|
SHAVE LESION 1.1-2.0 CM
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
SHAVE LESION 1.1-2.0 CM
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Ambetter Exchange |
$56.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.62
|
| Rate for Payer: Anthem Medicaid |
$56.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$56.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$56.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$67.49
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$138.19
|
| Rate for Payer: Healthspan PPO |
$121.50
|
| Rate for Payer: Humana Medicaid |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$56.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.01
|
| Rate for Payer: Molina Healthcare Passport |
$56.87
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$73.11
|
| Rate for Payer: UHCCP Medicaid |
$44.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$56.24
|
|
|
SHAVE LESION 1.1-2.0 CM
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
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 |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.94
|
| Rate for Payer: Ambetter Exchange |
$56.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.62
|
| Rate for Payer: Anthem Medicaid |
$56.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$56.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$56.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$67.49
|
| 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 |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$56.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.01
|
| Rate for Payer: Molina Healthcare Passport |
$56.87
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$73.11
|
| Rate for Payer: UHCCP Medicaid |
$44.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$56.24
|
|
|
SHAVE LESION 1.1-2.0 CM(T
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
761T0041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
SHAVE LESION 1.1-2.0 CM(T
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
761T0041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
SHAVE LESION .5CM/LESS
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Anthem Medicaid |
$148.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$358.56
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: Humana Commercial |
$367.20
|
| Rate for Payer: Humana KY Medicaid |
$148.56
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$150.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.16
|
| Rate for Payer: Ohio Health Group HMO |
$324.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.08
|
| Rate for Payer: PHCS Commercial |
$414.72
|
| Rate for Payer: United Healthcare All Payer |
$380.16
|
|
|
SHAVE LESION .5CM/LESS
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Ambetter Exchange |
$31.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$30.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.08
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$86.20
|
| Rate for Payer: Healthspan PPO |
$73.61
|
| Rate for Payer: Humana Medicaid |
$30.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.01
|
| Rate for Payer: Molina Healthcare Passport |
$30.40
|
| Rate for Payer: Multiplan PHCS |
$259.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.25
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.73
|
|
|
SHAVE LESION .5CM/LESS
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.96
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$358.56
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: Humana Commercial |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.16
|
| Rate for Payer: Ohio Health Group HMO |
$324.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.08
|
| Rate for Payer: PHCS Commercial |
$414.72
|
| Rate for Payer: United Healthcare All Payer |
$380.16
|
|
|
SHAVE LESION .5CM/LESS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761P0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Ambetter Exchange |
$31.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$30.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.08
|
| 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 |
$30.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.01
|
| Rate for Payer: Molina Healthcare Passport |
$30.40
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.25
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.73
|
|
|
SHAVE LESION .5CM/LESS(T
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761T0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem Medicaid |
$96.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Humana KY Medicaid |
$96.98
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$97.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
SHAVE LESION .5CM/LESS(T
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
761T0039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.96
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$234.06
|
| Rate for Payer: First Health Commercial |
$267.90
|
| Rate for Payer: Humana Commercial |
$239.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.16
|
| Rate for Payer: Ohio Health Group HMO |
$211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.58
|
| Rate for Payer: PHCS Commercial |
$270.72
|
| Rate for Payer: United Healthcare All Payer |
$248.16
|
|
|
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 |
$162.32 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.68
|
| 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 |
$283.20 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Ambetter Exchange |
$48.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$44.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.04
|
| 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 |
$44.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.26
|
| Rate for Payer: Molina Healthcare Passport |
$44.37
|
| Rate for Payer: Multiplan PHCS |
$283.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.88
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.37
|
|
|
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 |
$141.60 |
| 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 |
$377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.68
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
|
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 |
$120.00 |
| Rate for Payer: Aetna Commercial |
$73.33
|
| Rate for Payer: Ambetter Exchange |
$48.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$44.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.04
|
| 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 |
$44.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.26
|
| Rate for Payer: Molina Healthcare Passport |
$44.37
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.88
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.37
|
|
|
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 |
$93.54 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.68
|
| 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
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
761T0040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.60 |
| 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 |
$217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.68
|
| 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 |
$218.40 |
| 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 |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| 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 |
$436.80 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Ambetter Exchange |
$67.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.06
|
| Rate for Payer: Anthem Medicaid |
$76.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$67.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.70
|
| 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 |
$76.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$67.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.53
|
| Rate for Payer: Molina Healthcare Passport |
$76.99
|
| Rate for Payer: Multiplan PHCS |
$436.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.42
|
| Rate for Payer: UHCCP Medicaid |
$57.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.25
|
|
|
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 |
$250.36 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$567.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| 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 |
$163.28 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Ambetter Exchange |
$67.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.06
|
| Rate for Payer: Anthem Medicaid |
$76.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$67.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.70
|
| 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 |
$76.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$67.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.53
|
| Rate for Payer: Molina Healthcare Passport |
$76.99
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.42
|
| Rate for Payer: UHCCP Medicaid |
$57.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.25
|
|
|
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 |
$143.40 |
| 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 |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
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 |
$164.38 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$313.80 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Ambetter Exchange |
$58.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.31
|
| Rate for Payer: Anthem Medicaid |
$61.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.78
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$141.99
|
| Rate for Payer: Healthspan PPO |
$125.08
|
| Rate for Payer: Humana Medicaid |
$61.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.31
|
| Rate for Payer: Molina Healthcare Passport |
$61.09
|
| Rate for Payer: Multiplan PHCS |
$313.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.59
|
| Rate for Payer: UHCCP Medicaid |
$47.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.15
|
|
