercial |
$4,476.52
|
| Rate for Payer: Humana KY Medicaid |
$1,811.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,213.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,581.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.89
|
| Rate for Payer: PHCS Commercial |
$5,055.84
|
| Rate for Payer: United Healthcare All Payer |
$4,634.52
|
|
|
EXC - OTHER BENIGN INCL MARGI
|
Professional
|
Both
|
$3,198.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.23 |
| Max. Negotiated Rate |
$1,918.80 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Ambetter Exchange |
$137.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.23
|
| Rate for Payer: Anthem Medicaid |
$86.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.26
|
| Rate for Payer: Cash Price |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,599.00
|
| Rate for Payer: Cigna Commercial |
$242.33
|
| Rate for Payer: Healthspan PPO |
$201.13
|
| Rate for Payer: Humana Medicaid |
$86.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.84
|
| Rate for Payer: Molina Healthcare Passport |
$86.12
|
| Rate for Payer: Multiplan PHCS |
$1,918.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.04
|
| Rate for Payer: UHCCP Medicaid |
$77.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.72
|
|
|
EXC - OTHER BENIGN INCL MARGI
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$959.40 |
| Max. Negotiated Rate |
$3,070.08 |
| Rate for Payer: Aetna Commercial |
$2,462.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Cash Price |
$1,599.00
|
| Rate for Payer: Cigna Commercial |
$2,654.34
|
| Rate for Payer: First Health Commercial |
$3,038.10
|
| Rate for Payer: Humana Commercial |
$2,718.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,622.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,360.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,814.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,206.62
|
| Rate for Payer: PHCS Commercial |
$3,070.08
|
| Rate for Payer: United Healthcare All Payer |
$2,814.24
|
|
|
EXC - OTHER BENIGN INCL MARGI
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,070.08 |
| Rate for Payer: Aetna Commercial |
$2,462.46
|
| Rate for Payer: Anthem Medicaid |
$1,099.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,599.00
|
| Rate for Payer: Cigna Commercial |
$2,654.34
|
| Rate for Payer: First Health Commercial |
$3,038.10
|
| Rate for Payer: Humana Commercial |
$2,718.30
|
| Rate for Payer: Humana KY Medicaid |
$1,099.79
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,622.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,360.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,814.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,206.62
|
| Rate for Payer: PHCS Commercial |
$3,070.08
|
| Rate for Payer: United Healthcare All Payer |
$2,814.24
|
|
|
EXC - OTHER BENIGN INCL MARG(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
761P0065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.23 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Ambetter Exchange |
$137.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.23
|
| Rate for Payer: Anthem Medicaid |
$86.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.26
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$242.33
|
| Rate for Payer: Healthspan PPO |
$201.13
|
| Rate for Payer: Humana Medicaid |
$86.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.84
|
| Rate for Payer: Molina Healthcare Passport |
$86.12
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.04
|
| Rate for Payer: UHCCP Medicaid |
$77.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.72
|
|
