|
ICD ANALYSIS W/ REPROG DC
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ICD ANALYSIS W/ REPROG DC
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: Anthem Medicaid |
$71.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.00
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$143.07
|
| Rate for Payer: Healthspan PPO |
$133.07
|
| Rate for Payer: Humana Medicaid |
$71.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.93
|
| Rate for Payer: Molina Healthcare Passport |
$71.50
|
| Rate for Payer: Multiplan PHCS |
$114.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.70
|
| Rate for Payer: UHCCP Medicaid |
$66.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.22
|
|
|
ICD ANALYSIS W/ REPROG DC
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Humana Medicare Advantage |
$32.61
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Humana Medicare Advantage |
$32.61
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.73
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$116.33
|
| Rate for Payer: Anthem Medicaid |
$59.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| Rate for Payer: Healthspan PPO |
$109.35
|
| Rate for Payer: Humana Medicaid |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.22
|
| Rate for Payer: Molina Healthcare Passport |
$59.04
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.63
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.73
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
ICONIX 1 ANCHOR 1.4MM 1 STRAND
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 1 ANCHOR 1.4MM 1 STRAND
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 25 ANCHOR 2.3MM 2 STRAN
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 25 ANCHOR 2.3MM 2 STRAN
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 2 ANCHOR 2.3MM 2 STRAND
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 2 ANCHOR 2.3MM 2 STRAND
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 3 ANCHOR 2.3MM 3 STRAND
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICONIX 3 ANCHOR 2.3MM 3 STRAND
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
ICU ROOM RATE
|
Facility
|
IP
|
$3,432.00
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
I&D ABCESS COMPLICATED
|
Professional
|
Both
|
$749.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$749.00 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$82.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$749.00
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cigna Commercial |
$247.65
|
| Rate for Payer: Healthspan PPO |
$211.67
|
| Rate for Payer: Humana Medicaid |
$82.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$198.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.47
|
| Rate for Payer: Molina Healthcare Passport |
$82.81
|
| Rate for Payer: Multiplan PHCS |
$449.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$524.30
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.64
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.37 |
| Max. Negotiated Rate |
$719.04 |
| Rate for Payer: Aetna Commercial |
$576.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.22
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cigna Commercial |
$621.67
|
| Rate for Payer: First Health Commercial |
$711.55
|
| Rate for Payer: Humana Commercial |
$636.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.12
|
| Rate for Payer: Ohio Health Group HMO |
$561.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.19
|
| Rate for Payer: PHCS Commercial |
$719.04
|
| Rate for Payer: United Healthcare All Payer |
$659.12
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.37 |
| Max. Negotiated Rate |
$719.04 |
| Rate for Payer: Aetna Commercial |
$576.73
|
| Rate for Payer: Anthem Medicaid |
$257.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cigna Commercial |
$621.67
|
| Rate for Payer: First Health Commercial |
$711.55
|
| Rate for Payer: Humana Commercial |
$636.65
|
| Rate for Payer: Humana KY Medicaid |
$257.58
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$260.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.12
|
| Rate for Payer: Ohio Health Group HMO |
$561.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.19
|
| Rate for Payer: PHCS Commercial |
$719.04
|
| Rate for Payer: United Healthcare All Payer |
$659.12
|
|
|
I&D ABCESS COMPLICATED(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761P0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$82.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$247.65
|
| Rate for Payer: Healthspan PPO |
$211.67
|
| Rate for Payer: Humana Medicaid |
$82.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$198.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.47
|
| Rate for Payer: Molina Healthcare Passport |
$82.81
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.64
|
|
|
I&D ABCESS COMPLICATED(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761T0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
I&D ABCESS COMPLICATED(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761T0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
I & D ABSCESS
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
I & D ABSCESS
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
