|
PUNC ASPIR ABSCSS HEMA CYST(P
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761P2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$164.40 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$40.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$40.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.86
|
| Rate for Payer: Molina Healthcare Passport |
$40.06
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.40
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.46
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(P
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761P0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$164.40 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$40.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$40.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.86
|
| Rate for Payer: Molina Healthcare Passport |
$40.06
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.40
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.46
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$21.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$506.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$96.98
|
| Rate for Payer: Humana Medicaid |
$21.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.30
|
| Rate for Payer: Molina Healthcare Passport |
$21.86
|
| Rate for Payer: Multiplan PHCS |
$303.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$354.20
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.08
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.86
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Humana KY Medicaid |
$174.01
|
| Rate for Payer: Kentucky WC Medicaid |
$175.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.86
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
PUNCH BX SKIN EA SEP/ADDL(P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
761P2568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$21.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$96.98
|
| Rate for Payer: Humana Medicaid |
$21.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.30
|
| Rate for Payer: Molina Healthcare Passport |
$21.86
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.08
|
|
|
PUNCH BX SKIN EA SEP/ADDL(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
761T2568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
PUNCH BX SKIN EA SEP/ADDL(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
761T2568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.09
|
| Rate for Payer: Anthem Medicaid |
$40.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$196.96
|
| Rate for Payer: Humana Medicaid |
$40.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.89
|
| Rate for Payer: Molina Healthcare Passport |
$40.09
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$32.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.49
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PUNCH BX SKIN SINGLE LESION(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
761P0035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.09
|
| Rate for Payer: Anthem Medicaid |
$40.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$196.96
|
| Rate for Payer: Humana Medicaid |
$40.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.89
|
| Rate for Payer: Molina Healthcare Passport |
$40.09
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$32.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.49
|
|
|
PUNCH BX SKIN SINGLE LESION(T
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
761T0035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PUNCH BX SKIN SINGLE LESION(T
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
761T0035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PURAPLY 2*2
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
PURAPLY 2*2
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
PURAPLY AM WOUND MATRIX 16MM D
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
PURAPLY AM WOUND MATRIX 16MM D
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
PURAPLY AM WOUND MATRIX 2X2CM
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
PURAPLY AM WOUND MATRIX 2X2CM
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
PURAPLY AM WOUND MATRIX 2X4CM
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
25003714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
