|
DEST MOLL CONT TO 15
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
76100251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.68 |
| Max. Negotiated Rate |
$418.56 |
| Rate for Payer: Aetna Commercial |
$335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.08
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$361.88
|
| Rate for Payer: First Health Commercial |
$414.20
|
| Rate for Payer: Humana Commercial |
$370.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$383.68
|
| Rate for Payer: Ohio Health Group HMO |
$327.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.16
|
| Rate for Payer: PHCS Commercial |
$418.56
|
| Rate for Payer: United Healthcare All Payer |
$383.68
|
|
|
DEST MOLL CONT TO 15(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
761P0251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.13
|
| Rate for Payer: Anthem Medicaid |
$22.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Healthspan PPO |
$118.52
|
| Rate for Payer: Humana Medicaid |
$22.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.67
|
| Rate for Payer: Molina Healthcare Passport |
$22.23
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$37.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.45
|
|
|
DEST MOLL CONT TO 15(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
761T0251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| 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 |
$173.12
|
| 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 |
$207.74
|
| 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 |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
DEST MOLL CONT TO 15(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
761T0251
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| 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 |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
DESTR LESION(S) ANUS
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
76101935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
DESTR LESION(S) ANUS
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
76101935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
DESTR LESION(S) ANUS
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
76101935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$193.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.14
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$267.80
|
| Rate for Payer: Healthspan PPO |
$256.66
|
| Rate for Payer: Humana Medicaid |
$59.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.00
|
| Rate for Payer: Molina Healthcare Passport |
$59.80
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$146.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
|
|
DESTR LESION(S) ANUS (P
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 46900
|
| Hospital Charge Code |
761P1935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$193.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.14
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$267.80
|
| Rate for Payer: Healthspan PPO |
$256.66
|
| Rate for Payer: Humana Medicaid |
$59.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.00
|
| Rate for Payer: Molina Healthcare Passport |
$59.80
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$146.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
|
|
DESTR MALIG LESION FACE
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$775.68 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.48
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
DESTR MALIG LESION FACE
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.32
|
| Rate for Payer: Anthem Medicaid |
$81.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$808.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$212.97
|
| Rate for Payer: Healthspan PPO |
$192.58
|
| Rate for Payer: Humana Medicaid |
$81.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.04
|
| Rate for Payer: Molina Healthcare Passport |
$81.41
|
| Rate for Payer: Multiplan PHCS |
$484.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.60
|
| Rate for Payer: UHCCP Medicaid |
$81.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.22
|
|
|
DESTR MALIG LESION FACE
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$775.68 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem Medicaid |
$277.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Humana KY Medicaid |
$277.87
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$280.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.48
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
DESTR MALIG LESION FACE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
761P0267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.32
|
| Rate for Payer: Anthem Medicaid |
$81.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$212.97
|
| Rate for Payer: Healthspan PPO |
$192.58
|
| Rate for Payer: Humana Medicaid |
$81.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.04
|
| Rate for Payer: Molina Healthcare Passport |
$81.41
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$81.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.22
|
|
|
DESTR MALIG LESION FACE(T
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
761T0267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DESTR MALIG LESION FACE(T
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
761T0267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DESTROY CERV/THOR FACET JNT
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
76102346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.60
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
DESTROY CERV/THOR FACET JNT
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
76102346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.60
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
DESTROY CERV/THOR FACET JNT
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
76102346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$189.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,060.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$413.68
|
| Rate for Payer: Healthspan PPO |
$422.85
|
| Rate for Payer: Humana Medicaid |
$189.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$295.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.84
|
| Rate for Payer: Molina Healthcare Passport |
$189.06
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.95
|
|
|
DESTROY CERV/THOR FACET JNT(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
761P2346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$189.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,060.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$413.68
|
| Rate for Payer: Healthspan PPO |
$422.85
|
| Rate for Payer: Humana Medicaid |
$189.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$295.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.84
|
| Rate for Payer: Molina Healthcare Passport |
$189.06
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.95
|
|
|
DESTROY C/TH FACET JNT ADDL
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
76102347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$57.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Healthspan PPO |
$192.29
|
| Rate for Payer: Humana Medicaid |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.16
|
| Rate for Payer: Molina Healthcare Passport |
$57.02
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.00
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.59
|
|
|
DESTROY C/TH FACET JNT ADDL
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
76102347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
DESTROY C/TH FACET JNT ADDL
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
76102347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
DESTROY C/TH FACET JNT ADDL(P
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
761P2347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$57.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Healthspan PPO |
$192.29
|
| Rate for Payer: Humana Medicaid |
$57.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.16
|
| Rate for Payer: Molina Healthcare Passport |
$57.02
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.00
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.59
|
|
|
DESTROY INTERNAL HEMORRHOID(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
761P1940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$213.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.75
|
| Rate for Payer: Anthem Medicaid |
$104.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$216.43
|
| Rate for Payer: Healthspan PPO |
$245.34
|
| Rate for Payer: Humana Medicaid |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.22
|
| Rate for Payer: Molina Healthcare Passport |
$104.14
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$148.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.18
|
|
|
DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
76101940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
DESTROY INTERNAL HEMORRHOIDS
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
76101940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$213.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.75
|
| Rate for Payer: Anthem Medicaid |
$104.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$216.43
|
| Rate for Payer: Healthspan PPO |
$245.34
|
| Rate for Payer: Humana Medicaid |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.22
|
| Rate for Payer: Molina Healthcare Passport |
$104.14
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$148.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.18
|
|
