|
TRIMMING OF NAILS(T
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761T0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$47.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$47.80
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$48.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
TRIMMING OF NAILS(T
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761T0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761P2632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Ambetter Exchange |
$21.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.45
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.26
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$75.04
|
| Rate for Payer: Healthspan PPO |
$66.38
|
| Rate for Payer: Humana Medicaid |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.18
|
| Rate for Payer: Molina Healthcare Passport |
$20.76
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.36
|
| Rate for Payer: UHCCP Medicaid |
$17.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.05
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761T2632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem Medicaid |
$100.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Humana KY Medicaid |
$100.76
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$101.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761T2629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.54
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761T2629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem Medicaid |
$100.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Humana KY Medicaid |
$100.76
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$101.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761P2629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Ambetter Exchange |
$21.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.45
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.26
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$75.04
|
| Rate for Payer: Healthspan PPO |
$66.38
|
| Rate for Payer: Humana Medicaid |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.18
|
| Rate for Payer: Molina Healthcare Passport |
$20.76
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.36
|
| Rate for Payer: UHCCP Medicaid |
$17.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.05
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$145.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
761T2632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.54
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$243.19
|
| Rate for Payer: First Health Commercial |
$278.35
|
| Rate for Payer: Humana Commercial |
$249.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.84
|
| Rate for Payer: Ohio Health Group HMO |
$219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.17
|
| Rate for Payer: PHCS Commercial |
$281.28
|
| Rate for Payer: United Healthcare All Payer |
$257.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Ambetter Exchange |
$21.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.45
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.26
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$75.04
|
| Rate for Payer: Healthspan PPO |
$66.38
|
| Rate for Payer: Humana Medicaid |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.18
|
| Rate for Payer: Molina Healthcare Passport |
$20.76
|
| Rate for Payer: Multiplan PHCS |
$250.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.36
|
| Rate for Payer: UHCCP Medicaid |
$17.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.05
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$145.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
TRIM SKIN LESIONS 2 TO 4
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
76102632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Ambetter Exchange |
$21.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.45
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.26
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$75.04
|
| Rate for Payer: Healthspan PPO |
$66.38
|
| Rate for Payer: Humana Medicaid |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.18
|
| Rate for Payer: Molina Healthcare Passport |
$20.76
|
| Rate for Payer: Multiplan PHCS |
$250.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.36
|
| Rate for Payer: UHCCP Medicaid |
$17.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.05
|
|
|
TRINSICON CAPSULE (COMBIN 1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 51991063501
|
| Hospital Charge Code |
25001603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
TRINSICON CAPSULE (COMBIN 1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 51991063501
|
| Hospital Charge Code |
25001603
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
TRIOSTAT 10MCG/ML VIAL
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003545
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
TRIOSTAT 10MCG/ML VIAL
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003545
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$962.88 |
| Rate for Payer: Aetna Commercial |
$772.31
|
| Rate for Payer: Anthem Medicaid |
$344.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.34
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$832.49
|
| Rate for Payer: First Health Commercial |
$952.85
|
| Rate for Payer: Humana Commercial |
$852.55
|
| Rate for Payer: Humana KY Medicaid |
$344.93
|
| Rate for Payer: Kentucky WC Medicaid |
$348.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$351.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.64
|
| Rate for Payer: Ohio Health Group HMO |
$752.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.07
|
| Rate for Payer: PHCS Commercial |
$962.88
|
| Rate for Payer: United Healthcare All Payer |
$882.64
|
|
|
TRIO SUBLAT/SUBLIME & SRS/IPL
|
Professional
|
Both
|
$950.00
|
|
| Hospital Charge Code |
22200405
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
|
|
TRIPLE ANTIBOTIC OINT PKTS
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 45802014300
|
| Hospital Charge Code |
25003546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna Commercial |
$0.12
|
| Rate for Payer: First Health Commercial |
$0.14
|
| Rate for Payer: Humana Commercial |
$0.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.13
|
| Rate for Payer: Ohio Health Group HMO |
$0.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.10
|
| Rate for Payer: PHCS Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Payer |
$0.13
|
|
|
TRIPLE ANTIBOTIC OINT PKTS
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 45802014300
|
| Hospital Charge Code |
25003546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem Medicaid |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna Commercial |
$0.12
|
| Rate for Payer: First Health Commercial |
$0.14
|
| Rate for Payer: Humana Commercial |
$0.13
|
| Rate for Payer: Humana KY Medicaid |
$0.05
|
| Rate for Payer: Kentucky WC Medicaid |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.13
|
| Rate for Payer: Ohio Health Group HMO |
$0.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.10
|
| Rate for Payer: PHCS Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Payer |
$0.13
|
|
|
TRIPLE LUMEN EXTRACT BALLOON 1
|
Facility
|
IP
|
$1,825.77
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.73 |
| Max. Negotiated Rate |
$1,752.74 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.10
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.39
|
| Rate for Payer: First Health Commercial |
$1,734.48
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.78
|
| Rate for Payer: PHCS Commercial |
$1,752.74
|
| Rate for Payer: United Healthcare All Payer |
$1,606.68
|
|
|
TRIPLE LUMEN EXTRACT BALLOON 1
|
Facility
|
OP
|
$1,825.77
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.73 |
| Max. Negotiated Rate |
$1,752.74 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem Medicaid |
$627.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.10
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.39
|
| Rate for Payer: First Health Commercial |
$1,734.48
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Humana KY Medicaid |
$627.88
|
| Rate for Payer: Kentucky WC Medicaid |
$634.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.78
|
| Rate for Payer: PHCS Commercial |
$1,752.74
|
| Rate for Payer: United Healthcare All Payer |
$1,606.68
|
|
|
TRIPLE LUMEN EXTRACT BALLOON 2
|
Facility
|
IP
|
$1,825.77
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.73 |
| Max. Negotiated Rate |
$1,752.74 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.10
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.39
|
| Rate for Payer: First Health Commercial |
$1,734.48
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.78
|
| Rate for Payer: PHCS Commercial |
$1,752.74
|
| Rate for Payer: United Healthcare All Payer |
$1,606.68
|
|
|
TRIPLE LUMEN EXTRACT BALLOON 2
|
Facility
|
OP
|
$1,825.77
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.73 |
| Max. Negotiated Rate |
$1,752.74 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem Medicaid |
$627.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.10
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.39
|
| Rate for Payer: First Health Commercial |
$1,734.48
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Humana KY Medicaid |
$627.88
|
| Rate for Payer: Kentucky WC Medicaid |
$634.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,588.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.78
|
| Rate for Payer: PHCS Commercial |
$1,752.74
|
| Rate for Payer: United Healthcare All Payer |
$1,606.68
|
|
