|
DESTRUC PREMALIG LES 2-14
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.08
|
| Rate for Payer: Anthem Medicaid |
$7.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.00
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Healthspan PPO |
$8.51
|
| Rate for Payer: Humana Medicaid |
$7.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.08
|
| Rate for Payer: Molina Healthcare Passport |
$7.92
|
| Rate for Payer: Multiplan PHCS |
$108.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.70
|
| Rate for Payer: UHCCP Medicaid |
$2.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.00
|
|
|
DESTRUC PREMALIG LES 2-14
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$62.25
|
| Rate for Payer: Kentucky WC Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
DESTRUC PREMALIG LES 2-14
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
DESTRUC PREMALIG LES 2-14 (P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
761P0248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.08
|
| Rate for Payer: Anthem Medicaid |
$7.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$10.18
|
| Rate for Payer: Healthspan PPO |
$8.51
|
| Rate for Payer: Humana Medicaid |
$7.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.08
|
| Rate for Payer: Molina Healthcare Passport |
$7.92
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$2.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.00
|
|
|
DESTRUC PREMALIG LES 2-14 (T
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
761T0248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.78
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
DESTRUC PREMALIG LES 2-14 (T
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
761T0248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$51.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.78
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Humana KY Medicaid |
$51.93
|
| Rate for Payer: Kentucky WC Medicaid |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
76101939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$1,095.60
|
| Rate for Payer: First Health Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial |
$1,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.20
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
76101939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem Medicaid |
$453.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| 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 |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$1,095.60
|
| Rate for Payer: First Health Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial |
$1,122.00
|
| Rate for Payer: Humana KY Medicaid |
$453.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$458.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$463.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.20
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
DESTRUCTION ANAL LESION(S)
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
76101939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$260.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.37
|
| Rate for Payer: Anthem Medicaid |
$159.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,320.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$239.54
|
| Rate for Payer: Healthspan PPO |
$570.27
|
| Rate for Payer: Humana Medicaid |
$159.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.55
|
| Rate for Payer: Molina Healthcare Passport |
$159.36
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$924.00
|
| Rate for Payer: UHCCP Medicaid |
$153.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.95
|
|
|
DESTRUCTION ANAL LESION(S)
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$186.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.73
|
| Rate for Payer: Anthem Medicaid |
$63.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$284.25
|
| Rate for Payer: Healthspan PPO |
$267.68
|
| Rate for Payer: Humana Medicaid |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.91
|
| Rate for Payer: Molina Healthcare Passport |
$63.64
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$109.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.28
|
|
|
DESTRUCTION ANAL LESION(S)(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
761P1936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$186.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.73
|
| Rate for Payer: Anthem Medicaid |
$63.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$284.25
|
| Rate for Payer: Healthspan PPO |
$267.68
|
| Rate for Payer: Humana Medicaid |
$63.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.91
|
| Rate for Payer: Molina Healthcare Passport |
$63.64
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$109.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.28
|
|
|
DESTRUCTION ANAL LESION(S)(P
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
761P1939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$260.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.37
|
| Rate for Payer: Anthem Medicaid |
$159.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,320.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$239.54
|
| Rate for Payer: Healthspan PPO |
$570.27
|
| Rate for Payer: Humana Medicaid |
$159.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.55
|
| Rate for Payer: Molina Healthcare Passport |
$159.36
|
| Rate for Payer: Multiplan PHCS |
$792.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$924.00
|
| Rate for Payer: UHCCP Medicaid |
$153.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.95
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$2,337.51
|
|
|
Service Code
|
CPT 64624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,669.65 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$1,103.49
|
|
|
Service Code
|
CPT 64640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$788.21 |
| Max. Negotiated Rate |
$1,103.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT
|
Facility
|
OP
|
$2,337.51
|
|
|
Service Code
|
CPT 64633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,669.65 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$2,337.51
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,669.65 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$3,399.27
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.05 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$3,399.27
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.05 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$4,934.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
76102128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.42 |
| Max. Negotiated Rate |
$4,736.64 |
| Rate for Payer: Aetna Commercial |
$3,799.18
|
| Rate for Payer: Anthem Medicaid |
$1,696.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,848.52
|
| 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 |
$2,467.00
|
| Rate for Payer: Cash Price |
$2,467.00
|
| Rate for Payer: Cigna Commercial |
$4,095.22
|
| Rate for Payer: First Health Commercial |
$4,687.30
|
| Rate for Payer: Humana Commercial |
$4,193.90
|
| Rate for Payer: Humana KY Medicaid |
$1,696.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,714.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,045.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,641.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,730.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,341.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.54
|
| Rate for Payer: PHCS Commercial |
$4,736.64
|
| Rate for Payer: United Healthcare All Payer |
$4,341.92
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$3,087.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
76102124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.40 |
| Max. Negotiated Rate |
$2,964.21 |
| Rate for Payer: Aetna Commercial |
$2,377.54
|
| Rate for Payer: Anthem Medicaid |
$1,061.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.42
|
| 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 |
$1,543.86
|
| Rate for Payer: Cash Price |
$1,543.86
|
| Rate for Payer: Cigna Commercial |
$2,562.81
|
| Rate for Payer: First Health Commercial |
$2,933.33
|
| Rate for Payer: Humana Commercial |
$2,624.56
|
| Rate for Payer: Humana KY Medicaid |
$1,061.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$957.19
|
| Rate for Payer: PHCS Commercial |
$2,964.21
|
| Rate for Payer: United Healthcare All Payer |
$2,717.19
|
|
