|
EXCISION BIOPSY - SUPERFICIAL
|
Professional
|
Both
|
$3,372.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
76100436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$2,023.20 |
| Rate for Payer: Aetna Commercial |
$237.91
|
| Rate for Payer: Ambetter Exchange |
$150.33
|
| 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 Individual/Medicaid |
$150.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.40
|
| Rate for Payer: Cash Price |
$1,686.00
|
| Rate for Payer: Cash Price |
$1,686.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.33
|
| Rate for Payer: Molina Healthcare Passport |
$85.62
|
| Rate for Payer: Multiplan PHCS |
$2,023.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.43
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.33
|
|
|
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: Ambetter Exchange |
$150.33
|
| 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 Individual/Medicaid |
$150.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.33
|
| 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 |
$195.43
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.33
|
|
|
EXCISION BIOPSY - SUPERFICIA(T
|
Facility
|
OP
|
$3,072.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
761T0436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,056.46 |
| Max. Negotiated Rate |
$2,949.12 |
| Rate for Payer: Aetna Commercial |
$2,365.44
|
| Rate for Payer: Anthem Medicaid |
$1,056.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,396.16
|
| 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 |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cigna Commercial |
$2,549.76
|
| Rate for Payer: First Health Commercial |
$2,918.40
|
| Rate for Payer: Humana Commercial |
$2,611.20
|
| Rate for Payer: Humana KY Medicaid |
$1,056.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,067.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,519.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,267.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,077.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,703.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,304.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,672.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,119.68
|
| Rate for Payer: PHCS Commercial |
$2,949.12
|
| Rate for Payer: United Healthcare All Payer |
$2,703.36
|
|
|
EXCISION BIOPSY - SUPERFICIA(T
|
Facility
|
IP
|
$3,072.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
761T0436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.60 |
| Max. Negotiated Rate |
$2,949.12 |
| Rate for Payer: Aetna Commercial |
$2,365.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,396.16
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cigna Commercial |
$2,549.76
|
| Rate for Payer: First Health Commercial |
$2,918.40
|
| Rate for Payer: Humana Commercial |
$2,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,519.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,267.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$921.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,703.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,304.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,672.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,119.68
|
| Rate for Payer: PHCS Commercial |
$2,949.12
|
| Rate for Payer: United Healthcare All Payer |
$2,703.36
|
|
|
EXCISION CYSTIC HYGROMA - AX
|
Facility
|
OP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
76101601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,784.50 |
| 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 |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| 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 |
$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 |
$3,538.18
|
| 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 |
$4,245.82
|
| 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 |
$4,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,514.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,580.41
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
|
EXCISION CYSTIC HYGROMA - AX
|
Facility
|
IP
|
$5,189.00
|
|
|
Service Code
|
HCPCS 38550
|
| Hospital Charge Code |
76101601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.70 |
| 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 |
$4,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,514.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,580.41
|
| 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 |
$3,113.40 |
| Rate for Payer: Aetna Commercial |
$692.56
|
| Rate for Payer: Ambetter Exchange |
$497.88
|
| Rate for Payer: Anthem Medicaid |
$290.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$497.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$497.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$597.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$497.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.88
|
| 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 |
$647.24
|
| Rate for Payer: UHCCP Medicaid |
$1,816.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$497.88
|
|
|
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 |
$692.56 |
| Rate for Payer: Aetna Commercial |
$692.56
|
| Rate for Payer: Ambetter Exchange |
$497.88
|
| Rate for Payer: Anthem Medicaid |
$290.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$497.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$497.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$597.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$497.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.88
|
| 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 |
$647.24
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$497.88
|
|
|
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 |
$1,301.70 |
| 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 |
$3,471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.91
|
| 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 |
$1,492.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,341.03
|
| Rate for Payer: Anthem Medicaid |
$1,492.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.42
|
| 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 |
$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 |
$3,538.18
|
| 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 |
$4,245.82
|
| 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 |
$3,471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.91
|
| 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
|
$8,435.98
|
|
|
Service Code
|
CPT 15830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,025.70 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ARM
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 15836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); HIP
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 15834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 15839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 15832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
EXCISION FACE OVER 4.0 CM
|
Facility
|
IP
|
$5,934.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,780.20 |
| Max. Negotiated Rate |
$5,696.64 |
| Rate for Payer: Aetna Commercial |
$4,569.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,628.52
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,925.22
|
| Rate for Payer: First Health Commercial |
$5,637.30
|
| Rate for Payer: Humana Commercial |
$5,043.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,865.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,379.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,780.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,221.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,450.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,162.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,094.46
|
| Rate for Payer: PHCS Commercial |
$5,696.64
|
| Rate for Payer: United Healthcare All Payer |
$5,221.92
|
|
|
EXCISION FACE OVER 4.0 CM
|
Professional
|
Both
|
$5,934.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$3,560.40 |
| Rate for Payer: Aetna Commercial |
$579.62
|
| Rate for Payer: Ambetter Exchange |
$365.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$212.59
|
| Rate for Payer: Anthem Medicaid |
$302.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.98
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$551.54
|
| Rate for Payer: Healthspan PPO |
$574.30
|
| Rate for Payer: Humana Medicaid |
$302.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.15
|
| Rate for Payer: Molina Healthcare Passport |
$302.11
|
| Rate for Payer: Multiplan PHCS |
$3,560.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$475.57
|
| Rate for Payer: UHCCP Medicaid |
$223.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.82
|
|
|
EXCISION FACE OVER 4.0 CM
|
Facility
|
OP
|
$5,934.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,040.70 |
| Max. Negotiated Rate |
$5,696.64 |
| Rate for Payer: Aetna Commercial |
$4,569.18
|
| Rate for Payer: Anthem Medicaid |
$2,040.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,628.52
|
| 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 |
$2,967.00
|
| Rate for Payer: Cash Price |
$2,967.00
|
| Rate for Payer: Cigna Commercial |
$4,925.22
|
| Rate for Payer: First Health Commercial |
$5,637.30
|
| Rate for Payer: Humana Commercial |
$5,043.90
|
| Rate for Payer: Humana KY Medicaid |
$2,040.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,061.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,865.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,379.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,081.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,221.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,450.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,162.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,094.46
|
| Rate for Payer: PHCS Commercial |
$5,696.64
|
| Rate for Payer: United Healthcare All Payer |
$5,221.92
|
|
|
EXCISION FACE OVER 4.0 CM(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761P0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$579.62
|
| Rate for Payer: Ambetter Exchange |
$365.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$212.59
|
| Rate for Payer: Anthem Medicaid |
$302.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.98
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$551.54
|
| Rate for Payer: Healthspan PPO |
$574.30
|
| Rate for Payer: Humana Medicaid |
$302.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.15
|
| Rate for Payer: Molina Healthcare Passport |
$302.11
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$475.57
|
| Rate for Payer: UHCCP Medicaid |
$223.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.82
|
|
|
EXCISION FACE OVER 4.0 CM(T
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761T0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,628.02 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem Medicaid |
$1,628.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| 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 |
$2,367.00
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Humana KY Medicaid |
$1,628.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,118.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,266.46
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
EXCISION FACE OVER 4.0 CM(T
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
761T0092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,420.20 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,118.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,266.46
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
EXCISION GRAFT ABDOMEN
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,402.50 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,225.75
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
EXCISION GRAFT ABDOMEN
|
Professional
|
Both
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.85 |
| Max. Negotiated Rate |
$3,399.95 |
| Rate for Payer: Aetna Commercial |
$3,399.95
|
| Rate for Payer: Ambetter Exchange |
$1,795.60
|
| Rate for Payer: Anthem Medicaid |
$746.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,795.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,795.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,154.72
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,252.03
|
| Rate for Payer: Healthspan PPO |
$3,342.80
|
| Rate for Payer: Humana Medicaid |
$746.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,642.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,795.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,795.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$761.79
|
| Rate for Payer: Molina Healthcare Passport |
$746.85
|
| Rate for Payer: Multiplan PHCS |
$2,805.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,334.28
|
| Rate for Payer: UHCCP Medicaid |
$1,636.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$754.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,795.60
|
|
|
EXCISION GRAFT ABDOMEN
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 35907
|
| Hospital Charge Code |
76102925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,402.50 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem Medicaid |
$1,607.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Humana KY Medicaid |
$1,607.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,225.75
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
EXCISION GRAFT NECK
|
Professional
|
Both
|
$502.07
|
|
|
Service Code
|
HCPCS 35901
|
| Hospital Charge Code |
76102730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.72 |
| Max. Negotiated Rate |
$868.23 |
| Rate for Payer: Aetna Commercial |
$868.23
|
| Rate for Payer: Ambetter Exchange |
$448.67
|
| Rate for Payer: Anthem Medicaid |
$440.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.40
|
| Rate for Payer: Cash Price |
$251.04
|
| Rate for Payer: Cash Price |
$251.04
|
| Rate for Payer: Cigna Commercial |
$850.34
|
| Rate for Payer: Healthspan PPO |
$853.64
|
| Rate for Payer: Humana Medicaid |
$440.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.62
|
| Rate for Payer: Molina Healthcare Passport |
$440.80
|
| Rate for Payer: Multiplan PHCS |
$301.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.27
|
| Rate for Payer: UHCCP Medicaid |
$175.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$445.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.67
|
|
