|
I&D DEEP SHOULDER AREA
|
Facility
|
IP
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$3,891.84 |
| Rate for Payer: Aetna Commercial |
$3,121.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.12
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$3,364.82
|
| Rate for Payer: First Health Commercial |
$3,851.30
|
| Rate for Payer: Humana Commercial |
$3,445.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,991.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,567.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$810.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.74
|
| Rate for Payer: PHCS Commercial |
$3,891.84
|
| Rate for Payer: United Healthcare All Payer |
$3,567.52
|
|
|
I&D DEEP SHOULDER AREA
|
Professional
|
Both
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$4,054.00 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.33
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,054.00
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$416.05
|
| Rate for Payer: Healthspan PPO |
$532.22
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$2,432.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,837.80
|
| Rate for Payer: UHCCP Medicaid |
$137.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
OP
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$3,891.84 |
| Rate for Payer: Aetna Commercial |
$3,121.58
|
| Rate for Payer: Anthem Medicaid |
$1,394.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.12
|
| 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 |
$2,027.00
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$3,364.82
|
| Rate for Payer: First Health Commercial |
$3,851.30
|
| Rate for Payer: Humana Commercial |
$3,445.90
|
| Rate for Payer: Humana KY Medicaid |
$1,394.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,408.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,991.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,422.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,567.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$810.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.74
|
| Rate for Payer: PHCS Commercial |
$3,891.84
|
| Rate for Payer: United Healthcare All Payer |
$3,567.52
|
|
|
I&D DEEP SHOULDER AREA(P
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761P0432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.33
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$591.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$416.05
|
| Rate for Payer: Healthspan PPO |
$532.22
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$354.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.70
|
| Rate for Payer: UHCCP Medicaid |
$137.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
|
|
I&D DEEP SHOULDER AREA(T
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761T0432
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761T0432
|
|
Hospital Revenue Code
|
761
|
| 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 EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
45000286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
45000286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.85 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem Medicaid |
$909.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Humana KY Medicaid |
$909.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$918.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$927.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.95
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
761P2140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$342.70
|
| Rate for Payer: Anthem Medicaid |
$125.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$311.35
|
| Rate for Payer: Healthspan PPO |
$331.82
|
| Rate for Payer: Humana Medicaid |
$125.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.51
|
| Rate for Payer: Molina Healthcare Passport |
$125.99
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.25
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$342.70
|
| Rate for Payer: Anthem Medicaid |
$125.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$311.35
|
| Rate for Payer: Healthspan PPO |
$331.82
|
| Rate for Payer: Humana Medicaid |
$125.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.51
|
| Rate for Payer: Molina Healthcare Passport |
$125.99
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.25
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
45000268
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.19 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.53
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.37 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$557.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.27
|
| Rate for Payer: Anthem Medicaid |
$197.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$517.32
|
| Rate for Payer: Healthspan PPO |
$575.40
|
| Rate for Payer: Humana Medicaid |
$197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$507.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.32
|
| Rate for Payer: Molina Healthcare Passport |
$197.37
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$231.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.34
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
45000268
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.19 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem Medicaid |
$537.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Humana KY Medicaid |
$537.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$542.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.53
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
761P1910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.37 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$557.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.27
|
| Rate for Payer: Anthem Medicaid |
$197.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$517.32
|
| Rate for Payer: Healthspan PPO |
$575.40
|
| Rate for Payer: Humana Medicaid |
$197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$507.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.32
|
| Rate for Payer: Molina Healthcare Passport |
$197.37
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$231.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.34
|
|
|
I & D OF ABSCESS
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
45000327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
I & D OF ABSCESS
|
Facility
|
OP
|
$325.00
|
|
| Hospital Charge Code |
76102555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
I & D OF ABSCESS
|
Facility
|
IP
|
$325.00
|
|
| Hospital Charge Code |
76102555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
I & D OF ABSCESS
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
45000327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Humana KY Medicaid |
$116.58
|
| Rate for Payer: Kentucky WC Medicaid |
$117.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
IP
|
$1,549.00
|
|
| Hospital Charge Code |
45000331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.37 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,192.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.22
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$1,285.67
|
| Rate for Payer: First Health Commercial |
$1,471.55
|
| Rate for Payer: Humana Commercial |
$1,316.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.19
|
| Rate for Payer: PHCS Commercial |
$1,487.04
|
| Rate for Payer: United Healthcare All Payer |
$1,363.12
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
IP
|
$1,486.00
|
|
| Hospital Charge Code |
76102559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.18 |
| Max. Negotiated Rate |
$1,426.56 |
| Rate for Payer: Aetna Commercial |
$1,144.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,159.08
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$1,233.38
|
| Rate for Payer: First Health Commercial |
$1,411.70
|
| Rate for Payer: Humana Commercial |
$1,263.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,218.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,096.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,307.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,114.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.66
|
| Rate for Payer: PHCS Commercial |
$1,426.56
|
| Rate for Payer: United Healthcare All Payer |
$1,307.68
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
OP
|
$1,549.00
|
|
| Hospital Charge Code |
45000331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.37 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,192.73
|
| Rate for Payer: Anthem Medicaid |
$532.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.22
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$1,285.67
|
| Rate for Payer: First Health Commercial |
$1,471.55
|
| Rate for Payer: Humana Commercial |
$1,316.65
|
| Rate for Payer: Humana KY Medicaid |
$532.70
|
| Rate for Payer: Kentucky WC Medicaid |
$538.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.19
|
| Rate for Payer: PHCS Commercial |
$1,487.04
|
| Rate for Payer: United Healthcare All Payer |
$1,363.12
|
|
