|
SHAVE LESION .6 TO 1.0 CM
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$368.16
|
| 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: 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 |
$141.60
|
| 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
|
|
|
SHAVE LESION .6 TO 1.0 CM
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$35.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$472.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$115.39
|
| Rate for Payer: Healthspan PPO |
$101.43
|
| Rate for Payer: Humana Medicaid |
$35.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.10
|
| Rate for Payer: Molina Healthcare Passport |
$35.39
|
| Rate for Payer: Multiplan PHCS |
$283.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$330.40
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.74
|
|
|
SHAVE LESION .6 TO 1.0 CM(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
761P0040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$35.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$115.39
|
| Rate for Payer: Healthspan PPO |
$101.43
|
| Rate for Payer: Humana Medicaid |
$35.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.10
|
| Rate for Payer: Molina Healthcare Passport |
$35.39
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.74
|
|
|
SHAVE LESION .6 TO 1.0 CM(T
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
761T0040
|
|
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 .6 TO 1.0 CM(T
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
761T0040
|
|
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 OVER 2.0 CM
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
76100042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$567.84
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.68
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
SHAVE LESION OVER 2.0 CM
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
76100042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.06
|
| Rate for Payer: Anthem Medicaid |
$58.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$728.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$163.28
|
| Rate for Payer: Healthspan PPO |
$142.96
|
| Rate for Payer: Humana Medicaid |
$58.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.94
|
| Rate for Payer: Molina Healthcare Passport |
$58.76
|
| Rate for Payer: Multiplan PHCS |
$436.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.60
|
| Rate for Payer: UHCCP Medicaid |
$57.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.35
|
|
|
SHAVE LESION OVER 2.0 CM
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
76100042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem Medicaid |
$250.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$567.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Humana KY Medicaid |
$250.36
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$252.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$255.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.68
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
SHAVE LESION OVER 2.0 CM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
761P0042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.06
|
| Rate for Payer: Anthem Medicaid |
$58.76
|
| 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 |
$163.28
|
| Rate for Payer: Healthspan PPO |
$142.96
|
| Rate for Payer: Humana Medicaid |
$58.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.94
|
| Rate for Payer: Molina Healthcare Passport |
$58.76
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$57.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.35
|
|
|
SHAVE LESION OVER 2.0 CM(T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
761T0042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
SHAVE LESION OVER 2.0 CM(T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
761T0042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$495.36 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$177.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$428.28
|
| Rate for Payer: First Health Commercial |
$490.20
|
| Rate for Payer: Humana Commercial |
$438.60
|
| Rate for Payer: Humana KY Medicaid |
$177.45
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$179.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.08
|
| Rate for Payer: Ohio Health Group HMO |
$387.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.96
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.31
|
| Rate for Payer: Anthem Medicaid |
$48.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$141.99
|
| Rate for Payer: Healthspan PPO |
$125.08
|
| Rate for Payer: Humana Medicaid |
$48.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.46
|
| Rate for Payer: Molina Healthcare Passport |
$48.49
|
| Rate for Payer: Multiplan PHCS |
$309.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$361.20
|
| Rate for Payer: UHCCP Medicaid |
$47.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.97
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
761P0045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.31
|
| Rate for Payer: Anthem Medicaid |
$48.49
|
| 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 |
$141.99
|
| Rate for Payer: Healthspan PPO |
$125.08
|
| Rate for Payer: Humana Medicaid |
$48.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.46
|
| Rate for Payer: Molina Healthcare Passport |
$48.49
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$47.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.97
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.(T
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
761T0045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.46
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.(T
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
761T0045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem Medicaid |
$91.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Humana KY Medicaid |
$91.48
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$92.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.46
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
SHAVE LESION SNHFG .5CM >
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.62
|
| Rate for Payer: Anthem Medicaid |
$27.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$89.58
|
| Rate for Payer: Healthspan PPO |
$77.27
|
| Rate for Payer: Humana Medicaid |
$27.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.41
|
| Rate for Payer: Molina Healthcare Passport |
$27.85
|
| Rate for Payer: Multiplan PHCS |
$268.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$32.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.13
|
|
|
SHAVE LESION SNHFG .5CM >
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$429.12 |
| Rate for Payer: Aetna Commercial |
$344.19
|
| Rate for Payer: Anthem Medicaid |
$153.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$371.01
|
| Rate for Payer: First Health Commercial |
$424.65
|
| Rate for Payer: Humana Commercial |
$379.95
|
| Rate for Payer: Humana KY Medicaid |
$153.72
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$155.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$393.36
|
| Rate for Payer: Ohio Health Group HMO |
$335.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.57
|
| Rate for Payer: PHCS Commercial |
$429.12
|
| Rate for Payer: United Healthcare All Payer |
$393.36
|
|
|
SHAVE LESION SNHFG .5CM >
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$429.12 |
| Rate for Payer: Aetna Commercial |
$344.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.66
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$371.01
|
| Rate for Payer: First Health Commercial |
$424.65
|
| Rate for Payer: Humana Commercial |
$379.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$393.36
|
| Rate for Payer: Ohio Health Group HMO |
$335.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.57
|
| Rate for Payer: PHCS Commercial |
$429.12
|
| Rate for Payer: United Healthcare All Payer |
$393.36
|
|
|
SHAVE LESION SNHFG .5CM >(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761P0043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.62
|
| Rate for Payer: Anthem Medicaid |
$27.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$89.58
|
| Rate for Payer: Healthspan PPO |
$77.27
|
| Rate for Payer: Humana Medicaid |
$27.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.41
|
| Rate for Payer: Molina Healthcare Passport |
$27.85
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$32.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.13
|
|
|
SHAVE LESION SNHFG .5CM >(T
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761T0043
|
|
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 SNHFG .5CM >(T
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761T0043
|
|
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 SNHFG .6 - 1.0 CM
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
76100044
|
|
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 SNHFG .6 - 1.0 CM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
761T0044
|
|
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
|
|
