|
I&D BARTHOLINS GLAND ABSCES(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761P2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$450.00 |
| 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 |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| 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 |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$60.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.74
|
|
|
I&D BARTHOLINS GLAND ABSCES(T
|
Facility
|
IP
|
$556.66
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761T2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$534.39 |
| Rate for Payer: Aetna Commercial |
$428.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.19
|
| Rate for Payer: Cash Price |
$278.33
|
| Rate for Payer: Cigna Commercial |
$462.03
|
| Rate for Payer: First Health Commercial |
$528.83
|
| Rate for Payer: Humana Commercial |
$473.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.86
|
| Rate for Payer: Ohio Health Group HMO |
$417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.56
|
| Rate for Payer: PHCS Commercial |
$534.39
|
| Rate for Payer: United Healthcare All Payer |
$489.86
|
|
|
I&D BARTHOLINS GLAND ABSCES(T
|
Facility
|
OP
|
$556.66
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761T2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$534.39 |
| Rate for Payer: Aetna Commercial |
$428.63
|
| Rate for Payer: Anthem Medicaid |
$191.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$278.33
|
| Rate for Payer: Cash Price |
$278.33
|
| Rate for Payer: Cigna Commercial |
$462.03
|
| Rate for Payer: First Health Commercial |
$528.83
|
| Rate for Payer: Humana Commercial |
$473.16
|
| Rate for Payer: Humana KY Medicaid |
$191.44
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$193.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.86
|
| Rate for Payer: Ohio Health Group HMO |
$417.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.56
|
| Rate for Payer: PHCS Commercial |
$534.39
|
| Rate for Payer: United Healthcare All Payer |
$489.86
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
761P0964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$640.70 |
| Rate for Payer: Aetna Commercial |
$570.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.81
|
| Rate for Payer: Anthem Medicaid |
$178.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$619.26
|
| Rate for Payer: Healthspan PPO |
$640.70
|
| Rate for Payer: Humana Medicaid |
$178.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.27
|
| Rate for Payer: Molina Healthcare Passport |
$178.70
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$138.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.49
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$640.70 |
| Rate for Payer: Aetna Commercial |
$570.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.81
|
| Rate for Payer: Anthem Medicaid |
$178.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$619.26
|
| Rate for Payer: Healthspan PPO |
$640.70
|
| Rate for Payer: Humana Medicaid |
$178.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.27
|
| Rate for Payer: Molina Healthcare Passport |
$178.70
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$138.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.49
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Humana KY Medicaid |
$261.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$925.68 |
| Rate for Payer: Aetna Commercial |
$850.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.42
|
| Rate for Payer: Anthem Medicaid |
$281.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$925.68
|
| Rate for Payer: Healthspan PPO |
$895.56
|
| Rate for Payer: Humana Medicaid |
$281.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$286.68
|
| Rate for Payer: Molina Healthcare Passport |
$281.06
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$261.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$283.87
|
|
|
I&D BEL FASC FOOT MULT AREAS(P
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
761P0965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$925.68 |
| Rate for Payer: Aetna Commercial |
$850.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.42
|
| Rate for Payer: Anthem Medicaid |
$281.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$925.68
|
| Rate for Payer: Healthspan PPO |
$895.56
|
| Rate for Payer: Humana Medicaid |
$281.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$286.68
|
| Rate for Payer: Molina Healthcare Passport |
$281.06
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$261.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$283.87
|
|
|
I&D DEEP ABSCESS FOOT
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D DEEP ABSCESS FOOT
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
|
|
I&D DEEP ABSCESS FOOT
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D DEEP ABSCESS HAND
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Anthem Medicaid |
$750.00
|
| 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: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$750.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$765.00
|
| Rate for Payer: Molina Healthcare Passport |
$750.00
|
| 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 |
$757.50
|
|
|
I&D DEEP ABSCESS HAND
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
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 Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| 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 |
$203.93
|
| 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 |
$244.72
|
| 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 DEEP ABSCESS HAND
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
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 DEEP KNEE OR THIGH
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
I&D DEEP KNEE OR THIGH
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
45000156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem Medicaid |
$1,190.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| 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 |
$1,731.50
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Humana KY Medicaid |
$1,190.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,203.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.53
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP KNEE OR THIGH
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.59 |
| Max. Negotiated Rate |
$1,174.00 |
| Rate for Payer: Aetna Commercial |
$720.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$261.28
|
| Rate for Payer: Anthem Medicaid |
$250.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,174.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$779.99
|
| Rate for Payer: Healthspan PPO |
$838.56
|
| Rate for Payer: Humana Medicaid |
$250.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Molina Healthcare Passport |
$250.59
|
| Rate for Payer: Multiplan PHCS |
$704.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.80
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.10
|
|
|
I&D DEEP KNEE OR THIGH
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
45000156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.19 |
| Max. Negotiated Rate |
$3,324.48 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.53
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP KNEE OR THIGH
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| 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 |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
I&D DEEP KNEE OR THIGH(P
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
761P0808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.59 |
| Max. Negotiated Rate |
$1,174.00 |
| Rate for Payer: Aetna Commercial |
$720.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$261.28
|
| Rate for Payer: Anthem Medicaid |
$250.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,174.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$779.99
|
| Rate for Payer: Healthspan PPO |
$838.56
|
| Rate for Payer: Humana Medicaid |
$250.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Molina Healthcare Passport |
$250.59
|
| Rate for Payer: Multiplan PHCS |
$704.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.80
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.10
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.19 |
| Max. Negotiated Rate |
$3,324.48 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.53
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem Medicaid |
$1,190.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| 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 |
$1,731.50
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Humana KY Medicaid |
$1,190.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,203.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.53
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
