|
REMOVL FORGN BODY VESTBL MOUTH
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.37 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$324.89
|
| Rate for Payer: Ambetter Exchange |
$187.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.37
|
| Rate for Payer: Anthem Medicaid |
$151.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.56
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$429.61
|
| Rate for Payer: Healthspan PPO |
$372.83
|
| Rate for Payer: Humana Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.85
|
| Rate for Payer: Molina Healthcare Passport |
$151.81
|
| Rate for Payer: Multiplan PHCS |
$642.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.36
|
| Rate for Payer: UHCCP Medicaid |
$155.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.97
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761P1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.37 |
| Max. Negotiated Rate |
$429.61 |
| Rate for Payer: Aetna Commercial |
$324.89
|
| Rate for Payer: Ambetter Exchange |
$187.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.37
|
| Rate for Payer: Anthem Medicaid |
$151.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.56
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$429.61
|
| Rate for Payer: Healthspan PPO |
$372.83
|
| Rate for Payer: Humana Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.85
|
| Rate for Payer: Molina Healthcare Passport |
$151.81
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.36
|
| Rate for Payer: UHCCP Medicaid |
$155.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.97
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.99
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761T1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
REMOV OF IMPLAN W/CAPSULECTOMY
|
Facility
|
OP
|
$625.00
|
|
| Hospital Charge Code |
22200378
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REMOV OF IMPLAN W/CAPSULECTOMY
|
Professional
|
Both
|
$625.00
|
|
| Hospital Charge Code |
22200378
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
|
|
REMOV OF IMPLAN W/CAPSULECTOMY
|
Facility
|
IP
|
$625.00
|
|
| Hospital Charge Code |
22200378
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REMOV OF IMP W/O CAPSULECT -80
|
Professional
|
Both
|
$375.00
|
|
| Hospital Charge Code |
22200377
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
|
|
REMOV OF IMP W/O CAPSULECT -80
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
22200377
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
REMOV OF IMP W/O CAPSULECT -80
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
22200377
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem Medicaid |
$128.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Humana KY Medicaid |
$128.96
|
| Rate for Payer: Kentucky WC Medicaid |
$130.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761T0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761T0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$42.30
|
| Rate for Payer: Kentucky WC Medicaid |
$42.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761P0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Ambetter Exchange |
$15.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.46
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.12
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$25.30
|
| Rate for Payer: Healthspan PPO |
$21.38
|
| Rate for Payer: Humana Medicaid |
$12.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.93
|
| Rate for Payer: Molina Healthcare Passport |
$12.68
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.63
|
| Rate for Payer: UHCCP Medicaid |
$10.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.10
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Ambetter Exchange |
$15.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.46
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.12
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$25.30
|
| Rate for Payer: Healthspan PPO |
$21.38
|
| Rate for Payer: Humana Medicaid |
$12.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.93
|
| Rate for Payer: Molina Healthcare Passport |
$12.68
|
| Rate for Payer: Multiplan PHCS |
$118.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.63
|
| Rate for Payer: UHCCP Medicaid |
$10.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.10
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$95.02
|
| Rate for Payer: Ambetter Exchange |
$71.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.02
|
| Rate for Payer: Anthem Medicaid |
$32.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.61
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$105.32
|
| Rate for Payer: Healthspan PPO |
$89.24
|
| Rate for Payer: Humana Medicaid |
$32.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.41
|
| Rate for Payer: Molina Healthcare Passport |
$32.75
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.74
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.34
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
45000029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761T0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761T0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem Medicaid |
$134.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Humana KY Medicaid |
$134.12
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$135.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
45000029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761P0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial |
$95.02
|
| Rate for Payer: Ambetter Exchange |
$71.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.02
|
| Rate for Payer: Anthem Medicaid |
$32.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.61
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$105.32
|
| Rate for Payer: Healthspan PPO |
$89.24
|
| Rate for Payer: Humana Medicaid |
$32.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.41
|
| Rate for Payer: Molina Healthcare Passport |
$32.75
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.74
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.34
|
|
|
REMV/REPLC PENIS PROS COMPL
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
HCPCS 54417
|
| Hospital Charge Code |
76102885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.40 |
| Max. Negotiated Rate |
$2,100.48 |
| Rate for Payer: Aetna Commercial |
$1,684.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,706.64
|
| Rate for Payer: Cash Price |
$1,094.00
|
| Rate for Payer: Cigna Commercial |
$1,816.04
|
| Rate for Payer: First Health Commercial |
$2,078.60
|
| Rate for Payer: Humana Commercial |
$1,859.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,794.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,614.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,925.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,641.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,903.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,509.72
|
| Rate for Payer: PHCS Commercial |
$2,100.48
|
| Rate for Payer: United Healthcare All Payer |
$1,925.44
|
|
