|
I & D ABSCESS
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$562.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.10
|
| Rate for Payer: Anthem Medicaid |
$203.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: Healthspan PPO |
$661.08
|
| Rate for Payer: Humana Medicaid |
$203.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.26
|
| Rate for Payer: Molina Healthcare Passport |
$203.20
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$212.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.23
|
|
|
I&D ABSCESS DEEP FOREARM
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$848.98 |
| Rate for Payer: Aetna Commercial |
$725.96
|
| Rate for Payer: Anthem Medicaid |
$207.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$848.98
|
| Rate for Payer: Healthspan PPO |
$657.56
|
| Rate for Payer: Humana Medicaid |
$207.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.34
|
| Rate for Payer: Molina Healthcare Passport |
$207.20
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.27
|
|
|
I&D ABSCESS DEEP FOREARM
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
I&D ABSCESS DEEP FOREARM
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
I&D ABSCESS DEEP FOREARM(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
761P0568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$848.98 |
| Rate for Payer: Aetna Commercial |
$725.96
|
| Rate for Payer: Anthem Medicaid |
$207.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$848.98
|
| Rate for Payer: Healthspan PPO |
$657.56
|
| Rate for Payer: Humana Medicaid |
$207.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.34
|
| Rate for Payer: Molina Healthcare Passport |
$207.20
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.27
|
|
|
I & D ABSCESS(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
761P0887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$562.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.10
|
| Rate for Payer: Anthem Medicaid |
$203.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: Healthspan PPO |
$661.08
|
| Rate for Payer: Humana Medicaid |
$203.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.26
|
| Rate for Payer: Molina Healthcare Passport |
$203.20
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$212.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.23
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$623.04 |
| Rate for Payer: Aetna Commercial |
$499.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.22
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$538.67
|
| Rate for Payer: First Health Commercial |
$616.55
|
| Rate for Payer: Humana Commercial |
$551.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$532.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$571.12
|
| Rate for Payer: Ohio Health Group HMO |
$486.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.19
|
| Rate for Payer: PHCS Commercial |
$623.04
|
| Rate for Payer: United Healthcare All Payer |
$571.12
|
|
|
I&D ABSCESS SIMPLE
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna Commercial |
$132.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.75
|
| Rate for Payer: Anthem Medicaid |
$39.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.00
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: Healthspan PPO |
$122.10
|
| Rate for Payer: Humana Medicaid |
$39.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.53
|
| Rate for Payer: Molina Healthcare Passport |
$39.74
|
| Rate for Payer: Multiplan PHCS |
$389.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$454.30
|
| Rate for Payer: UHCCP Medicaid |
$62.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.14
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000016
|
|
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 Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| 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 |
$173.12
|
| 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 |
$207.74
|
| 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 SIMPLE
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000017
|
|
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 Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| 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 |
$173.12
|
| 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 |
$207.74
|
| 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 SIMPLE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000017
|
|
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 ABSCESS SIMPLE
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$623.04 |
| Rate for Payer: Aetna Commercial |
$499.73
|
| Rate for Payer: Anthem Medicaid |
$223.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$538.67
|
| Rate for Payer: First Health Commercial |
$616.55
|
| Rate for Payer: Humana Commercial |
$551.65
|
| Rate for Payer: Humana KY Medicaid |
$223.19
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$225.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$532.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$571.12
|
| Rate for Payer: Ohio Health Group HMO |
$486.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.19
|
| Rate for Payer: PHCS Commercial |
$623.04
|
| Rate for Payer: United Healthcare All Payer |
$571.12
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000016
|
|
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 ABSCESS SIMPLE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761P0008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$132.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.75
|
| Rate for Payer: Anthem Medicaid |
$39.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: Healthspan PPO |
$122.10
|
| Rate for Payer: Humana Medicaid |
$39.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.53
|
| Rate for Payer: Molina Healthcare Passport |
$39.74
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$62.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.14
|
|
|
I&D ABSCESS SIMPLE(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761T0008
|
|
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 Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| 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 |
$173.12
|
| 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 |
$207.74
|
| 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 SIMPLE(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761T0008
|
|
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
|
|
|
IDARUBICIN 10MG/10ML VIAL
|
Facility
|
OP
|
$245.78
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25003912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Anthem Medicaid |
$84.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.71
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$233.49
|
| Rate for Payer: Humana Commercial |
$208.91
|
| Rate for Payer: Humana KY Medicaid |
$84.52
|
| Rate for Payer: Kentucky WC Medicaid |
$85.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$201.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$181.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$216.29
|
| Rate for Payer: Ohio Health Group HMO |
$184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.19
|
| Rate for Payer: PHCS Commercial |
$235.95
|
| Rate for Payer: United Healthcare All Payer |
$216.29
|
|
|
IDARUBICIN 10MG/10ML VIAL
|
Facility
|
IP
|
$245.78
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25003912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.71
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$233.49
|
| Rate for Payer: Humana Commercial |
$208.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$201.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$181.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$216.29
|
| Rate for Payer: Ohio Health Group HMO |
$184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.19
|
| Rate for Payer: PHCS Commercial |
$235.95
|
| Rate for Payer: United Healthcare All Payer |
$216.29
|
|
|
IDARUBICIN 1MG/ML [5MG VIAL]
|
Facility
|
IP
|
$215.25
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25002631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$165.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.90
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cigna Commercial |
$178.66
|
| Rate for Payer: First Health Commercial |
$204.49
|
| Rate for Payer: Humana Commercial |
$182.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.42
|
| Rate for Payer: Ohio Health Group HMO |
$161.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.73
|
| Rate for Payer: PHCS Commercial |
$206.64
|
| Rate for Payer: United Healthcare All Payer |
$189.42
|
|
|
IDARUBICIN 1MG/ML [5MG VIAL]
|
Facility
|
OP
|
$215.25
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25002631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$165.74
|
| Rate for Payer: Anthem Medicaid |
$74.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.90
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cigna Commercial |
$178.66
|
| Rate for Payer: First Health Commercial |
$204.49
|
| Rate for Payer: Humana Commercial |
$182.96
|
| Rate for Payer: Humana KY Medicaid |
$74.02
|
| Rate for Payer: Kentucky WC Medicaid |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.42
|
| Rate for Payer: Ohio Health Group HMO |
$161.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.73
|
| Rate for Payer: PHCS Commercial |
$206.64
|
| Rate for Payer: United Healthcare All Payer |
$189.42
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
IP
|
$1,006.66
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$966.39 |
| Rate for Payer: Aetna Commercial |
$775.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.19
|
| Rate for Payer: Cash Price |
$503.33
|
| Rate for Payer: Cigna Commercial |
$835.53
|
| Rate for Payer: First Health Commercial |
$956.33
|
| Rate for Payer: Humana Commercial |
$855.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.86
|
| Rate for Payer: Ohio Health Group HMO |
$755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.06
|
| Rate for Payer: PHCS Commercial |
$966.39
|
| Rate for Payer: United Healthcare All Payer |
$885.86
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
45000289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
45000289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
OP
|
$1,006.66
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$966.39 |
| Rate for Payer: Aetna Commercial |
$775.13
|
| Rate for Payer: Anthem Medicaid |
$346.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$503.33
|
| Rate for Payer: Cash Price |
$503.33
|
| Rate for Payer: Cigna Commercial |
$835.53
|
| Rate for Payer: First Health Commercial |
$956.33
|
| Rate for Payer: Humana Commercial |
$855.66
|
| Rate for Payer: Humana KY Medicaid |
$346.19
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$349.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$353.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.86
|
| Rate for Payer: Ohio Health Group HMO |
$755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.06
|
| Rate for Payer: PHCS Commercial |
$966.39
|
| Rate for Payer: United Healthcare All Payer |
$885.86
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Professional
|
Both
|
$1,006.66
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$1,006.66 |
| Rate for Payer: Aetna Commercial |
$138.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.62
|
| Rate for Payer: Anthem Medicaid |
$53.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,006.66
|
| Rate for Payer: Cash Price |
$503.33
|
| Rate for Payer: Cash Price |
$503.33
|
| Rate for Payer: Cigna Commercial |
$203.93
|
| Rate for Payer: Healthspan PPO |
$178.47
|
| Rate for Payer: Humana Medicaid |
$53.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.27
|
| Rate for Payer: Molina Healthcare Passport |
$53.21
|
| Rate for Payer: Multiplan PHCS |
$604.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.66
|
| Rate for Payer: UHCCP Medicaid |
$60.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.74
|
|
