|
SHAVE LESION SNHFG .6 - 1.0 CM
|
Facility
|
OP
|
$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 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 SNHFG .6 - 1.0 CM
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
761P0044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$40.27
|
| 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 |
$121.58
|
| Rate for Payer: Healthspan PPO |
$106.18
|
| Rate for Payer: Humana Medicaid |
$40.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.08
|
| Rate for Payer: Molina Healthcare Passport |
$40.27
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.67
|
|
|
SHAVE LESION SNHFG .6 - 1.0 CM
|
Facility
|
OP
|
$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 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
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$40.27
|
| 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 |
$121.58
|
| Rate for Payer: Healthspan PPO |
$106.18
|
| Rate for Payer: Humana Medicaid |
$40.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.08
|
| Rate for Payer: Molina Healthcare Passport |
$40.27
|
| Rate for Payer: Multiplan PHCS |
$313.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$365.40
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.67
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$64.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.00
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$166.71
|
| Rate for Payer: Healthspan PPO |
$142.25
|
| Rate for Payer: Humana Medicaid |
$64.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.57
|
| Rate for Payer: Molina Healthcare Passport |
$64.28
|
| Rate for Payer: Multiplan PHCS |
$479.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.30
|
| Rate for Payer: UHCCP Medicaid |
$62.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.92
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem Medicaid |
$274.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Humana KY Medicaid |
$274.78
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$277.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
SHAVE LESION SNHFG OVER 2.0(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
761P0046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$64.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$166.71
|
| Rate for Payer: Healthspan PPO |
$142.25
|
| Rate for Payer: Humana Medicaid |
$64.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.57
|
| Rate for Payer: Molina Healthcare Passport |
$64.28
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$62.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.92
|
|
|
SHAVE LESION SNHFG OVER 2.0(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
761T0046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SHAVE LESION SNHFG OVER 2.0(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
761T0046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem Medicaid |
$274.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Humana KY Medicaid |
$274.78
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$277.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna Commercial |
$105.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.48
|
| Rate for Payer: Anthem Medicaid |
$52.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.00
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$152.63
|
| Rate for Payer: Healthspan PPO |
$135.41
|
| Rate for Payer: Humana Medicaid |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.97
|
| Rate for Payer: Molina Healthcare Passport |
$52.91
|
| Rate for Payer: Multiplan PHCS |
$479.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.30
|
| Rate for Payer: UHCCP Medicaid |
$51.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.44
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
761P0049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$105.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.48
|
| Rate for Payer: Anthem Medicaid |
$52.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$152.63
|
| Rate for Payer: Healthspan PPO |
$135.41
|
| Rate for Payer: Humana Medicaid |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.97
|
| Rate for Payer: Molina Healthcare Passport |
$52.91
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$51.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.44
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
761T0049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
761T0049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.41
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem Medicaid |
$175.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Humana KY Medicaid |
$175.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.41
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.59
|
| Rate for Payer: Anthem Medicaid |
$44.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.00
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$132.76
|
| Rate for Payer: Healthspan PPO |
$117.22
|
| Rate for Payer: Humana Medicaid |
$44.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.03
|
| Rate for Payer: Molina Healthcare Passport |
$44.15
|
| Rate for Payer: Multiplan PHCS |
$306.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$357.70
|
| Rate for Payer: UHCCP Medicaid |
$42.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.59
|
|
|
SHAVE LSN FEENL .6-1.0 CM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
761P0048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.59
|
| Rate for Payer: Anthem Medicaid |
$44.15
|
| 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 |
$132.76
|
| Rate for Payer: Healthspan PPO |
$117.22
|
| Rate for Payer: Humana Medicaid |
$44.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.03
|
| Rate for Payer: Molina Healthcare Passport |
$44.15
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$42.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.59
|
|
|
SHAVE LSN FEENL .6-1.0 CM(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
761T0048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
SHAVE LSN FEENL .6-1.0 CM(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
761T0048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
SHAVE LSN FEENL OVER 2.0 CM
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.49
|
| Rate for Payer: Anthem Medicaid |
$71.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$884.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$196.63
|
| Rate for Payer: Healthspan PPO |
$170.34
|
| Rate for Payer: Humana Medicaid |
$71.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.58
|
| Rate for Payer: Molina Healthcare Passport |
$71.16
|
| Rate for Payer: Multiplan PHCS |
$530.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$618.80
|
| Rate for Payer: UHCCP Medicaid |
$69.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.87
|
|
|
SHAVE LSN FEENL OVER 2.0 CM
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.04
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
|
SHAVE LSN FEENL OVER 2.0 CM
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.92 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem Medicaid |
$304.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Humana KY Medicaid |
$304.01
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$307.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.04
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
