|
SHAVE LSN FEENL 1.1-2.0 CM
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.59 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$406.50
|
| 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: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| 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 |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| 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(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 |
$180.00 |
| 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 |
$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 |
$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 |
$180.00
|
| 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
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM(T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
761T0049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
SHAVE LSN FEENL 1.1-2.0 CM(T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
761T0049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.42 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.58 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
SHAVE LSN FEENL .6-1.0 CM
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Ambetter Exchange |
$59.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.59
|
| Rate for Payer: Anthem Medicaid |
$55.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.90
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$132.76
|
| Rate for Payer: Healthspan PPO |
$117.22
|
| Rate for Payer: Humana Medicaid |
$55.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.66
|
| Rate for Payer: Molina Healthcare Passport |
$55.55
|
| Rate for Payer: Multiplan PHCS |
$316.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.80
|
| Rate for Payer: UHCCP Medicaid |
$42.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.08
|
|
|
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 |
$150.00 |
| Rate for Payer: Aetna Commercial |
$91.47
|
| Rate for Payer: Ambetter Exchange |
$59.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.59
|
| Rate for Payer: Anthem Medicaid |
$55.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.90
|
| 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 |
$55.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.66
|
| Rate for Payer: Molina Healthcare Passport |
$55.55
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.80
|
| Rate for Payer: UHCCP Medicaid |
$42.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.08
|
|
|
SHAVE LSN FEENL .6-1.0 CM(T
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
761T0048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
SHAVE LSN FEENL .6-1.0 CM(T
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
761T0048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
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 |
$265.20 |
| 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 |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| 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 |
$304.01 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
|
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 |
$530.40 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Ambetter Exchange |
$89.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.49
|
| Rate for Payer: Anthem Medicaid |
$91.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.78
|
| 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 |
$91.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.97
|
| Rate for Payer: Molina Healthcare Passport |
$91.15
|
| Rate for Payer: Multiplan PHCS |
$530.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.77
|
| Rate for Payer: UHCCP Medicaid |
$69.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.82
|
|
|
SHAVE LSN FEENL OVER 2.0 CM(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761P0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Ambetter Exchange |
$89.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.49
|
| Rate for Payer: Anthem Medicaid |
$91.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.78
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$196.63
|
| Rate for Payer: Healthspan PPO |
$170.34
|
| Rate for Payer: Humana Medicaid |
$91.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.97
|
| Rate for Payer: Molina Healthcare Passport |
$91.15
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.77
|
| Rate for Payer: UHCCP Medicaid |
$69.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.82
|
|
|
SHAVE LSN FEENL OVER 2.0 CM(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761T0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SHAVE LSN FEENL OVER 2.0 CM(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
761T0050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.64 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761T0047
|
|
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
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem Medicaid |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Humana KY Medicaid |
$165.07
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$166.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.20
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761P0047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$62.66
|
| Rate for Payer: Ambetter Exchange |
$42.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.60
|
| Rate for Payer: Anthem Medicaid |
$41.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.88
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$106.30
|
| Rate for Payer: Healthspan PPO |
$92.03
|
| Rate for Payer: Humana Medicaid |
$41.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.22
|
| Rate for Payer: Molina Healthcare Passport |
$41.39
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.12
|
| Rate for Payer: UHCCP Medicaid |
$39.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.40
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.20
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
761T0047
|
|
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
|
|
|
SHAVING EPIDERMAL .5 CM OR LES
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
76100047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$62.66
|
| Rate for Payer: Ambetter Exchange |
$42.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.60
|
| Rate for Payer: Anthem Medicaid |
$41.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.88
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$106.30
|
| Rate for Payer: Healthspan PPO |
$92.03
|
| Rate for Payer: Humana Medicaid |
$41.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.22
|
| Rate for Payer: Molina Healthcare Passport |
$41.39
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.12
|
| Rate for Payer: UHCCP Medicaid |
$39.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.40
|
|
|
SHEATH 20F 25CM
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem Medicaid |
$1,286.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Humana KY Medicaid |
$1,286.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,299.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,311.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,580.60
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
SHEATH 20F 25CM
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,580.60
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
SHEATH 24F 25CM
|
Facility
|
OP
|
$3,672.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.75 |
| Max. Negotiated Rate |
$3,525.60 |
| Rate for Payer: Aetna Commercial |
$2,827.82
|
| Rate for Payer: Anthem Medicaid |
$1,262.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,864.55
|
| Rate for Payer: Cash Price |
$1,836.25
|
| Rate for Payer: Cigna Commercial |
$3,048.18
|
| Rate for Payer: First Health Commercial |
$3,488.88
|
| Rate for Payer: Humana Commercial |
$3,121.62
|
| Rate for Payer: Humana KY Medicaid |
$1,262.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,275.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,011.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,710.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,288.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,754.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.03
|
| Rate for Payer: PHCS Commercial |
$3,525.60
|
| Rate for Payer: United Healthcare All Payer |
$3,231.80
|
|
