|
DESTRUCTION ANAL LESION(S)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
76101936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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)
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
76101939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$1,267.20 |
| Rate for Payer: Aetna Commercial |
$1,016.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,029.60
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$1,095.60
|
| Rate for Payer: First Health Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial |
$1,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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)(P
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
761P1939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$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
|
|
|
DESTRUCTION ANAL LESION(S)(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 46910
|
| Hospital Charge Code |
761P1936
|
|
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 BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$2,526.05
|
|
|
Service Code
|
CPT 64624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,804.32 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$1,151.65
|
|
|
Service Code
|
CPT 64640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$1,151.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT
|
Facility
|
OP
|
$2,526.05
|
|
|
Service Code
|
CPT 64633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,804.32 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$2,526.05
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,804.32 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$257.03
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$3,547.47
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,533.91 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$3,547.47
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,533.91 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 56515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$4,934.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
76102128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$4,736.64 |
| Rate for Payer: Aetna Commercial |
$3,799.18
|
| Rate for Payer: Anthem Medicaid |
$1,696.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,848.52
|
| 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 |
$2,467.00
|
| Rate for Payer: Cash Price |
$2,467.00
|
| Rate for Payer: Cigna Commercial |
$4,095.22
|
| Rate for Payer: First Health Commercial |
$4,687.30
|
| Rate for Payer: Humana Commercial |
$4,193.90
|
| Rate for Payer: Humana KY Medicaid |
$1,696.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,714.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,045.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,641.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,730.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,341.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,292.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,404.46
|
| Rate for Payer: PHCS Commercial |
$4,736.64
|
| Rate for Payer: United Healthcare All Payer |
$4,341.92
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$3,087.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
76102124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$926.32 |
| 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 |
$2,470.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.53
|
| Rate for Payer: PHCS Commercial |
$2,964.21
|
| Rate for Payer: United Healthcare All Payer |
$2,717.19
|
|
|
DESTRUCTION PENIS LESION(S)
|
Professional
|
Both
|
$3,087.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
76102124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$1,852.63 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Ambetter Exchange |
$91.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.30
|
| Rate for Payer: Anthem Medicaid |
$52.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.34
|
| 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 |
$52.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.79
|
| Rate for Payer: Molina Healthcare Passport |
$52.74
|
| Rate for Payer: Multiplan PHCS |
$1,852.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.46
|
| Rate for Payer: UHCCP Medicaid |
$61.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.12
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
OP
|
$3,087.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
76102124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$2,964.21 |
| Rate for Payer: Aetna Commercial |
$2,377.54
|
| Rate for Payer: Anthem Medicaid |
$1,061.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.42
|
| 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 |
$1,543.86
|
| Rate for Payer: Cash Price |
$1,543.86
|
| Rate for Payer: Cigna Commercial |
$2,562.81
|
| Rate for Payer: First Health Commercial |
$2,933.33
|
| Rate for Payer: Humana Commercial |
$2,624.56
|
| Rate for Payer: Humana KY Medicaid |
$1,061.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.53
|
| Rate for Payer: PHCS Commercial |
$2,964.21
|
| Rate for Payer: United Healthcare All Payer |
$2,717.19
|
|
|
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 |
$2,960.40 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Ambetter Exchange |
$163.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.86
|
| Rate for Payer: Anthem Medicaid |
$141.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$163.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.16
|
| 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 |
$141.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$163.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.71
|
| Rate for Payer: Molina Healthcare Passport |
$141.87
|
| Rate for Payer: Multiplan PHCS |
$2,960.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$212.51
|
| Rate for Payer: UHCCP Medicaid |
$108.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.47
|
|
|
DESTRUCTION PENIS LESION(S)
|
Facility
|
IP
|
$4,934.00
|
|
|
Service Code
|
HCPCS 54065
|
| Hospital Charge Code |
76102128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,480.20 |
| 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 |
$3,947.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,292.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,404.46
|
| Rate for Payer: PHCS Commercial |
$4,736.64
|
| Rate for Payer: United Healthcare All Payer |
$4,341.92
|
|
|
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 |
$480.00 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Ambetter Exchange |
$163.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$102.86
|
| Rate for Payer: Anthem Medicaid |
$141.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$163.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.16
|
| 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 |
$141.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$163.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.71
|
| Rate for Payer: Molina Healthcare Passport |
$141.87
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$212.51
|
| Rate for Payer: UHCCP Medicaid |
$108.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.47
|
|
|
DESTRUCTION PENIS LESION(S)(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
761P2124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Ambetter Exchange |
$91.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.30
|
| Rate for Payer: Anthem Medicaid |
$52.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.34
|
| 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 |
$52.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.79
|
| Rate for Payer: Molina Healthcare Passport |
$52.74
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.46
|
| Rate for Payer: UHCCP Medicaid |
$61.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.12
|
|
|
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 |
$872.72 |
| 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 |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,979.42
|
| 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 |
$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 |
$1,690.17
|
| 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 |
$2,028.20
|
| 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 |
$2,030.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.03
|
| 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
|
$2,537.72
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
761T2124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$761.32 |
| 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 |
$2,030.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.03
|
| 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 |
$1,421.68 |
| 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 |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,224.52
|
| 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 |
$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 |
$1,690.17
|
| 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 |
$2,028.20
|
| 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 |
$3,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,596.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,852.46
|
| Rate for Payer: PHCS Commercial |
$3,968.64
|
| Rate for Payer: United Healthcare All Payer |
$3,637.92
|
|
|
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 |
$1,240.20 |
| 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 |
$3,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,596.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,852.46
|
| Rate for Payer: PHCS Commercial |
$3,968.64
|
| Rate for Payer: United Healthcare All Payer |
$3,637.92
|
|
