|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.90 |
| Max. Negotiated Rate |
$502.08 |
| Rate for Payer: Aetna Commercial |
$402.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.94
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$434.09
|
| Rate for Payer: First Health Commercial |
$496.85
|
| Rate for Payer: Humana Commercial |
$444.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$460.24
|
| Rate for Payer: Ohio Health Group HMO |
$392.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.87
|
| Rate for Payer: PHCS Commercial |
$502.08
|
| Rate for Payer: United Healthcare All Payer |
$460.24
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.0
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.86 |
| Max. Negotiated Rate |
$502.08 |
| Rate for Payer: Aetna Commercial |
$402.71
|
| Rate for Payer: Anthem Medicaid |
$179.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$434.09
|
| Rate for Payer: First Health Commercial |
$496.85
|
| Rate for Payer: Humana Commercial |
$444.55
|
| Rate for Payer: Humana KY Medicaid |
$179.86
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$181.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$460.24
|
| Rate for Payer: Ohio Health Group HMO |
$392.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.87
|
| Rate for Payer: PHCS Commercial |
$502.08
|
| Rate for Payer: United Healthcare All Payer |
$460.24
|
|
|
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 |
$150.00 |
| 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 |
$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 |
$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 |
$150.00
|
| 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
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.(T
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
761T0045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem Medicaid |
$93.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Humana KY Medicaid |
$93.88
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$94.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
SHAVE LESION SNHFG 1.1 TO 2.(T
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
761T0045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
SHAVE LESION SNHFG .5CM >
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Ambetter Exchange |
$35.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.62
|
| Rate for Payer: Anthem Medicaid |
$34.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.30
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$89.58
|
| Rate for Payer: Healthspan PPO |
$77.27
|
| Rate for Payer: Humana Medicaid |
$34.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare Passport |
$34.82
|
| Rate for Payer: Multiplan PHCS |
$279.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.25
|
|
|
SHAVE LESION SNHFG .5CM >
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$358.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.70
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$385.95
|
| Rate for Payer: First Health Commercial |
$441.75
|
| Rate for Payer: Humana Commercial |
$395.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.20
|
| Rate for Payer: Ohio Health Group HMO |
$348.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$446.40
|
| Rate for Payer: United Healthcare All Payer |
$409.20
|
|
|
SHAVE LESION SNHFG .5CM >
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.91 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$358.05
|
| Rate for Payer: Anthem Medicaid |
$159.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$385.95
|
| Rate for Payer: First Health Commercial |
$441.75
|
| Rate for Payer: Humana Commercial |
$395.25
|
| Rate for Payer: Humana KY Medicaid |
$159.91
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.20
|
| Rate for Payer: Ohio Health Group HMO |
$348.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$446.40
|
| Rate for Payer: United Healthcare All Payer |
$409.20
|
|
|
SHAVE LESION SNHFG .5CM >(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761P0043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Ambetter Exchange |
$35.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.62
|
| Rate for Payer: Anthem Medicaid |
$34.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.30
|
| 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 |
$34.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare Passport |
$34.82
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.25
|
|
|
SHAVE LESION SNHFG .5CM >(T
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761T0043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
SHAVE LESION SNHFG .5CM >(T
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
761T0043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
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 |
$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 SNHFG .6 - 1.0 CM
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.52 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$417.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$454.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.18
|
| 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 |
$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 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 |
$313.20 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Ambetter Exchange |
$45.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$49.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.97
|
| 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 |
$49.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.79
|
| Rate for Payer: Molina Healthcare Passport |
$49.79
|
| Rate for Payer: Multiplan PHCS |
$313.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.55
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.81
|
|
|
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 |
$150.00 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Ambetter Exchange |
$45.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.69
|
| Rate for Payer: Anthem Medicaid |
$49.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.97
|
| 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 |
$49.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.79
|
| Rate for Payer: Molina Healthcare Passport |
$49.79
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.55
|
| Rate for Payer: UHCCP Medicaid |
$40.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.81
|
|
|
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 |
$156.60 |
| 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 |
$417.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$454.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.18
|
| Rate for Payer: PHCS Commercial |
$501.12
|
| Rate for Payer: United Healthcare All Payer |
$459.36
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Ambetter Exchange |
$65.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$83.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$166.71
|
| Rate for Payer: Healthspan PPO |
$142.25
|
| Rate for Payer: Humana Medicaid |
$83.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.72
|
| Rate for Payer: Molina Healthcare Passport |
$83.06
|
| Rate for Payer: Multiplan PHCS |
$489.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.05
|
| Rate for Payer: UHCCP Medicaid |
$62.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.42
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.62 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
SHAVE LESION SNHFG OVER 2.0
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
76100046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.04
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
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 |
$180.00 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Ambetter Exchange |
$65.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$83.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.50
|
| 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 |
$83.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.72
|
| Rate for Payer: Molina Healthcare Passport |
$83.06
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.05
|
| Rate for Payer: UHCCP Medicaid |
$62.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.42
|
|
|
SHAVE LESION SNHFG OVER 2.0(T
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
761T0046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.80 |
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
SHAVE LESION SNHFG OVER 2.0(T
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
761T0046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$397.32
|
| Rate for Payer: Anthem Medicaid |
$177.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.04
|
| Rate for Payer: PHCS Commercial |
$495.36
|
| Rate for Payer: United Healthcare All Payer |
$454.08
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$105.13
|
| Rate for Payer: Ambetter Exchange |
$70.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.48
|
| Rate for Payer: Anthem Medicaid |
$67.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.06
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$152.63
|
| Rate for Payer: Healthspan PPO |
$135.41
|
| Rate for Payer: Humana Medicaid |
$67.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.29
|
| Rate for Payer: Molina Healthcare Passport |
$67.93
|
| Rate for Payer: Multiplan PHCS |
$487.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.06
|
| Rate for Payer: UHCCP Medicaid |
$51.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.05
|
|
