|
DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
76101940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$300.00
|
| 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: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| 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 |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| 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 VAG LESIONS COMPLEX
|
Facility
|
OP
|
$5,975.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
76102169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$776.75 |
| Max. Negotiated Rate |
$5,736.00 |
| Rate for Payer: Aetna Commercial |
$4,600.75
|
| Rate for Payer: Anthem Medicaid |
$2,054.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,660.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,987.50
|
| Rate for Payer: Cash Price |
$2,987.50
|
| Rate for Payer: Cigna Commercial |
$4,959.25
|
| Rate for Payer: First Health Commercial |
$5,676.25
|
| Rate for Payer: Humana Commercial |
$5,078.75
|
| Rate for Payer: Humana KY Medicaid |
$2,054.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,075.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,899.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,409.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,096.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,258.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.25
|
| Rate for Payer: PHCS Commercial |
$5,736.00
|
| Rate for Payer: United Healthcare All Payer |
$5,258.00
|
|
|
DESTROY VAG LESIONS COMPLEX
|
Facility
|
IP
|
$5,975.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
76102169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$776.75 |
| Max. Negotiated Rate |
$5,736.00 |
| Rate for Payer: Aetna Commercial |
$4,600.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,660.50
|
| Rate for Payer: Cash Price |
$2,987.50
|
| Rate for Payer: Cigna Commercial |
$4,959.25
|
| Rate for Payer: First Health Commercial |
$5,676.25
|
| Rate for Payer: Humana Commercial |
$5,078.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,899.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,409.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,792.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,258.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.25
|
| Rate for Payer: PHCS Commercial |
$5,736.00
|
| Rate for Payer: United Healthcare All Payer |
$5,258.00
|
|
|
DESTROY VAG LESIONS COMPLEX
|
Professional
|
Both
|
$5,975.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
76102169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.68
|
| Rate for Payer: Anthem Medicaid |
$181.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,975.00
|
| Rate for Payer: Cash Price |
$2,987.50
|
| Rate for Payer: Cash Price |
$2,987.50
|
| Rate for Payer: Cigna Commercial |
$253.83
|
| Rate for Payer: Healthspan PPO |
$277.71
|
| Rate for Payer: Humana Medicaid |
$181.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.70
|
| Rate for Payer: Molina Healthcare Passport |
$181.08
|
| Rate for Payer: Multiplan PHCS |
$3,585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,182.50
|
| Rate for Payer: UHCCP Medicaid |
$134.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.89
|
|
|
DESTROY VAG LESIONS COMPLEX(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
761P2169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.68
|
| Rate for Payer: Anthem Medicaid |
$181.08
|
| 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 |
$253.83
|
| Rate for Payer: Healthspan PPO |
$277.71
|
| Rate for Payer: Humana Medicaid |
$181.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.70
|
| Rate for Payer: Molina Healthcare Passport |
$181.08
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$134.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.89
|
|
|
DESTROY VAG LESIONS COMPLEX(T
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
761T2169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$698.75 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,666.25
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DESTROY VAG LESIONS COMPLEX(T
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
761T2169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$698.75 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,666.25
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DESTROY VAG LESIONS SIMPLE
|
Professional
|
Both
|
$5,717.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
76102168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$5,717.13 |
| Rate for Payer: Aetna Commercial |
$143.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.35
|
| Rate for Payer: Anthem Medicaid |
$50.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,717.13
|
| Rate for Payer: Cash Price |
$2,858.56
|
| Rate for Payer: Cash Price |
$2,858.56
|
| Rate for Payer: Cigna Commercial |
$168.88
|
| Rate for Payer: Healthspan PPO |
$161.65
|
| Rate for Payer: Humana Medicaid |
$50.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.35
|
| Rate for Payer: Molina Healthcare Passport |
$50.34
|
| Rate for Payer: Multiplan PHCS |
$3,430.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,001.99
|
| Rate for Payer: UHCCP Medicaid |
$62.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.84
|
|
|
DESTROY VAG LESIONS SIMPLE
|
Facility
|
OP
|
$5,717.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
76102168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$743.23 |
| Max. Negotiated Rate |
$5,488.44 |
| Rate for Payer: Aetna Commercial |
$4,402.19
|
| Rate for Payer: Anthem Medicaid |
$1,966.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,459.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,858.56
|
| Rate for Payer: Cash Price |
$2,858.56
|
| Rate for Payer: Cigna Commercial |
$4,745.22
|
| Rate for Payer: First Health Commercial |
$5,431.27
|
| Rate for Payer: Humana Commercial |
$4,859.56
|
| Rate for Payer: Humana KY Medicaid |
$1,966.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,986.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,688.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,219.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,005.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,031.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,287.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,143.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,772.31
|
| Rate for Payer: PHCS Commercial |
$5,488.44
|
| Rate for Payer: United Healthcare All Payer |
$5,031.07
|
|
|
DESTROY VAG LESIONS SIMPLE
|
Facility
|
IP
|
$5,717.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
76102168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$743.23 |
| Max. Negotiated Rate |
$5,488.44 |
| Rate for Payer: Aetna Commercial |
$4,402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,459.36
|
| Rate for Payer: Cash Price |
$2,858.56
|
| Rate for Payer: Cigna Commercial |
$4,745.22
|
| Rate for Payer: First Health Commercial |
$5,431.27
|
| Rate for Payer: Humana Commercial |
$4,859.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,688.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,219.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,031.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,287.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,143.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$743.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,772.31
|
| Rate for Payer: PHCS Commercial |
$5,488.44
|
| Rate for Payer: United Healthcare All Payer |
$5,031.07
|
|
|
DESTROY VAG LESIONS SIMPLE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761P2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$143.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.35
|
| Rate for Payer: Anthem Medicaid |
$50.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$168.88
|
| Rate for Payer: Healthspan PPO |
$161.65
|
| Rate for Payer: Humana Medicaid |
$50.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.35
|
| Rate for Payer: Molina Healthcare Passport |
$50.34
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$62.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.84
|
|
|
DESTROY VAG LESIONS SIMPLE(T
|
Facility
|
OP
|
$5,492.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761T2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$713.98 |
| Max. Negotiated Rate |
$5,272.44 |
| Rate for Payer: Aetna Commercial |
$4,228.94
|
| Rate for Payer: Anthem Medicaid |
$1,888.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,283.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,746.06
|
| Rate for Payer: Cash Price |
$2,746.06
|
| Rate for Payer: Cigna Commercial |
$4,558.47
|
| Rate for Payer: First Health Commercial |
$5,217.52
|
| Rate for Payer: Humana Commercial |
$4,668.31
|
| Rate for Payer: Humana KY Medicaid |
$1,888.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,907.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,926.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.56
|
| Rate for Payer: PHCS Commercial |
$5,272.44
|
| Rate for Payer: United Healthcare All Payer |
$4,833.07
|
|
|
DESTROY VAG LESIONS SIMPLE(T
|
Facility
|
IP
|
$5,492.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761T2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$713.98 |
| Max. Negotiated Rate |
$5,272.44 |
| Rate for Payer: Aetna Commercial |
$4,228.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,283.86
|
| Rate for Payer: Cash Price |
$2,746.06
|
| Rate for Payer: Cigna Commercial |
$4,558.47
|
| Rate for Payer: First Health Commercial |
$5,217.52
|
| Rate for Payer: Humana Commercial |
$4,668.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.56
|
| Rate for Payer: PHCS Commercial |
$5,272.44
|
| Rate for Payer: United Healthcare All Payer |
$4,833.07
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DESTROY VULVA LESION/S COMPL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$294.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.70
|
| Rate for Payer: Anthem Medicaid |
$133.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$326.02
|
| Rate for Payer: Healthspan PPO |
$319.59
|
| Rate for Payer: Humana Medicaid |
$133.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.29
|
| Rate for Payer: Molina Healthcare Passport |
$133.62
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$115.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.96
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DESTROY VULVA LESION/S COMP(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
761P2159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$294.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.70
|
| Rate for Payer: Anthem Medicaid |
$133.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$326.02
|
| Rate for Payer: Healthspan PPO |
$319.59
|
| Rate for Payer: Humana Medicaid |
$133.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.29
|
| Rate for Payer: Molina Healthcare Passport |
$133.62
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$115.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.96
|
|
|
DESTROY VULVA LESIONS SIM
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
DESTROY VULVA LESIONS SIM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
DESTROY VULVA LESIONS SIM
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$168.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$53.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$193.11
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$53.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.41
|
| Rate for Payer: Molina Healthcare Passport |
$53.34
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.87
|
|
|
DESTROY VULVA LESIONS SIM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
761P2158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$168.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$53.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$193.11
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$53.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.41
|
| Rate for Payer: Molina Healthcare Passport |
$53.34
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.87
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.92
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$172.91
|
| Rate for Payer: Healthspan PPO |
$279.41
|
| Rate for Payer: Humana Medicaid |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$105.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
761P1938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.92
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$172.91
|
| Rate for Payer: Healthspan PPO |
$279.41
|
| Rate for Payer: Humana Medicaid |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$105.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
|
