|
EXCISION BARTHOLIN GLAND/CYST
|
Professional
|
Both
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.98 |
| Max. Negotiated Rate |
$4,658.40 |
| Rate for Payer: Aetna Commercial |
$448.76
|
| Rate for Payer: Ambetter Exchange |
$296.34
|
| Rate for Payer: Anthem Medicaid |
$195.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$296.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$296.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$355.61
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$436.93
|
| Rate for Payer: Healthspan PPO |
$434.51
|
| Rate for Payer: Humana Medicaid |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$296.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.90
|
| Rate for Payer: Molina Healthcare Passport |
$195.98
|
| Rate for Payer: Multiplan PHCS |
$4,658.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.24
|
| Rate for Payer: UHCCP Medicaid |
$2,717.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.34
|
|
|
EXCISION BARTHOLIN GLAND/CYST
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
76102164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,329.20 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,754.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,357.16
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
EXCISION BENIGN
|
Facility
|
OP
|
$2,434.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.05 |
| Max. Negotiated Rate |
$2,336.64 |
| Rate for Payer: Aetna Commercial |
$1,874.18
|
| Rate for Payer: Anthem Medicaid |
$837.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,898.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,217.00
|
| Rate for Payer: Cash Price |
$1,217.00
|
| Rate for Payer: Cigna Commercial |
$2,020.22
|
| Rate for Payer: First Health Commercial |
$2,312.30
|
| Rate for Payer: Humana Commercial |
$2,068.90
|
| Rate for Payer: Humana KY Medicaid |
$837.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$845.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,995.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,796.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$853.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,141.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,825.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,117.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,679.46
|
| Rate for Payer: PHCS Commercial |
$2,336.64
|
| Rate for Payer: United Healthcare All Payer |
$2,141.92
|
|
|
EXCISION BENIGN
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.08 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem Medicaid |
$751.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Humana KY Medicaid |
$751.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXCISION BENIGN
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
45000031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXCISION BENIGN
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.20 |
| Max. Negotiated Rate |
$2,336.64 |
| Rate for Payer: Aetna Commercial |
$1,874.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,898.52
|
| Rate for Payer: Cash Price |
$1,217.00
|
| Rate for Payer: Cigna Commercial |
$2,020.22
|
| Rate for Payer: First Health Commercial |
$2,312.30
|
| Rate for Payer: Humana Commercial |
$2,068.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,995.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,796.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,141.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,825.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,117.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,679.46
|
| Rate for Payer: PHCS Commercial |
$2,336.64
|
| Rate for Payer: United Healthcare All Payer |
$2,141.92
|
|
|
EXCISION BENIGN
|
Professional
|
Both
|
$2,434.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$1,460.40 |
| Rate for Payer: Aetna Commercial |
$113.91
|
| Rate for Payer: Ambetter Exchange |
$77.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.65
|
| Rate for Payer: Anthem Medicaid |
$44.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.88
|
| Rate for Payer: Cash Price |
$1,217.00
|
| Rate for Payer: Cash Price |
$1,217.00
|
| Rate for Payer: Cigna Commercial |
$156.41
|
| Rate for Payer: Healthspan PPO |
$127.88
|
| Rate for Payer: Humana Medicaid |
$44.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$98.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.70
|
| Rate for Payer: Molina Healthcare Passport |
$44.80
|
| Rate for Payer: Multiplan PHCS |
$1,460.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.62
|
| Rate for Payer: UHCCP Medicaid |
$48.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.40
|
|
|
EXCISION - BENIGN LESION
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Aetna Commercial |
$178.81
|
| Rate for Payer: Ambetter Exchange |
$124.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.37
|
| Rate for Payer: Anthem Medicaid |
$70.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.99
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$216.66
|
| Rate for Payer: Healthspan PPO |
$178.06
|
| Rate for Payer: Humana Medicaid |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$159.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.93
|
| Rate for Payer: Molina Healthcare Passport |
$70.52
|
| Rate for Payer: Multiplan PHCS |
$1,299.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.41
|
| Rate for Payer: UHCCP Medicaid |
$70.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.16
|
|
|
EXCISION - BENIGN LESION
|
Facility
|
IP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.80 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,884.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.54
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
EXCISION - BENIGN LESION
|
Facility
|
OP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem Medicaid |
$744.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Humana KY Medicaid |
$744.89
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,884.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.54
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
EXCISION BENIGN LESION
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem Medicaid |
$1,731.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Humana KY Medicaid |
$1,731.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,380.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,474.15
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
EXCISION BENIGN LESION
|
Professional
|
Both
|
$5,035.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$3,021.00 |
| Rate for Payer: Aetna Commercial |
$331.75
|
| Rate for Payer: Ambetter Exchange |
$235.14
|
| 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 Individual/Medicaid |
$235.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$282.17
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cash Price |
$2,517.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$235.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.72
|
| Rate for Payer: Molina Healthcare Passport |
$137.96
|
| Rate for Payer: Multiplan PHCS |
$3,021.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$305.68
|
| Rate for Payer: UHCCP Medicaid |
$132.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$235.14
|
|
|
EXCISION BENIGN LESION
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,510.50 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,380.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,474.15
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
EXCISION BENIGN LESION
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,818.56 |
| Rate for Payer: Aetna Commercial |
$2,260.72
|
| Rate for Payer: Anthem Medicaid |
$1,009.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cigna Commercial |
$2,436.88
|
| Rate for Payer: First Health Commercial |
$2,789.20
|
| Rate for Payer: Humana Commercial |
$2,495.60
|
| Rate for Payer: Humana KY Medicaid |
$1,009.69
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,019.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,407.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,166.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,029.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,583.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,554.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.84
|
| Rate for Payer: PHCS Commercial |
$2,818.56
|
| Rate for Payer: United Healthcare All Payer |
$2,583.68
|
|
|
EXCISION BENIGN LESION
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$1,761.60 |
| Rate for Payer: Aetna Commercial |
$154.48
|
| Rate for Payer: Ambetter Exchange |
$102.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.96
|
| Rate for Payer: Anthem Medicaid |
$64.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.88
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cigna Commercial |
$199.93
|
| Rate for Payer: Healthspan PPO |
$166.73
|
| Rate for Payer: Humana Medicaid |
$64.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.45
|
| Rate for Payer: Molina Healthcare Passport |
$64.17
|
| Rate for Payer: Multiplan PHCS |
$1,761.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.12
|
| Rate for Payer: UHCCP Medicaid |
$60.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.40
|
|
|
EXCISION BENIGN LESION
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.80 |
| Max. Negotiated Rate |
$2,818.56 |
| Rate for Payer: Aetna Commercial |
$2,260.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.08
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cigna Commercial |
$2,436.88
|
| Rate for Payer: First Health Commercial |
$2,789.20
|
| Rate for Payer: Humana Commercial |
$2,495.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,407.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,166.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$880.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,583.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,554.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.84
|
| Rate for Payer: PHCS Commercial |
$2,818.56
|
| Rate for Payer: United Healthcare All Payer |
$2,583.68
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
EXCISION - BENIGN LESION FACE
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$906.60 |
| Rate for Payer: Aetna Commercial |
$135.24
|
| Rate for Payer: Ambetter Exchange |
$99.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$52.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.47
|
| Rate for Payer: Cash Price |
$755.50
|
| Rate for Payer: Cash Price |
$755.50
|
| Rate for Payer: Cigna Commercial |
$177.41
|
| Rate for Payer: Healthspan PPO |
$139.37
|
| Rate for Payer: Humana Medicaid |
$52.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.28
|
| Rate for Payer: Molina Healthcare Passport |
$52.24
|
| Rate for Payer: Multiplan PHCS |
$906.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.43
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.56
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
IP
|
$1,511.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.30 |
| Max. Negotiated Rate |
$1,450.56 |
| Rate for Payer: Aetna Commercial |
$1,163.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,178.58
|
| Rate for Payer: Cash Price |
$755.50
|
| Rate for Payer: Cigna Commercial |
$1,254.13
|
| Rate for Payer: First Health Commercial |
$1,435.45
|
| Rate for Payer: Humana Commercial |
$1,284.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,329.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,314.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.59
|
| Rate for Payer: PHCS Commercial |
$1,450.56
|
| Rate for Payer: United Healthcare All Payer |
$1,329.68
|
|
|
EXCISION - BENIGN LESION FACE
|
Facility
|
OP
|
$1,511.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.63 |
| Max. Negotiated Rate |
$1,450.56 |
| Rate for Payer: Aetna Commercial |
$1,163.47
|
| Rate for Payer: Anthem Medicaid |
$519.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,178.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$755.50
|
| Rate for Payer: Cash Price |
$755.50
|
| Rate for Payer: Cigna Commercial |
$1,254.13
|
| Rate for Payer: First Health Commercial |
$1,435.45
|
| Rate for Payer: Humana Commercial |
$1,284.35
|
| Rate for Payer: Humana KY Medicaid |
$519.63
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$524.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,329.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,314.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.59
|
| Rate for Payer: PHCS Commercial |
$1,450.56
|
| Rate for Payer: United Healthcare All Payer |
$1,329.68
|
|
|
EXCISION - BENIGN LESION FAC(P
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761P0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$324.60 |
| Rate for Payer: Aetna Commercial |
$135.24
|
| Rate for Payer: Ambetter Exchange |
$99.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.18
|
| Rate for Payer: Anthem Medicaid |
$52.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.47
|
| 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 |
$52.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.28
|
| Rate for Payer: Molina Healthcare Passport |
$52.24
|
| Rate for Payer: Multiplan PHCS |
$324.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.43
|
| Rate for Payer: UHCCP Medicaid |
$57.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.56
|
|
|
EXCISION - BENIGN LESION FAC(T
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761T0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
EXCISION - BENIGN LESION FAC(T
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
761T0063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
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
|
$2,095.90
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
