|
CRYOPROBE RIGHT ANGLE 2.4MM
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$217.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$217.00
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$219.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$378.60 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Ambetter Exchange |
$105.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.55
|
| Rate for Payer: Anthem Medicaid |
$50.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.80
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$172.70
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$50.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.11
|
| Rate for Payer: Molina Healthcare Passport |
$50.11
|
| Rate for Payer: Multiplan PHCS |
$378.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.37
|
| Rate for Payer: UHCCP Medicaid |
$58.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.67
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
CRYOSURGERY PENIS LESION(S)(P
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761P2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Ambetter Exchange |
$105.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.55
|
| Rate for Payer: Anthem Medicaid |
$50.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.80
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$172.70
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$50.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.11
|
| Rate for Payer: Molina Healthcare Passport |
$50.11
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.37
|
| Rate for Payer: UHCCP Medicaid |
$58.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.67
|
|
|
CRYOSURGERY PENIS LESION(S)(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761T2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
CRYOSURGERY PENIS LESION(S)(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761T2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$539.40
|
| Rate for Payer: Ambetter Exchange |
$376.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$299.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$376.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$376.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.79
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$529.16
|
| Rate for Payer: Healthspan PPO |
$527.86
|
| Rate for Payer: Humana Medicaid |
$299.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$376.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.10
|
| Rate for Payer: Molina Healthcare Passport |
$299.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$489.44
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$376.49
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CRYOTHERAPY - DESTRUCTION(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
761P2386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$539.40
|
| Rate for Payer: Ambetter Exchange |
$376.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$299.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$376.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$376.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.79
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$529.16
|
| Rate for Payer: Healthspan PPO |
$527.86
|
| Rate for Payer: Humana Medicaid |
$299.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$376.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.10
|
| Rate for Payer: Molina Healthcare Passport |
$299.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$489.44
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$376.49
|
|
|
CRYOTHERAPY OF SKIN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
CRYOTHERAPY OF SKIN
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Ambetter Exchange |
$46.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.37
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$62.81
|
| Rate for Payer: Healthspan PPO |
$55.48
|
| Rate for Payer: Humana Medicaid |
$29.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.01
|
| Rate for Payer: Molina Healthcare Passport |
$29.42
|
| Rate for Payer: Multiplan PHCS |
$123.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.98
|
| Rate for Payer: UHCCP Medicaid |
$34.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.14
|
|
|
CRYOTHERAPY OF SKIN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$70.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$70.50
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$71.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
CRYOTHERAPY OF SKIN(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761P0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Ambetter Exchange |
$46.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.37
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$62.81
|
| Rate for Payer: Healthspan PPO |
$55.48
|
| Rate for Payer: Humana Medicaid |
$29.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.01
|
| Rate for Payer: Molina Healthcare Passport |
$29.42
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.98
|
| Rate for Payer: UHCCP Medicaid |
$34.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.14
|
|
|
CRYOTHERAPY OF SKIN(T
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761T0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$36.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$36.11
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
CRYOTHERAPY OF SKIN(T
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761T0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
CRYPTOCCUS NEOFORM SER ANTIG
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 87327
|
| Hospital Charge Code |
30001347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$13.42
|
| Rate for Payer: Humana Medicare Advantage |
$13.42
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
CRYPTOCCUS NEOFORM SER ANTIG
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 87327
|
| Hospital Charge Code |
30001347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
CRYPTOSPORIDIUM DFA DETECTION
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
30001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
CRYPTOSPORIDIUM DFA DETECTION
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
30001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$7.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Humana KY Medicaid |
$7.33
|
| Rate for Payer: Humana Medicare Advantage |
$7.33
|
| Rate for Payer: Kentucky WC Medicaid |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: Ambetter Exchange |
$7.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$29.67
|
| Rate for Payer: Healthspan PPO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.33
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.53
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.33
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.95
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
C-SECTION
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
