|
LARYNGOSCOPY W/STROBOSCOPY
|
Facility
|
OP
|
$1,899.00
|
|
|
Service Code
|
HCPCS 31579
|
| Hospital Charge Code |
76101166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.79 |
| Max. Negotiated Rate |
$1,823.04 |
| Rate for Payer: Aetna Commercial |
$1,462.23
|
| Rate for Payer: Anthem Medicaid |
$653.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$358.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$502.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.37
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cigna Commercial |
$1,576.17
|
| Rate for Payer: First Health Commercial |
$1,804.05
|
| Rate for Payer: Humana Commercial |
$1,614.15
|
| Rate for Payer: Humana KY Medicaid |
$653.07
|
| Rate for Payer: Humana Medicare Advantage |
$358.79
|
| Rate for Payer: Kentucky WC Medicaid |
$659.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.31
|
| Rate for Payer: PHCS Commercial |
$1,823.04
|
| Rate for Payer: United Healthcare All Payer |
$1,671.12
|
|
|
LARYNGOSCOPY W/STROBOSCOPY
|
Facility
|
IP
|
$1,899.00
|
|
|
Service Code
|
HCPCS 31579
|
| Hospital Charge Code |
76101166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$569.70 |
| Max. Negotiated Rate |
$1,823.04 |
| Rate for Payer: Aetna Commercial |
$1,462.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.22
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Cigna Commercial |
$1,576.17
|
| Rate for Payer: First Health Commercial |
$1,804.05
|
| Rate for Payer: Humana Commercial |
$1,614.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.31
|
| Rate for Payer: PHCS Commercial |
$1,823.04
|
| Rate for Payer: United Healthcare All Payer |
$1,671.12
|
|
|
LARYNGOSCOPY W/STROBOSCOPY(P
|
Professional
|
Both
|
$1,281.00
|
|
|
Service Code
|
HCPCS 31579
|
| Hospital Charge Code |
761P1166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Aetna Commercial |
$211.26
|
| Rate for Payer: Ambetter Exchange |
$112.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.01
|
| Rate for Payer: Anthem Medicaid |
$135.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.34
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$331.47
|
| Rate for Payer: Healthspan PPO |
$260.75
|
| Rate for Payer: Humana Medicaid |
$135.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$184.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.83
|
| Rate for Payer: Molina Healthcare Passport |
$135.13
|
| Rate for Payer: Multiplan PHCS |
$768.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.61
|
| Rate for Payer: UHCCP Medicaid |
$76.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.78
|
|
|
LARYNGOSCOPY W/STROBOSCOPY(T
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 31579
|
| Hospital Charge Code |
761T1166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.53 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem Medicaid |
$212.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$358.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$502.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.37
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Humana KY Medicaid |
$212.53
|
| Rate for Payer: Humana Medicare Advantage |
$358.79
|
| Rate for Payer: Kentucky WC Medicaid |
$214.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
LARYNGOSCOPY W/STROBOSCOPY(T
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 31579
|
| Hospital Charge Code |
761T1166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
LARYNGOTOMY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 31300
|
| Hospital Charge Code |
76101161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LARYNGOTOMY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 31300
|
| Hospital Charge Code |
76101161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
LARYNGOTOMY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 31300
|
| Hospital Charge Code |
76101161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,787.19 |
| Rate for Payer: Aetna Commercial |
$1,787.19
|
| Rate for Payer: Ambetter Exchange |
$1,162.02
|
| Rate for Payer: Anthem Medicaid |
$731.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,162.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,162.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,394.42
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,751.81
|
| Rate for Payer: Healthspan PPO |
$1,507.17
|
| Rate for Payer: Humana Medicaid |
$731.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,604.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,162.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$746.01
|
| Rate for Payer: Molina Healthcare Passport |
$731.38
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,510.63
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,162.02
|
|
|
LARYNGOTOMY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 31300
|
| Hospital Charge Code |
761P1161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,787.19 |
| Rate for Payer: Aetna Commercial |
$1,787.19
|
| Rate for Payer: Ambetter Exchange |
$1,162.02
|
| Rate for Payer: Anthem Medicaid |
$731.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,162.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,162.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,394.42
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,751.81
|
| Rate for Payer: Healthspan PPO |
$1,507.17
|
| Rate for Payer: Humana Medicaid |
$731.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,604.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,162.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$746.01
|
| Rate for Payer: Molina Healthcare Passport |
$731.38
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,510.63
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,162.02
|
|
|
LARYNSCOPE FLEX W/BIOPSY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 31576
|
| Hospital Charge Code |
41000026
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
LARYNSCOPE FLEX W/BIOPSY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 31576
|
| Hospital Charge Code |
41000026
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$184.72
|
| Rate for Payer: Ambetter Exchange |
$112.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$133.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.50
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$317.37
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$133.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.09
|
| Rate for Payer: Molina Healthcare Passport |
$133.42
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.80
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.92
|
|
|
LARYNSCOPE FLEX W/BIOPSY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 31576
|
| Hospital Charge Code |
41000026
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
LARYNSCOPE FLEX W/BIOPSY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 31576
|
| Hospital Charge Code |
410P0026
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$184.72
|
| Rate for Payer: Ambetter Exchange |
$112.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$133.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.50
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$317.37
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$133.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.09
|
| Rate for Payer: Molina Healthcare Passport |
$133.42
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.80
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.92
|
|
|
LASER SURGERY ANAL LESIONS
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 46917
|
| Hospital Charge Code |
76101937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem Medicaid |
$113.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$257.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| Rate for Payer: Humana KY Medicaid |
$113.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$114.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
LASER SURGERY ANAL LESIONS
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 46917
|
| Hospital Charge Code |
76101937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$257.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
LASER SURGERY ANAL LESIONS
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 46917
|
| Hospital Charge Code |
76101937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$500.88 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: Ambetter Exchange |
$122.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.04
|
| Rate for Payer: Anthem Medicaid |
$112.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.59
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$174.55
|
| Rate for Payer: Healthspan PPO |
$500.88
|
| Rate for Payer: Humana Medicaid |
$112.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.93
|
| Rate for Payer: Molina Healthcare Passport |
$112.68
|
| Rate for Payer: Multiplan PHCS |
$198.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.81
|
| Rate for Payer: UHCCP Medicaid |
$117.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.16
|
|
|
LASER SURGERY ANAL LESIONS(P
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 46917
|
| Hospital Charge Code |
761P1937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$500.88 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: Ambetter Exchange |
$122.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.04
|
| Rate for Payer: Anthem Medicaid |
$112.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.59
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$174.55
|
| Rate for Payer: Healthspan PPO |
$500.88
|
| Rate for Payer: Humana Medicaid |
$112.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.93
|
| Rate for Payer: Molina Healthcare Passport |
$112.68
|
| Rate for Payer: Multiplan PHCS |
$198.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.81
|
| Rate for Payer: UHCCP Medicaid |
$117.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.16
|
|
|
LASER SURGERY OF PROSTATE
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 52648
|
| Hospital Charge Code |
76102115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,203.65 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
LASER SURGERY OF PROSTATE
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 52648
|
| Hospital Charge Code |
76102115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.60 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$1,118.32
|
| Rate for Payer: Ambetter Exchange |
$655.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$480.60
|
| Rate for Payer: Anthem Medicaid |
$660.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$655.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$786.56
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$981.77
|
| Rate for Payer: Healthspan PPO |
$2,744.24
|
| Rate for Payer: Humana Medicaid |
$660.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$939.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$655.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.44
|
| Rate for Payer: Molina Healthcare Passport |
$660.24
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$852.11
|
| Rate for Payer: UHCCP Medicaid |
$504.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$666.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$655.47
|
|
|
LASER SURGERY OF PROSTATE
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 52648
|
| Hospital Charge Code |
76102115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
LASER SURGERY OF PROSTATE(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 52648
|
| Hospital Charge Code |
761P2115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.60 |
| Max. Negotiated Rate |
$2,744.24 |
| Rate for Payer: Aetna Commercial |
$1,118.32
|
| Rate for Payer: Ambetter Exchange |
$655.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$480.60
|
| Rate for Payer: Anthem Medicaid |
$660.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$655.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$786.56
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$981.77
|
| Rate for Payer: Healthspan PPO |
$2,744.24
|
| Rate for Payer: Humana Medicaid |
$660.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$939.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$655.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$673.44
|
| Rate for Payer: Molina Healthcare Passport |
$660.24
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$852.11
|
| Rate for Payer: UHCCP Medicaid |
$504.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$666.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$655.47
|
|
|
LASER SURG PENIS LESION(S)
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
HCPCS 54057
|
| Hospital Charge Code |
76102126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$4,940.16 |
| Rate for Payer: Aetna Commercial |
$3,962.42
|
| Rate for Payer: Anthem Medicaid |
$1,769.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cigna Commercial |
$4,271.18
|
| Rate for Payer: First Health Commercial |
$4,888.70
|
| Rate for Payer: Humana Commercial |
$4,374.10
|
| Rate for Payer: Humana KY Medicaid |
$1,769.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.74
|
| Rate for Payer: PHCS Commercial |
$4,940.16
|
| Rate for Payer: United Healthcare All Payer |
$4,528.48
|
|
|
LASER SURG PENIS LESION(S)
|
Facility
|
IP
|
$5,146.00
|
|
|
Service Code
|
HCPCS 54057
|
| Hospital Charge Code |
76102126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,543.80 |
| Max. Negotiated Rate |
$4,940.16 |
| Rate for Payer: Aetna Commercial |
$3,962.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.88
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cigna Commercial |
$4,271.18
|
| Rate for Payer: First Health Commercial |
$4,888.70
|
| Rate for Payer: Humana Commercial |
$4,374.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.74
|
| Rate for Payer: PHCS Commercial |
$4,940.16
|
| Rate for Payer: United Healthcare All Payer |
$4,528.48
|
|
|
LASER SURG PENIS LESION(S)
|
Professional
|
Both
|
$5,146.00
|
|
|
Service Code
|
HCPCS 54057
|
| Hospital Charge Code |
76102126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$3,087.60 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Ambetter Exchange |
$90.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.97
|
| Rate for Payer: Anthem Medicaid |
$80.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.83
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cigna Commercial |
$124.76
|
| Rate for Payer: Healthspan PPO |
$206.20
|
| Rate for Payer: Humana Medicaid |
$80.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.41
|
| Rate for Payer: Molina Healthcare Passport |
$80.79
|
| Rate for Payer: Multiplan PHCS |
$3,087.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.90
|
| Rate for Payer: UHCCP Medicaid |
$51.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.69
|
|
|
LASER SURG PENIS LESION(S)(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 54057
|
| Hospital Charge Code |
761P2126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$145.51
|
| Rate for Payer: Ambetter Exchange |
$90.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.97
|
| Rate for Payer: Anthem Medicaid |
$80.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.83
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$124.76
|
| Rate for Payer: Healthspan PPO |
$206.20
|
| Rate for Payer: Humana Medicaid |
$80.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.41
|
| Rate for Payer: Molina Healthcare Passport |
$80.79
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.90
|
| Rate for Payer: UHCCP Medicaid |
$51.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.69
|
|
