|
SGMNTL FEM/TIB MAL-FEM 80MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MAL-FEM 80MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 160MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 160MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 180MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 180MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 200MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 200MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 220MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/F PROV 220MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB M/M PROV 200MM
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
SGMNTL FEM/TIB M/M PROV 200MM
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
SHAVE LESION 1.1-2.0 CM
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.62
|
| Rate for Payer: Anthem Medicaid |
$44.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$138.19
|
| Rate for Payer: Healthspan PPO |
$121.50
|
| Rate for Payer: Humana Medicaid |
$44.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.83
|
| Rate for Payer: Molina Healthcare Passport |
$44.93
|
| Rate for Payer: Multiplan PHCS |
$313.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$365.40
|
| Rate for Payer: UHCCP Medicaid |
$44.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.38
|
|
|
SHAVE LESION 1.1-2.0 CM
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.86 |
| Max. Negotiated Rate |
$501.12 |
| Rate for Payer: Aetna Commercial |
$401.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.16
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$433.26
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Humana Commercial |
$443.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.36
|
| Rate for Payer: Ohio Health Group HMO |
$391.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.82
|
| Rate for Payer: PHCS Commercial |
$501.12
|
| Rate for Payer: United Healthcare All Payer |
$459.36
|
|
|
SHAVE LESION 1.1-2.0 CM
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.86 |
| Max. Negotiated Rate |
$501.12 |
| Rate for Payer: Aetna Commercial |
$401.94
|
| Rate for Payer: Anthem Medicaid |
$179.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$433.26
|
| Rate for Payer: First Health Commercial |
$495.90
|
| Rate for Payer: Humana Commercial |
$443.70
|
| Rate for Payer: Humana KY Medicaid |
$179.52
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$181.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.36
|
| Rate for Payer: Ohio Health Group HMO |
$391.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.82
|
| Rate for Payer: PHCS Commercial |
$501.12
|
| Rate for Payer: United Healthcare All Payer |
$459.36
|
|
|
SHAVE LESION 1.1-2.0 CM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
761P0041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.62
|
| Rate for Payer: Anthem Medicaid |
$44.93
|
| 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 |
$138.19
|
| Rate for Payer: Healthspan PPO |
$121.50
|
| Rate for Payer: Humana Medicaid |
$44.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.83
|
| Rate for Payer: Molina Healthcare Passport |
$44.93
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$44.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.38
|
|
|
SHAVE LESION 1.1-2.0 CM(T
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
761T0041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVE LESION 1.1-2.0 CM(T
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
761T0041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVE LESION .5CM/LESS
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$23.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$86.20
|
| Rate for Payer: Healthspan PPO |
$73.61
|
| Rate for Payer: Humana Medicaid |
$23.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.76
|
| Rate for Payer: Molina Healthcare Passport |
$23.29
|
| Rate for Payer: Multiplan PHCS |
$253.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$295.40
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.52
|
|
|
SHAVE LESION .5CM/LESS
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem Medicaid |
$145.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Humana KY Medicaid |
$145.13
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$146.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$148.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
SHAVE LESION .5CM/LESS
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$405.12 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
SHAVE LESION .5CM/LESS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761P0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$23.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$86.20
|
| Rate for Payer: Healthspan PPO |
$73.61
|
| Rate for Payer: Humana Medicaid |
$23.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.76
|
| Rate for Payer: Molina Healthcare Passport |
$23.29
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.52
|
|
|
SHAVE LESION .5CM/LESS(T
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761T0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVE LESION .5CM/LESS(T
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761T0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
SHAVE LESION .6 TO 1.0 CM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$453.12 |
| Rate for Payer: Aetna Commercial |
$363.44
|
| Rate for Payer: Anthem Medicaid |
$162.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$391.76
|
| Rate for Payer: First Health Commercial |
$448.40
|
| Rate for Payer: Humana Commercial |
$401.20
|
| Rate for Payer: Humana KY Medicaid |
$162.32
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$163.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$348.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$415.36
|
| Rate for Payer: Ohio Health Group HMO |
$354.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.32
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
