|
TANDEM UNIPOLAR 53MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 54MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 54MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 55MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 55MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 57MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 57MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 59MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 59MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 61MM
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
TANDEM UNIPOLAR 61MM
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$257.03
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Ambetter Exchange |
$20.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.31
|
| Rate for Payer: Anthem Medicaid |
$40.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.49
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$84.59
|
| Rate for Payer: Humana Medicaid |
$40.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.50
|
| Rate for Payer: Molina Healthcare Passport |
$40.69
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.53
|
| Rate for Payer: UHCCP Medicaid |
$16.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.41
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Kentucky WC Medicaid |
$165.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
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 |
$135.00 |
| Rate for Payer: Ambetter Exchange |
$20.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.31
|
| Rate for Payer: Anthem Medicaid |
$40.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.49
|
| 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 |
$40.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.50
|
| Rate for Payer: Molina Healthcare Passport |
$40.69
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.53
|
| Rate for Payer: UHCCP Medicaid |
$16.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.41
|
|
|
TANGNTL BX SKIN EA SEP/ADDL(T
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
761T0034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
TANGNTL BX SKIN EA SEP/ADDL(T
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
761T0034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Ambetter Exchange |
$35.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.52
|
| Rate for Payer: Anthem Medicaid |
$75.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.17
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$156.68
|
| Rate for Payer: Humana Medicaid |
$75.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.80
|
| Rate for Payer: Molina Healthcare Passport |
$75.29
|
| Rate for Payer: Multiplan PHCS |
$427.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.68
|
| Rate for Payer: UHCCP Medicaid |
$26.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.14
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem Medicaid |
$245.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Humana KY Medicaid |
$245.20
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$247.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
76102567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
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 |
$156.68 |
| Rate for Payer: Ambetter Exchange |
$35.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.52
|
| Rate for Payer: Anthem Medicaid |
$75.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.17
|
| 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 |
$75.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.80
|
| Rate for Payer: Molina Healthcare Passport |
$75.29
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.68
|
| Rate for Payer: UHCCP Medicaid |
$26.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.14
|
|
|
TANGNTL BX SKIN SINGLE LES(T
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
761T2567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
TANGNTL BX SKIN SINGLE LES(T
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
761T2567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.66 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem Medicaid |
$162.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Humana KY Medicaid |
$162.66
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
TAP 2.0 MM
|
Facility
|
IP
|
$1,744.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.21 |
| Max. Negotiated Rate |
$1,674.27 |
| Rate for Payer: Aetna Commercial |
$1,342.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.34
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cigna Commercial |
$1,447.54
|
| Rate for Payer: First Health Commercial |
$1,656.83
|
| Rate for Payer: Humana Commercial |
$1,482.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.38
|
| Rate for Payer: PHCS Commercial |
$1,674.27
|
| Rate for Payer: United Healthcare All Payer |
$1,534.75
|
|
