|
TANDEM UNIPOLAR 54MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 54MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 55MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 55MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 57MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 57MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 59MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 59MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 61MM
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
TANDEM UNIPOLAR 61MM
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.31
|
| Rate for Payer: Anthem Medicaid |
$18.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$84.59
|
| Rate for Payer: Humana Medicaid |
$18.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.86
|
| Rate for Payer: Molina Healthcare Passport |
$18.49
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.00
|
| Rate for Payer: UHCCP Medicaid |
$16.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.67
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$354.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.80
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: First Health Commercial |
$437.00
|
| Rate for Payer: Humana Commercial |
$391.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$377.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.80
|
| Rate for Payer: Ohio Health Group HMO |
$345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.60
|
| Rate for Payer: PHCS Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Payer |
$404.80
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$354.20
|
| Rate for Payer: Anthem Medicaid |
$158.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.80
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: First Health Commercial |
$437.00
|
| Rate for Payer: Humana Commercial |
$391.00
|
| Rate for Payer: Humana KY Medicaid |
$158.19
|
| Rate for Payer: Kentucky WC Medicaid |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$377.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.80
|
| Rate for Payer: Ohio Health Group HMO |
$345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.60
|
| Rate for Payer: PHCS Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Payer |
$404.80
|
|
|
TANGNTL BX SKIN EA SEP/ADDL(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
761P0034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.31
|
| Rate for Payer: Anthem Medicaid |
$18.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$84.59
|
| Rate for Payer: Humana Medicaid |
$18.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.86
|
| Rate for Payer: Molina Healthcare Passport |
$18.49
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$16.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.67
|
|
|
TANGNTL BX SKIN EA SEP/ADDL(T
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
761T0034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
TANGNTL BX SKIN EA SEP/ADDL(T
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
761T0034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem Medicaid |
$235.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Humana KY Medicaid |
$235.23
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.52
|
| Rate for Payer: Anthem Medicaid |
$31.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$156.68
|
| Rate for Payer: Humana Medicaid |
$31.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.59
|
| Rate for Payer: Molina Healthcare Passport |
$31.95
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.80
|
| Rate for Payer: UHCCP Medicaid |
$26.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.27
|
|
|
TANGNTL BX SKIN SINGLE LES(P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
761P2567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.52
|
| Rate for Payer: Anthem Medicaid |
$31.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$156.68
|
| Rate for Payer: Humana Medicaid |
$31.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.59
|
| Rate for Payer: Molina Healthcare Passport |
$31.95
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$26.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.27
|
|
|
TANGNTL BX SKIN SINGLE LES(T
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
761T2567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.64
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
TANGNTL BX SKIN SINGLE LES(T
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
761T2567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem Medicaid |
$152.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Humana KY Medicaid |
$152.69
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$154.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.64
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
TAP 2.0 MM
|
Facility
|
IP
|
$1,758.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.67 |
| Max. Negotiated Rate |
$1,688.61 |
| Rate for Payer: Aetna Commercial |
$1,354.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.00
|
| Rate for Payer: Cash Price |
$879.49
|
| Rate for Payer: Cigna Commercial |
$1,459.95
|
| Rate for Payer: First Health Commercial |
$1,671.02
|
| Rate for Payer: Humana Commercial |
$1,495.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.28
|
| Rate for Payer: PHCS Commercial |
$1,688.61
|
| Rate for Payer: United Healthcare All Payer |
$1,547.89
|
|
|
TAP 2.0 MM
|
Facility
|
OP
|
$1,758.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.67 |
| Max. Negotiated Rate |
$1,688.61 |
| Rate for Payer: Aetna Commercial |
$1,354.41
|
| Rate for Payer: Anthem Medicaid |
$604.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.00
|
| Rate for Payer: Cash Price |
$879.49
|
| Rate for Payer: Cigna Commercial |
$1,459.95
|
| Rate for Payer: First Health Commercial |
$1,671.02
|
| Rate for Payer: Humana Commercial |
$1,495.12
|
| Rate for Payer: Humana KY Medicaid |
$604.91
|
| Rate for Payer: Kentucky WC Medicaid |
$611.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.28
|
| Rate for Payer: PHCS Commercial |
$1,688.61
|
| Rate for Payer: United Healthcare All Payer |
$1,547.89
|
|
