|
EXCISION - BENIGN LESION FACE
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$1,393.92 |
| Rate for Payer: Aetna Commercial |
$1,118.04
|
| Rate for Payer: Anthem Medicaid |
$499.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,132.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,205.16
|
| Rate for Payer: First Health Commercial |
$1,379.40
|
| Rate for Payer: Humana Commercial |
$1,234.20
|
| Rate for Payer: Humana KY Medicaid |
$499.34
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$504.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,190.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,071.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$509.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,277.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$450.12
|
| Rate for Payer: PHCS Commercial |
$1,393.92
|
| Rate for Payer: United Healthcare All Payer |
$1,277.76
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXCISION - BENIGN LESION FACE
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$135.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,452.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$177.41
|
| Rate for Payer: Healthspan PPO |
$139.37
|
| Rate for Payer: Humana Medicaid |
$42.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.85
|
| Rate for Payer: Molina Healthcare Passport |
$42.99
|
| Rate for Payer: Multiplan PHCS |
$871.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,016.40
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.42
|
|
|
EXCISION - BENIGN LESION FAC(P
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761P0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Aetna Commercial |
$135.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.00
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$177.41
|
| Rate for Payer: Healthspan PPO |
$139.37
|
| Rate for Payer: Humana Medicaid |
$42.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.85
|
| Rate for Payer: Molina Healthcare Passport |
$42.99
|
| Rate for Payer: Multiplan PHCS |
$324.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$378.70
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.42
|
|
|
EXCISION - BENIGN LESION FAC(T
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761T0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXCISION - BENIGN LESION FAC(T
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761T0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 11426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 11400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
CPT 11401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 11402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 11403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
EXCISION - BENIGN LESION(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
761P0064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.37
|
| Rate for Payer: Anthem Medicaid |
$59.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$216.66
|
| Rate for Payer: Healthspan PPO |
$178.06
|
| Rate for Payer: Humana Medicaid |
$59.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$159.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.30
|
| Rate for Payer: Molina Healthcare Passport |
$59.12
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$70.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.71
|
|
|
EXCISION BENIGN LESION(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
761P0058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$154.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.96
|
| Rate for Payer: Anthem Medicaid |
$54.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$199.93
|
| Rate for Payer: Healthspan PPO |
$166.73
|
| Rate for Payer: Humana Medicaid |
$54.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.74
|
| Rate for Payer: Molina Healthcare Passport |
$54.65
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$60.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.20
|
|
|
EXCISION BENIGN LESION(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
761P0056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$331.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.49
|
| Rate for Payer: Anthem Medicaid |
$137.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$378.50
|
| Rate for Payer: Healthspan PPO |
$325.61
|
| Rate for Payer: Humana Medicaid |
$137.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$297.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.72
|
| Rate for Payer: Molina Healthcare Passport |
$137.96
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$132.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.34
|
|
|
EXCISION - BENIGN LESION(T
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
761T0064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.65 |
| Max. Negotiated Rate |
$1,636.80 |
| Rate for Payer: Aetna Commercial |
$1,312.85
|
| Rate for Payer: Anthem Medicaid |
$586.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$1,415.15
|
| Rate for Payer: First Health Commercial |
$1,619.75
|
| Rate for Payer: Humana Commercial |
$1,449.25
|
| Rate for Payer: Humana KY Medicaid |
$586.35
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$592.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.55
|
| Rate for Payer: PHCS Commercial |
$1,636.80
|
| Rate for Payer: United Healthcare All Payer |
$1,500.40
|
|
|
EXCISION - BENIGN LESION(T
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
761T0064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.65 |
| Max. Negotiated Rate |
$1,636.80 |
| Rate for Payer: Aetna Commercial |
$1,312.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.90
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna Commercial |
$1,415.15
|
| Rate for Payer: First Health Commercial |
$1,619.75
|
| Rate for Payer: Humana Commercial |
$1,449.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.55
|
| Rate for Payer: PHCS Commercial |
$1,636.80
|
| Rate for Payer: United Healthcare All Payer |
$1,500.40
|
|
|
EXCISION BENIGN LESION(T
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
761T0058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
