|
EXCISION BENIGN LESION(T
|
Facility
|
IP
|
$4,212.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
761T0056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.56 |
| Max. Negotiated Rate |
$4,043.52 |
| Rate for Payer: Aetna Commercial |
$3,243.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.36
|
| Rate for Payer: Cash Price |
$2,106.00
|
| Rate for Payer: Cigna Commercial |
$3,495.96
|
| Rate for Payer: First Health Commercial |
$4,001.40
|
| Rate for Payer: Humana Commercial |
$3,580.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,706.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.72
|
| Rate for Payer: PHCS Commercial |
$4,043.52
|
| Rate for Payer: United Healthcare All Payer |
$3,706.56
|
|
|
EXCISION BENIGN LESION(T
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$1,930.50
|
| 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: 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 |
$742.50
|
| 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
|
|
|
EXCISION BENIGN LESION(T
|
Facility
|
OP
|
$4,212.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
761T0056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.56 |
| Max. Negotiated Rate |
$4,043.52 |
| Rate for Payer: Aetna Commercial |
$3,243.24
|
| Rate for Payer: Anthem Medicaid |
$1,448.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,106.00
|
| Rate for Payer: Cash Price |
$2,106.00
|
| Rate for Payer: Cigna Commercial |
$3,495.96
|
| Rate for Payer: First Health Commercial |
$4,001.40
|
| Rate for Payer: Humana Commercial |
$3,580.20
|
| Rate for Payer: Humana KY Medicaid |
$1,448.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,706.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.72
|
| Rate for Payer: PHCS Commercial |
$4,043.52
|
| Rate for Payer: United Healthcare All Payer |
$3,706.56
|
|
|
EXCISION BENIGN(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
761P0057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$113.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.65
|
| Rate for Payer: Anthem Medicaid |
$37.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$156.41
|
| Rate for Payer: Healthspan PPO |
$127.88
|
| Rate for Payer: Humana Medicaid |
$37.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.59
|
| Rate for Payer: Molina Healthcare Passport |
$37.83
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$48.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.21
|
|
|
EXCISION BENIGN(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
761T0057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXCISION BENIGN(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
761T0057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXCISION BIOPSY - SUPERFICIAL
|
Facility
|
IP
|
$3,371.73
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.32 |
| Max. Negotiated Rate |
$3,236.86 |
| Rate for Payer: Aetna Commercial |
$2,596.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,629.95
|
| Rate for Payer: Cash Price |
$1,685.87
|
| Rate for Payer: Cigna Commercial |
$2,798.54
|
| Rate for Payer: First Health Commercial |
$3,203.14
|
| Rate for Payer: Humana Commercial |
$2,865.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,764.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,488.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,011.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,967.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,528.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.24
|
| Rate for Payer: PHCS Commercial |
$3,236.86
|
| Rate for Payer: United Healthcare All Payer |
$2,967.12
|
|
|
EXCISION BIOPSY - SUPERFICIAL
|
Facility
|
OP
|
$3,371.73
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.32 |
| Max. Negotiated Rate |
$3,236.86 |
| Rate for Payer: Aetna Commercial |
$2,596.23
|
| Rate for Payer: Anthem Medicaid |
$1,159.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,629.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,685.87
|
| Rate for Payer: Cash Price |
$1,685.87
|
| Rate for Payer: Cigna Commercial |
$2,798.54
|
| Rate for Payer: First Health Commercial |
$3,203.14
|
| Rate for Payer: Humana Commercial |
$2,865.97
|
| Rate for Payer: Humana KY Medicaid |
$1,159.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,764.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,488.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,182.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,967.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,528.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.24
|
| Rate for Payer: PHCS Commercial |
$3,236.86
|
| Rate for Payer: United Healthcare All Payer |
$2,967.12
|
|
|
EXCISION BIOPSY - SUPERFICIAL
|
Professional
|
Both
|
$3,371.73
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$3,371.73 |
| Rate for Payer: Aetna Commercial |
$237.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$85.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,371.73
|
| Rate for Payer: Cash Price |
$1,685.87
|
| Rate for Payer: Cash Price |
$1,685.87
|
| Rate for Payer: Cigna Commercial |
$311.71
|
| Rate for Payer: Healthspan PPO |
$268.83
|
| Rate for Payer: Humana Medicaid |
$85.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.33
|
| Rate for Payer: Molina Healthcare Passport |
$85.62
|
| Rate for Payer: Multiplan PHCS |
$2,023.04
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,360.21
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.48
|
|
|
EXCISION BIOPSY - SUPERFICIA(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
761P0436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$311.71 |
| Rate for Payer: Aetna Commercial |
$237.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$85.62
|
| 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 |
$311.71
|
| Rate for Payer: Healthspan PPO |
$268.83
|
| Rate for Payer: Humana Medicaid |
$85.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.33
|
| Rate for Payer: Molina Healthcare Passport |
$85.62
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.48
|
|
|
EXCISION BIOPSY - SUPERFICIA(T
|
Facility
|
OP
|
$3,071.73
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
761T0436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.32 |
| Max. Negotiated Rate |
$2,948.86 |
| Rate for Payer: Aetna Commercial |
$2,365.23
|
| Rate for Payer: Anthem Medicaid |
$1,056.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,395.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cigna Commercial |
$2,549.54
|
| Rate for Payer: First Health Commercial |
$2,918.14
|
| Rate for Payer: Humana Commercial |
$2,610.97
|
| Rate for Payer: Humana KY Medicaid |
$1,056.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,067.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,518.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,266.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,077.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,703.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,303.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.24
|
| Rate for Payer: PHCS Commercial |
$2,948.86
|
| Rate for Payer: United Healthcare All Payer |
$2,703.12
|
|
|
EXCISION BIOPSY - SUPERFICIA(T
|
Facility
|
IP
|
$3,071.73
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
761T0436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.32 |
| Max. Negotiated Rate |
$2,948.86 |
| Rate for Payer: Aetna Commercial |
$2,365.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,395.95
|
| Rate for Payer: Cash Price |
$1,535.87
|
| Rate for Payer: Cigna Commercial |
$2,549.54
|
| Rate for Payer: First Health Commercial |
$2,918.14
|
| Rate for Payer: Humana Commercial |
$2,610.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,518.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,266.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$921.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,703.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,303.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.24
|
| Rate for Payer: PHCS Commercial |
$2,948.86
|
| Rate for Payer: United Healthcare All Payer |
$2,703.12
|
|
|
EXCISION CYSTIC HYGROMA - AX
|
Facility
|
IP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
76101601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.57 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$4,306.87
|
| Rate for Payer: First Health Commercial |
$4,929.55
|
| Rate for Payer: Humana Commercial |
$4,410.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,254.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,829.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,566.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.59
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
|
EXCISION CYSTIC HYGROMA - AX
|
Facility
|
OP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
76101601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.57 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem Medicaid |
$1,784.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$4,306.87
|
| Rate for Payer: First Health Commercial |
$4,929.55
|
| Rate for Payer: Humana Commercial |
$4,410.65
|
| Rate for Payer: Humana KY Medicaid |
$1,784.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,254.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,829.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,566.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.59
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
|
EXCISION CYSTIC HYGROMA - AX
|
Professional
|
Both
|
$5,189.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
76101601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.33 |
| Max. Negotiated Rate |
$5,189.00 |
| Rate for Payer: Aetna Commercial |
$692.56
|
| Rate for Payer: Anthem Medicaid |
$290.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,189.00
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$641.26
|
| Rate for Payer: Healthspan PPO |
$553.77
|
| Rate for Payer: Humana Medicaid |
$290.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.14
|
| Rate for Payer: Molina Healthcare Passport |
$290.33
|
| Rate for Payer: Multiplan PHCS |
$3,113.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,632.30
|
| Rate for Payer: UHCCP Medicaid |
$1,816.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.23
|
|
|
EXCISION CYSTIC HYGROMA - AX(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
761P1601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.33 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$692.56
|
| Rate for Payer: Anthem Medicaid |
$290.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$641.26
|
| Rate for Payer: Healthspan PPO |
$553.77
|
| Rate for Payer: Humana Medicaid |
$290.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.14
|
| Rate for Payer: Molina Healthcare Passport |
$290.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.23
|
|
|
EXCISION CYSTIC HYGROMA - AX(T
|
Facility
|
IP
|
$4,339.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
761T1601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.07 |
| Max. Negotiated Rate |
$4,165.44 |
| Rate for Payer: Aetna Commercial |
$3,341.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.42
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cigna Commercial |
$3,601.37
|
| Rate for Payer: First Health Commercial |
$4,122.05
|
| Rate for Payer: Humana Commercial |
$3,688.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.09
|
| Rate for Payer: PHCS Commercial |
$4,165.44
|
| Rate for Payer: United Healthcare All Payer |
$3,818.32
|
|
|
EXCISION CYSTIC HYGROMA - AX(T
|
Facility
|
OP
|
$4,339.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
761T1601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.07 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Aetna Commercial |
$3,341.03
|
| Rate for Payer: Anthem Medicaid |
$1,492.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cash Price |
$2,169.50
|
| Rate for Payer: Cigna Commercial |
$3,601.37
|
| Rate for Payer: First Health Commercial |
$4,122.05
|
| Rate for Payer: Humana Commercial |
$3,688.15
|
| Rate for Payer: Humana KY Medicaid |
$1,492.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,522.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.09
|
| Rate for Payer: PHCS Commercial |
$4,165.44
|
| Rate for Payer: United Healthcare All Payer |
$3,818.32
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY
|
Facility
|
OP
|
$7,894.80
|
|
|
Service Code
|
CPT 15830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,639.14 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ARM
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 15836
|
|
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, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); HIP
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 15834
|
|
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, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 15839
|
|
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, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 15832
|
|
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 FACE OVER 4.0 CM
|
Facility
|
OP
|
$5,645.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$5,419.20 |
| Rate for Payer: Aetna Commercial |
$4,346.65
|
| Rate for Payer: Anthem Medicaid |
$1,941.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,403.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,822.50
|
| Rate for Payer: Cash Price |
$2,822.50
|
| Rate for Payer: Cigna Commercial |
$4,685.35
|
| Rate for Payer: First Health Commercial |
$5,362.75
|
| Rate for Payer: Humana Commercial |
$4,798.25
|
| Rate for Payer: Humana KY Medicaid |
$1,941.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,961.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,628.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,166.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,980.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,967.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,233.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,749.95
|
| Rate for Payer: PHCS Commercial |
$5,419.20
|
| Rate for Payer: United Healthcare All Payer |
$4,967.60
|
|
|
EXCISION FACE OVER 4.0 CM
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$5,419.20 |
| Rate for Payer: Aetna Commercial |
$4,346.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,403.10
|
| Rate for Payer: Cash Price |
$2,822.50
|
| Rate for Payer: Cigna Commercial |
$4,685.35
|
| Rate for Payer: First Health Commercial |
$5,362.75
|
| Rate for Payer: Humana Commercial |
$4,798.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,628.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,166.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,693.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,967.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,233.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,749.95
|
| Rate for Payer: PHCS Commercial |
$5,419.20
|
| Rate for Payer: United Healthcare All Payer |
$4,967.60
|
|
