|
DESTRUCTION PENIS LESION(S)
|
Professional
|
Both
|
$3,087.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
76102124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$3,087.72 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.30
|
| Rate for Payer: Anthem Medicaid |
$44.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,087.72
|
| Rate for Payer: Cash Price |
$1,543.86
|
| Rate for Payer: Cash Price |
$1,543.86
|
| Rate for Payer: Cigna Commercial |
$162.72
|
| Rate for Payer: Healthspan PPO |
$172.22
|
| Rate for Payer: Humana Medicaid |
$44.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.45
|
| Rate for Payer: Molina Healthcare Passport |
$44.56
|
| Rate for Payer: Multiplan PHCS |
$1,852.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,161.40
|
| Rate for Payer: UHCCP Medicaid |
$61.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.01
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$3,848.52
|
| 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: 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 |
$1,480.20
|
| 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)
|
Professional
|
Both
|
$4,934.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
76102128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$4,934.00 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.86
|
| Rate for Payer: Anthem Medicaid |
$108.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,934.00
|
| Rate for Payer: Cash Price |
$2,467.00
|
| Rate for Payer: Cash Price |
$2,467.00
|
| Rate for Payer: Cigna Commercial |
$291.06
|
| Rate for Payer: Healthspan PPO |
$307.04
|
| Rate for Payer: Humana Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.91
|
| Rate for Payer: Molina Healthcare Passport |
$108.74
|
| Rate for Payer: Multiplan PHCS |
$2,960.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,453.80
|
| Rate for Payer: UHCCP Medicaid |
$108.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.83
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$2,408.42
|
| 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: 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 |
$926.32
|
| 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
|
|
|
DESTRUCTION PENIS LESION(S)(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
761P2124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.30
|
| Rate for Payer: Anthem Medicaid |
$44.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$162.72
|
| Rate for Payer: Healthspan PPO |
$172.22
|
| Rate for Payer: Humana Medicaid |
$44.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.45
|
| Rate for Payer: Molina Healthcare Passport |
$44.56
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$61.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.01
|
|
|
DESTRUCTION PENIS LESION(S)(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
761P2128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.86
|
| Rate for Payer: Anthem Medicaid |
$108.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$291.06
|
| Rate for Payer: Healthspan PPO |
$307.04
|
| Rate for Payer: Humana Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.91
|
| Rate for Payer: Molina Healthcare Passport |
$108.74
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$108.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.83
|
|
|
DESTRUCTION PENIS LESION(S)(T
|
Facility
|
IP
|
$2,537.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
761T2124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.90 |
| Max. Negotiated Rate |
$2,436.21 |
| Rate for Payer: Aetna Commercial |
$1,954.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,979.42
|
| Rate for Payer: Cash Price |
$1,268.86
|
| Rate for Payer: Cigna Commercial |
$2,106.31
|
| Rate for Payer: First Health Commercial |
$2,410.83
|
| Rate for Payer: Humana Commercial |
$2,157.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,233.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,903.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.69
|
| Rate for Payer: PHCS Commercial |
$2,436.21
|
| Rate for Payer: United Healthcare All Payer |
$2,233.19
|
|
|
DESTRUCTION PENIS LESION(S)(T
|
Facility
|
IP
|
$4,134.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
761T2128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.42 |
| Max. Negotiated Rate |
$3,968.64 |
| Rate for Payer: Aetna Commercial |
$3,183.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,224.52
|
| Rate for Payer: Cash Price |
$2,067.00
|
| Rate for Payer: Cigna Commercial |
$3,431.22
|
| Rate for Payer: First Health Commercial |
$3,927.30
|
| Rate for Payer: Humana Commercial |
$3,513.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,100.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,281.54
|
| Rate for Payer: PHCS Commercial |
$3,968.64
|
| Rate for Payer: United Healthcare All Payer |
$3,637.92
|
|
|
DESTRUCTION PENIS LESION(S)(T
|
Facility
|
OP
|
$2,537.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
761T2124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.90 |
| Max. Negotiated Rate |
$2,436.21 |
| Rate for Payer: Aetna Commercial |
$1,954.04
|
| Rate for Payer: Anthem Medicaid |
$872.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,979.42
|
| 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 |
$1,268.86
|
| Rate for Payer: Cash Price |
$1,268.86
|
| Rate for Payer: Cigna Commercial |
$2,106.31
|
| Rate for Payer: First Health Commercial |
$2,410.83
|
| Rate for Payer: Humana Commercial |
$2,157.06
|
| Rate for Payer: Humana KY Medicaid |
$872.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$881.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$890.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,233.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,903.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.69
|
| Rate for Payer: PHCS Commercial |
$2,436.21
|
| Rate for Payer: United Healthcare All Payer |
$2,233.19
|
|
|
DESTRUCTION PENIS LESION(S)(T
|
Facility
|
OP
|
$4,134.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
761T2128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.42 |
| Max. Negotiated Rate |
$3,968.64 |
| Rate for Payer: Aetna Commercial |
$3,183.18
|
| Rate for Payer: Anthem Medicaid |
$1,421.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,224.52
|
| 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 |
$2,067.00
|
| Rate for Payer: Cash Price |
$2,067.00
|
| Rate for Payer: Cigna Commercial |
$3,431.22
|
| Rate for Payer: First Health Commercial |
$3,927.30
|
| Rate for Payer: Humana Commercial |
$3,513.90
|
| Rate for Payer: Humana KY Medicaid |
$1,421.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,436.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,450.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,100.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,281.54
|
| Rate for Payer: PHCS Commercial |
$3,968.64
|
| Rate for Payer: United Healthcare All Payer |
$3,637.92
|
|
|
DESTRUCTION RECTAL TUMOR
|
Professional
|
Both
|
$7,975.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
76102667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.39 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Aetna Commercial |
$961.90
|
| Rate for Payer: Anthem Medicaid |
$394.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,975.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna Commercial |
$878.69
|
| Rate for Payer: Healthspan PPO |
$811.17
|
| Rate for Payer: Humana Medicaid |
$394.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.28
|
| Rate for Payer: Molina Healthcare Passport |
$394.39
|
| Rate for Payer: Multiplan PHCS |
$4,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,582.50
|
| Rate for Payer: UHCCP Medicaid |
$2,791.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.33
|
|
|
DESTRUCTION RECTAL TUMOR
|
Facility
|
OP
|
$7,975.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
76102667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$7,656.00 |
| Rate for Payer: Aetna Commercial |
$6,140.75
|
| Rate for Payer: Anthem Medicaid |
$2,742.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.50
|
| 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 |
$3,987.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna Commercial |
$6,619.25
|
| Rate for Payer: First Health Commercial |
$7,576.25
|
| Rate for Payer: Humana Commercial |
$6,778.75
|
| Rate for Payer: Humana KY Medicaid |
$2,742.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.25
|
| Rate for Payer: PHCS Commercial |
$7,656.00
|
| Rate for Payer: United Healthcare All Payer |
$7,018.00
|
|
|
DESTRUCTION RECTAL TUMOR
|
Facility
|
IP
|
$7,975.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
76102667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$7,656.00 |
| Rate for Payer: Aetna Commercial |
$6,140.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna Commercial |
$6,619.25
|
| Rate for Payer: First Health Commercial |
$7,576.25
|
| Rate for Payer: Humana Commercial |
$6,778.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.25
|
| Rate for Payer: PHCS Commercial |
$7,656.00
|
| Rate for Payer: United Healthcare All Payer |
$7,018.00
|
|
|
DESTRUCTION RECTAL TUMOR (P
|
Professional
|
Both
|
$2,670.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
761P2667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.39 |
| Max. Negotiated Rate |
$2,670.00 |
| Rate for Payer: Aetna Commercial |
$961.90
|
| Rate for Payer: Anthem Medicaid |
$394.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,670.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$878.69
|
| Rate for Payer: Healthspan PPO |
$811.17
|
| Rate for Payer: Humana Medicaid |
$394.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.28
|
| Rate for Payer: Molina Healthcare Passport |
$394.39
|
| Rate for Payer: Multiplan PHCS |
$1,602.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,869.00
|
| Rate for Payer: UHCCP Medicaid |
$934.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.33
|
|
|
DESTRUCTION RECTAL TUMOR (T
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
761T2667
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.65 |
| Max. Negotiated Rate |
$5,092.80 |
| Rate for Payer: Aetna Commercial |
$4,084.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,137.90
|
| Rate for Payer: Cash Price |
$2,652.50
|
| Rate for Payer: Cigna Commercial |
$4,403.15
|
| Rate for Payer: First Health Commercial |
$5,039.75
|
| Rate for Payer: Humana Commercial |
$4,509.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,350.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,915.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,591.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,668.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,061.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,644.55
|
| Rate for Payer: PHCS Commercial |
$5,092.80
|
| Rate for Payer: United Healthcare All Payer |
$4,668.40
|
|
|
DESTRUCTION RECTAL TUMOR (T
|
Facility
|
OP
|
$5,305.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
761T2667
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.65 |
| Max. Negotiated Rate |
$5,092.80 |
| Rate for Payer: Aetna Commercial |
$4,084.85
|
| Rate for Payer: Anthem Medicaid |
$1,824.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,137.90
|
| 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 |
$2,652.50
|
| Rate for Payer: Cash Price |
$2,652.50
|
| Rate for Payer: Cigna Commercial |
$4,403.15
|
| Rate for Payer: First Health Commercial |
$5,039.75
|
| Rate for Payer: Humana Commercial |
$4,509.25
|
| Rate for Payer: Humana KY Medicaid |
$1,824.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,842.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,350.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,915.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,860.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,668.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,061.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,644.55
|
| Rate for Payer: PHCS Commercial |
$5,092.80
|
| Rate for Payer: United Healthcare All Payer |
$4,668.40
|
|
|
DESTRUCT LESION 15 OR MORE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$117.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.49
|
| Rate for Payer: Anthem Medicaid |
$43.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$161.62
|
| Rate for Payer: Healthspan PPO |
$140.81
|
| Rate for Payer: Humana Medicaid |
$43.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.08
|
| Rate for Payer: Molina Healthcare Passport |
$43.22
|
| Rate for Payer: Multiplan PHCS |
$290.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.80
|
| Rate for Payer: UHCCP Medicaid |
$46.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.65
|
|
|
DESTRUCT LESION 15 OR MORE
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
DESTRUCT LESION 15 OR MORE
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
76100252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem Medicaid |
$166.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Humana KY Medicaid |
$166.45
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$168.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
DESTRUCT LESION 15 OR MORE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
761P0252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$117.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.49
|
| Rate for Payer: Anthem Medicaid |
$43.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$161.62
|
| Rate for Payer: Healthspan PPO |
$140.81
|
| Rate for Payer: Humana Medicaid |
$43.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.08
|
| Rate for Payer: Molina Healthcare Passport |
$43.22
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$46.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.65
|
|
|
DESTRUCT LESION 15 OR MORE(T
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
761T0252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem Medicaid |
$97.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Humana KY Medicaid |
$97.67
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$98.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
DESTRUCT LESION 15 OR MORE(T
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
761T0252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
DESTRUCT PREMAL LESION 15+ (P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
761P0249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$191.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.51
|
| Rate for Payer: Anthem Medicaid |
$143.35
|
| 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 |
$231.55
|
| Rate for Payer: Healthspan PPO |
$193.84
|
| Rate for Payer: Humana Medicaid |
$143.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.22
|
| Rate for Payer: Molina Healthcare Passport |
$143.35
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$92.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.78
|
|
|
DESTRUCT PREMAL LESION 15+ (T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
761T0249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
DESTRUCT PREMAL LESION 15+ (T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
761T0249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
