|
DESTROY VAG LESIONS SIMPLE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761P2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$168.88 |
| 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 |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$168.88
|
| Rate for Payer: Healthspan PPO |
$161.65
|
| Rate for Payer: Humana Medicaid |
$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 |
$135.00
|
| 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(T
|
Facility
|
IP
|
$5,492.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761T2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,647.64 |
| Max. Negotiated Rate |
$5,272.44 |
| Rate for Payer: Aetna Commercial |
$4,228.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,283.86
|
| Rate for Payer: Cash Price |
$2,746.06
|
| Rate for Payer: Cigna Commercial |
$4,558.47
|
| Rate for Payer: First Health Commercial |
$5,217.52
|
| Rate for Payer: Humana Commercial |
$4,668.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,778.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,789.57
|
| Rate for Payer: PHCS Commercial |
$5,272.44
|
| Rate for Payer: United Healthcare All Payer |
$4,833.07
|
|
|
DESTROY VAG LESIONS SIMPLE(T
|
Facility
|
OP
|
$5,492.13
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
761T2168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,888.74 |
| Max. Negotiated Rate |
$5,272.44 |
| Rate for Payer: Aetna Commercial |
$4,228.94
|
| Rate for Payer: Anthem Medicaid |
$1,888.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,283.86
|
| 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 |
$2,746.06
|
| Rate for Payer: Cash Price |
$2,746.06
|
| Rate for Payer: Cigna Commercial |
$4,558.47
|
| Rate for Payer: First Health Commercial |
$5,217.52
|
| Rate for Payer: Humana Commercial |
$4,668.31
|
| Rate for Payer: Humana KY Medicaid |
$1,888.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,907.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,926.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,778.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,789.57
|
| Rate for Payer: PHCS Commercial |
$5,272.44
|
| Rate for Payer: United Healthcare All Payer |
$4,833.07
|
|
|
DESTROY VULVA LESION/S COMPL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$294.76
|
| Rate for Payer: Ambetter Exchange |
$200.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.70
|
| Rate for Payer: Anthem Medicaid |
$133.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.02
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$326.02
|
| Rate for Payer: Healthspan PPO |
$319.59
|
| Rate for Payer: Humana Medicaid |
$133.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.29
|
| Rate for Payer: Molina Healthcare Passport |
$133.62
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.03
|
| Rate for Payer: UHCCP Medicaid |
$115.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.02
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DESTROY VULVA LESION/S COMPL
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
76102159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DESTROY VULVA LESION/S COMP(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
761P2159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$294.76
|
| Rate for Payer: Ambetter Exchange |
$200.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.70
|
| Rate for Payer: Anthem Medicaid |
$133.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.02
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$326.02
|
| Rate for Payer: Healthspan PPO |
$319.59
|
| Rate for Payer: Humana Medicaid |
$133.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$256.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.29
|
| Rate for Payer: Molina Healthcare Passport |
$133.62
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.03
|
| Rate for Payer: UHCCP Medicaid |
$115.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.02
|
|
|
DESTROY VULVA LESIONS SIM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
DESTROY VULVA LESIONS SIM
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
DESTROY VULVA LESIONS SIM
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
76102158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$168.66
|
| Rate for Payer: Ambetter Exchange |
$124.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$60.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.46
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$193.11
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$60.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.80
|
| Rate for Payer: Molina Healthcare Passport |
$60.59
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.91
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.55
|
|
|
DESTROY VULVA LESIONS SIM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 56501
|
| Hospital Charge Code |
761P2158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$168.66
|
| Rate for Payer: Ambetter Exchange |
$124.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$60.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.46
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$193.11
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$60.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.80
|
| Rate for Payer: Molina Healthcare Passport |
$60.59
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.91
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.55
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
761P1938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$279.41 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Ambetter Exchange |
$130.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.92
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$130.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$156.82
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$172.91
|
| Rate for Payer: Healthspan PPO |
$279.41
|
| Rate for Payer: Humana Medicaid |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$130.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$169.88
|
| Rate for Payer: UHCCP Medicaid |
$105.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$130.68
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$112.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
DESTRUC. OF LESION - ANUS;SIMP
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 46922
|
| Hospital Charge Code |
76101938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$279.41 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Ambetter Exchange |
$130.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.92
|
| Rate for Payer: Anthem Medicaid |
$93.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$130.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$156.82
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$172.91
|
| Rate for Payer: Healthspan PPO |
$279.41
|
| Rate for Payer: Humana Medicaid |
$93.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$130.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.89
|
| Rate for Payer: Molina Healthcare Passport |
$93.03
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$169.88
|
| Rate for Payer: UHCCP Medicaid |
$105.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$130.68
|
|
|
DESTRUC PREMALIG LES 2-14
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$66.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
DESTRUC PREMALIG LES 2-14
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
DESTRUC PREMALIG LES 2-14
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
76100248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Ambetter Exchange |
$1.88
|
| 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 Individual/Medicaid |
$1.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.26
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.08
|
| Rate for Payer: Molina Healthcare Passport |
$7.92
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.44
|
| Rate for Payer: UHCCP Medicaid |
$2.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.88
|
|
|
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 |
$1.88 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Ambetter Exchange |
$1.88
|
| 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 Individual/Medicaid |
$1.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.88
|
| 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 |
$2.44
|
| Rate for Payer: UHCCP Medicaid |
$2.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.88
|
|
|
DESTRUC PREMALIG LES 2-14 (T
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
761T0248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DESTRUC PREMALIG LES 2-14 (T
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
761T0248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
76101939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.95 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem Medicaid |
$453.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| 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 |
$2,533.91
|
| 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 |
$3,040.69
|
| 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 |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$910.80
|
| Rate for Payer: PHCS Commercial |
$1,267.20
|
| Rate for Payer: United Healthcare All Payer |
$1,161.60
|
|
|
DESTRUCTION ANAL LESION(S)
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$186.29
|
| Rate for Payer: Ambetter Exchange |
$127.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.73
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.60
|
| 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 |
$72.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.66
|
| Rate for Payer: Molina Healthcare Passport |
$72.22
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.32
|
| Rate for Payer: UHCCP Medicaid |
$109.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.17
|
|
|
DESTRUCTION ANAL LESION(S)
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
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 |
$792.00 |
| Rate for Payer: Aetna Commercial |
$260.36
|
| Rate for Payer: Ambetter Exchange |
$173.04
|
| 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 Individual/Medicaid |
$173.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$173.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.04
|
| 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 |
$224.95
|
| Rate for Payer: UHCCP Medicaid |
$153.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.04
|
|
