|
EXC I PRESSURE ULCER
|
Professional
|
Both
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.71 |
| Max. Negotiated Rate |
$5,522.22 |
| Rate for Payer: Aetna Commercial |
$1,287.73
|
| Rate for Payer: Ambetter Exchange |
$892.17
|
| Rate for Payer: Anthem Medicaid |
$520.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$892.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$892.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,070.60
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$1,254.18
|
| Rate for Payer: Healthspan PPO |
$1,029.66
|
| Rate for Payer: Humana Medicaid |
$520.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,117.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$892.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$531.12
|
| Rate for Payer: Molina Healthcare Passport |
$520.71
|
| Rate for Payer: Multiplan PHCS |
$5,522.22
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,159.82
|
| Rate for Payer: UHCCP Medicaid |
$3,221.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$892.17
|
|
|
EXC I PRESSURE ULCER
|
Facility
|
OP
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$8,835.55 |
| Rate for Payer: Aetna Commercial |
$7,086.85
|
| Rate for Payer: Anthem Medicaid |
$3,165.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,178.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$7,639.07
|
| Rate for Payer: First Health Commercial |
$8,743.51
|
| Rate for Payer: Humana Commercial |
$7,823.15
|
| Rate for Payer: Humana KY Medicaid |
$3,165.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,228.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,362.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,007.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,350.55
|
| Rate for Payer: PHCS Commercial |
$8,835.55
|
| Rate for Payer: United Healthcare All Payer |
$8,099.26
|
|
|
EXC I PRESSURE ULCER(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761P0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.71 |
| Max. Negotiated Rate |
$1,287.73 |
| Rate for Payer: Aetna Commercial |
$1,287.73
|
| Rate for Payer: Ambetter Exchange |
$892.17
|
| Rate for Payer: Anthem Medicaid |
$520.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$892.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$892.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,070.60
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,254.18
|
| Rate for Payer: Healthspan PPO |
$1,029.66
|
| Rate for Payer: Humana Medicaid |
$520.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,117.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$892.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$531.12
|
| Rate for Payer: Molina Healthcare Passport |
$520.71
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,159.82
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$892.17
|
|
|
EXC I PRESSURE ULCER(T
|
Facility
|
OP
|
$7,603.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761T0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,614.91 |
| Max. Negotiated Rate |
$7,299.55 |
| Rate for Payer: Aetna Commercial |
$5,854.85
|
| Rate for Payer: Anthem Medicaid |
$2,614.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,930.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cigna Commercial |
$6,311.07
|
| Rate for Payer: First Health Commercial |
$7,223.52
|
| Rate for Payer: Humana Commercial |
$6,463.15
|
| Rate for Payer: Humana KY Medicaid |
$2,614.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,641.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,235.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,611.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,667.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,691.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,702.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,082.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,615.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,246.55
|
| Rate for Payer: PHCS Commercial |
$7,299.55
|
| Rate for Payer: United Healthcare All Payer |
$6,691.26
|
|
|
EXC I PRESSURE ULCER(T
|
Facility
|
IP
|
$7,603.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
761T0237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,281.11 |
| Max. Negotiated Rate |
$7,299.55 |
| Rate for Payer: Aetna Commercial |
$5,854.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,930.89
|
| Rate for Payer: Cash Price |
$3,801.85
|
| Rate for Payer: Cigna Commercial |
$6,311.07
|
| Rate for Payer: First Health Commercial |
$7,223.52
|
| Rate for Payer: Humana Commercial |
$6,463.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,235.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,611.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,281.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,691.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,702.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,082.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,615.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,246.55
|
| Rate for Payer: PHCS Commercial |
$7,299.55
|
| Rate for Payer: United Healthcare All Payer |
$6,691.26
|
|
|
EXCIS BX CERVICAL LYMPH
|
Professional
|
Both
|
$6,942.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$4,165.20 |
| Rate for Payer: Aetna Commercial |
$671.35
|
| Rate for Payer: Ambetter Exchange |
$445.95
|
| Rate for Payer: Anthem Medicaid |
$236.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$445.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$445.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$535.14
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: Healthspan PPO |
$536.81
|
| Rate for Payer: Humana Medicaid |
$236.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$445.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$241.14
|
| Rate for Payer: Molina Healthcare Passport |
$236.41
|
| Rate for Payer: Multiplan PHCS |
$4,165.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$579.74
|
| Rate for Payer: UHCCP Medicaid |
$2,429.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$445.95
|
|
|
EXCIS BX CERVICAL LYMPH
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,387.35 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
EXCIS BX CERVICAL LYMPH
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
76101596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
EXCIS BX CERVICAL LYMPH(P
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761P1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$671.35 |
| Rate for Payer: Aetna Commercial |
$671.35
|
| Rate for Payer: Ambetter Exchange |
$445.95
|
| Rate for Payer: Anthem Medicaid |
$236.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$445.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$445.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$535.14
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: Healthspan PPO |
$536.81
|
| Rate for Payer: Humana Medicaid |
$236.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$445.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$241.14
|
| Rate for Payer: Molina Healthcare Passport |
$236.41
|
| Rate for Payer: Multiplan PHCS |
$421.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$579.74
|
| Rate for Payer: UHCCP Medicaid |
$245.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$445.95
|
|
|
EXCIS BX CERVICAL LYMPH(T
|
Facility
|
OP
|
$6,240.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761T1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,145.94 |
| Max. Negotiated Rate |
$5,990.40 |
| Rate for Payer: Aetna Commercial |
$4,804.80
|
| Rate for Payer: Anthem Medicaid |
$2,145.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,867.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,120.00
|
| Rate for Payer: Cash Price |
$3,120.00
|
| Rate for Payer: Cigna Commercial |
$5,179.20
|
| Rate for Payer: First Health Commercial |
$5,928.00
|
| Rate for Payer: Humana Commercial |
$5,304.00
|
| Rate for Payer: Humana KY Medicaid |
$2,145.94
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,167.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,116.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,605.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,188.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,491.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,428.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,305.60
|
| Rate for Payer: PHCS Commercial |
$5,990.40
|
| Rate for Payer: United Healthcare All Payer |
$5,491.20
|
|
|
EXCIS BX CERVICAL LYMPH(T
|
Facility
|
IP
|
$6,240.00
|
|
|
Service Code
|
HCPCS 38520
|
| Hospital Charge Code |
761T1596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,872.00 |
| Max. Negotiated Rate |
$5,990.40 |
| Rate for Payer: Aetna Commercial |
$4,804.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,867.20
|
| Rate for Payer: Cash Price |
$3,120.00
|
| Rate for Payer: Cigna Commercial |
$5,179.20
|
| Rate for Payer: First Health Commercial |
$5,928.00
|
| Rate for Payer: Humana Commercial |
$5,304.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,116.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,605.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,491.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,428.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,305.60
|
| Rate for Payer: PHCS Commercial |
$5,990.40
|
| Rate for Payer: United Healthcare All Payer |
$5,491.20
|
|
|
EXCISE EXCESSIVE SKIN ARM
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 15836
|
| Hospital Charge Code |
76102711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,067.25 |
| Rate for Payer: Aetna Commercial |
$1,067.25
|
| Rate for Payer: Ambetter Exchange |
$752.54
|
| Rate for Payer: Anthem Medicaid |
$441.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$752.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$752.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$903.05
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,007.39
|
| Rate for Payer: Healthspan PPO |
$853.36
|
| Rate for Payer: Humana Medicaid |
$441.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$752.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$752.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.23
|
| Rate for Payer: Molina Healthcare Passport |
$441.40
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$978.30
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$445.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$752.54
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Facility
|
OP
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,001.84 |
| Max. Negotiated Rate |
$5,588.16 |
| Rate for Payer: Aetna Commercial |
$4,482.17
|
| Rate for Payer: Anthem Medicaid |
$2,001.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,540.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$4,831.43
|
| Rate for Payer: First Health Commercial |
$5,529.95
|
| Rate for Payer: Humana Commercial |
$4,947.85
|
| Rate for Payer: Humana KY Medicaid |
$2,001.84
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,022.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,295.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,042.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,122.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,365.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,064.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.49
|
| Rate for Payer: PHCS Commercial |
$5,588.16
|
| Rate for Payer: United Healthcare All Payer |
$5,122.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Professional
|
Both
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.59 |
| Max. Negotiated Rate |
$3,492.60 |
| Rate for Payer: Aetna Commercial |
$1,280.96
|
| Rate for Payer: Ambetter Exchange |
$880.43
|
| Rate for Payer: Anthem Medicaid |
$539.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$880.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,056.52
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$1,190.93
|
| Rate for Payer: Healthspan PPO |
$1,024.24
|
| Rate for Payer: Humana Medicaid |
$539.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$880.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$880.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.38
|
| Rate for Payer: Molina Healthcare Passport |
$539.59
|
| Rate for Payer: Multiplan PHCS |
$3,492.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,144.56
|
| Rate for Payer: UHCCP Medicaid |
$2,037.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$880.43
|
|
|
EXCISE EXCESSIVE SKIN BUTTCK
|
Facility
|
IP
|
$5,821.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
76100222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,746.30 |
| Max. Negotiated Rate |
$5,588.16 |
| Rate for Payer: Aetna Commercial |
$4,482.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,540.38
|
| Rate for Payer: Cash Price |
$2,910.50
|
| Rate for Payer: Cigna Commercial |
$4,831.43
|
| Rate for Payer: First Health Commercial |
$5,529.95
|
| Rate for Payer: Humana Commercial |
$4,947.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,773.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,295.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,746.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,122.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,365.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,064.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.49
|
| Rate for Payer: PHCS Commercial |
$5,588.16
|
| Rate for Payer: United Healthcare All Payer |
$5,122.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTC(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761P0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.59 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,280.96
|
| Rate for Payer: Ambetter Exchange |
$880.43
|
| Rate for Payer: Anthem Medicaid |
$539.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$880.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,056.52
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,190.93
|
| Rate for Payer: Healthspan PPO |
$1,024.24
|
| Rate for Payer: Humana Medicaid |
$539.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,156.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$880.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$880.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$550.38
|
| Rate for Payer: Molina Healthcare Passport |
$539.59
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,144.56
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$880.43
|
|
|
EXCISE EXCESSIVE SKIN BUTTC(T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761T0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.30 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN BUTTC(T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15835
|
| Hospital Charge Code |
761T0222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Facility
|
IP
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,321.80 |
| Max. Negotiated Rate |
$4,229.76 |
| Rate for Payer: Aetna Commercial |
$3,392.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.68
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$3,656.98
|
| Rate for Payer: First Health Commercial |
$4,185.70
|
| Rate for Payer: Humana Commercial |
$3,745.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,833.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.14
|
| Rate for Payer: PHCS Commercial |
$4,229.76
|
| Rate for Payer: United Healthcare All Payer |
$3,877.28
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Facility
|
OP
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,515.22 |
| Max. Negotiated Rate |
$4,229.76 |
| Rate for Payer: Aetna Commercial |
$3,392.62
|
| Rate for Payer: Anthem Medicaid |
$1,515.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,436.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$3,656.98
|
| Rate for Payer: First Health Commercial |
$4,185.70
|
| Rate for Payer: Humana Commercial |
$3,745.10
|
| Rate for Payer: Humana KY Medicaid |
$1,515.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,530.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,612.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,251.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,545.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,304.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,833.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.14
|
| Rate for Payer: PHCS Commercial |
$4,229.76
|
| Rate for Payer: United Healthcare All Payer |
$3,877.28
|
|
|
EXCISE EXCESSIVE SKIN HIP
|
Professional
|
Both
|
$4,406.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.36 |
| Max. Negotiated Rate |
$2,643.60 |
| Rate for Payer: Aetna Commercial |
$1,214.53
|
| Rate for Payer: Ambetter Exchange |
$843.92
|
| Rate for Payer: Anthem Medicaid |
$520.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$843.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$843.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,012.70
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cash Price |
$2,203.00
|
| Rate for Payer: Cigna Commercial |
$1,153.37
|
| Rate for Payer: Healthspan PPO |
$971.12
|
| Rate for Payer: Humana Medicaid |
$520.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$843.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Molina Healthcare Passport |
$520.36
|
| Rate for Payer: Multiplan PHCS |
$2,643.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,097.10
|
| Rate for Payer: UHCCP Medicaid |
$1,542.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$843.92
|
|
|
EXCISE EXCESSIVE SKIN HIP(P
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761P0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.75 |
| Max. Negotiated Rate |
$1,214.53 |
| Rate for Payer: Aetna Commercial |
$1,214.53
|
| Rate for Payer: Ambetter Exchange |
$843.92
|
| Rate for Payer: Anthem Medicaid |
$520.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$843.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$843.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,012.70
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$1,153.37
|
| Rate for Payer: Healthspan PPO |
$971.12
|
| Rate for Payer: Humana Medicaid |
$520.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$843.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Molina Healthcare Passport |
$520.36
|
| Rate for Payer: Multiplan PHCS |
$651.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,097.10
|
| Rate for Payer: UHCCP Medicaid |
$379.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$843.92
|
|
|
EXCISE EXCESSIVE SKIN HIP(T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761T0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.30 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN HIP(T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15834
|
| Hospital Charge Code |
761T0221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
EXCISE EXCESSIVE SKIN TISSUE
|
Facility
|
IP
|
$12,357.00
|
|
|
Service Code
|
HCPCS 15832
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,707.10 |
| Max. Negotiated Rate |
$11,862.72 |
| Rate for Payer: Aetna Commercial |
$9,514.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,638.46
|
| Rate for Payer: Cash Price |
$6,178.50
|
| Rate for Payer: Cigna Commercial |
$10,256.31
|
| Rate for Payer: First Health Commercial |
$11,739.15
|
| Rate for Payer: Humana Commercial |
$10,503.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,132.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,119.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,707.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,874.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,885.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,750.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,526.33
|
| Rate for Payer: PHCS Commercial |
$11,862.72
|
| Rate for Payer: United Healthcare All Payer |
$10,874.16
|
|
