|
DESTR MALIG LESION FACE
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
76100267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.52
|
| 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 |
$212.97 |
| Rate for Payer: Aetna Commercial |
$175.02
|
| Rate for Payer: Ambetter Exchange |
$111.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.32
|
| Rate for Payer: Anthem Medicaid |
$109.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.56
|
| 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 |
$109.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$111.63
|
| Rate for Payer: Molina Healthcare Passport |
$109.44
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.69
|
| Rate for Payer: UHCCP Medicaid |
$81.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$110.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.30
|
|
|
DESTR MALIG LESION FACE(T
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
761T0267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.40 |
| 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 |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DESTR MALIG LESION FACE(T
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
761T0267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.51 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| 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 |
$318.00 |
| 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 |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| 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 |
$364.53 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| 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 |
$1,804.32
|
| 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 |
$2,165.18
|
| 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 |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| 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 |
$636.00 |
| Rate for Payer: Ambetter Exchange |
$180.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$353.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$216.92
|
| 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 |
$353.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$295.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.75
|
| Rate for Payer: Molina Healthcare Passport |
$353.68
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.77
|
|
|
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 |
$636.00 |
| Rate for Payer: Ambetter Exchange |
$180.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$353.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$216.92
|
| 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 |
$353.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$295.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.75
|
| Rate for Payer: Molina Healthcare Passport |
$353.68
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.77
|
|
|
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 |
$177.00 |
| 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 |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
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 |
$177.00 |
| 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 |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
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 |
$354.00 |
| Rate for Payer: Ambetter Exchange |
$63.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$160.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.90
|
| 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 |
$160.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.13
|
| Rate for Payer: Molina Healthcare Passport |
$160.91
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.22
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.25
|
|
|
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 |
$354.00 |
| Rate for Payer: Ambetter Exchange |
$63.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$160.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.90
|
| 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 |
$160.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.13
|
| Rate for Payer: Molina Healthcare Passport |
$160.91
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.22
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.25
|
|
|
DESTROY INTERNAL HEMORRHOID(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
761P1940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.64 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$213.31
|
| Rate for Payer: Ambetter Exchange |
$143.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.75
|
| Rate for Payer: Anthem Medicaid |
$140.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.79
|
| 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 |
$140.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.45
|
| Rate for Payer: Molina Healthcare Passport |
$140.64
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.11
|
| Rate for Payer: UHCCP Medicaid |
$148.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.16
|
|
|
DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
76101940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| 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 |
$140.64 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$213.31
|
| Rate for Payer: Ambetter Exchange |
$143.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.75
|
| Rate for Payer: Anthem Medicaid |
$140.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.79
|
| 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 |
$140.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.45
|
| Rate for Payer: Molina Healthcare Passport |
$140.64
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.11
|
| Rate for Payer: UHCCP Medicaid |
$148.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.16
|
|
|
DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
76101940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| 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 |
$1,089.45
|
| 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 |
$1,307.34
|
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| 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 |
$2,054.80 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,660.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,122.75
|
| 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 |
$3,585.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Ambetter Exchange |
$174.71
|
| 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 Individual/Medicaid |
$174.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$174.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.71
|
| 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 |
$227.12
|
| Rate for Payer: UHCCP Medicaid |
$134.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.71
|
|
|
DESTROY VAG LESIONS COMPLEX
|
Facility
|
IP
|
$5,975.00
|
|
|
Service Code
|
HCPCS 57065
|
| Hospital Charge Code |
76102169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,792.50 |
| 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 |
$4,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,122.75
|
| Rate for Payer: PHCS Commercial |
$5,736.00
|
| Rate for Payer: United Healthcare All Payer |
$5,258.00
|
|
|
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 |
$360.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Ambetter Exchange |
$174.71
|
| 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 Individual/Medicaid |
$174.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$174.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.71
|
| 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 |
$227.12
|
| Rate for Payer: UHCCP Medicaid |
$134.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.71
|
|
|
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 |
$1,848.46 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
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 |
$1,612.50 |
| 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 |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| 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 |
$59.35 |
| Max. Negotiated Rate |
$3,430.28 |
| Rate for Payer: Aetna Commercial |
$143.95
|
| Rate for Payer: Ambetter Exchange |
$107.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.35
|
| Rate for Payer: Anthem Medicaid |
$61.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.89
|
| 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 |
$61.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.57
|
| Rate for Payer: Molina Healthcare Passport |
$61.34
|
| Rate for Payer: Multiplan PHCS |
$3,430.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.63
|
| Rate for Payer: UHCCP Medicaid |
$62.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.41
|
|
|
DESTROY VAG LESIONS SIMPLE
|
Facility
|
IP
|
$5,717.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
76102168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,715.14 |
| 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 |
$4,573.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,973.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,944.82
|
| Rate for Payer: PHCS Commercial |
$5,488.44
|
| Rate for Payer: United Healthcare All Payer |
$5,031.07
|
|
|
DESTROY VAG LESIONS SIMPLE
|
Facility
|
OP
|
$5,717.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
76102168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,966.12 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,459.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,573.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,973.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,944.82
|
| Rate for Payer: PHCS Commercial |
$5,488.44
|
| Rate for Payer: United Healthcare All Payer |
$5,031.07
|
|
