|
I & D OF HEMATOMA/FLUID
|
Facility
|
OP
|
$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 Medicaid |
$511.04
|
| 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: Humana KY Medicaid |
$511.04
|
| Rate for Payer: Kentucky WC Medicaid |
$516.24
|
| 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: Molina Healthcare Medicaid |
$521.29
|
| 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 PELVIC/HIP AREA
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
I & D PELVIC/HIP AREA
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.90 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$891.61
|
| Rate for Payer: Anthem Medicaid |
$293.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$983.78
|
| Rate for Payer: Healthspan PPO |
$807.61
|
| Rate for Payer: Humana Medicaid |
$293.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.78
|
| Rate for Payer: Molina Healthcare Passport |
$293.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.84
|
|
|
I & D PELVIC/HIP AREA
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
I & D PELVIC/HIP AREA(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
761P0759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.90 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$891.61
|
| Rate for Payer: Anthem Medicaid |
$293.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$983.78
|
| Rate for Payer: Healthspan PPO |
$807.61
|
| Rate for Payer: Humana Medicaid |
$293.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.78
|
| Rate for Payer: Molina Healthcare Passport |
$293.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.84
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.82
|
| Rate for Payer: Anthem Medicaid |
$44.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$201.81
|
| Rate for Payer: Humana Medicaid |
$44.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.05
|
| Rate for Payer: Molina Healthcare Passport |
$44.17
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$80.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.61
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
45000269
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem Medicaid |
$409.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Humana KY Medicaid |
$409.24
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.90
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
45000269
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.90
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$77.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$77.38
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$78.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
I&D PERIANAL ABSCES SIMPLE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
761P1912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.82
|
| Rate for Payer: Anthem Medicaid |
$44.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$201.81
|
| Rate for Payer: Humana Medicaid |
$44.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.05
|
| Rate for Payer: Molina Healthcare Passport |
$44.17
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$80.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.61
|
|
|
I & D PERITONSILLAR
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$193.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.98
|
| Rate for Payer: Anthem Medicaid |
$59.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$604.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$248.86
|
| Rate for Payer: Healthspan PPO |
$217.63
|
| Rate for Payer: Humana Medicaid |
$59.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.10
|
| Rate for Payer: Molina Healthcare Passport |
$59.90
|
| Rate for Payer: Multiplan PHCS |
$362.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.80
|
| Rate for Payer: UHCCP Medicaid |
$114.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.50
|
|
|
I & D PERITONSILLAR
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$579.84 |
| Rate for Payer: Aetna Commercial |
$465.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.12
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$501.32
|
| Rate for Payer: First Health Commercial |
$573.80
|
| Rate for Payer: Humana Commercial |
$513.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$495.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$531.52
|
| Rate for Payer: Ohio Health Group HMO |
$453.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.24
|
| Rate for Payer: PHCS Commercial |
$579.84
|
| Rate for Payer: United Healthcare All Payer |
$531.52
|
|
|
I & D PERITONSILLAR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
45000262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
I & D PERITONSILLAR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
45000262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
I & D PERITONSILLAR
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$579.84 |
| Rate for Payer: Aetna Commercial |
$465.08
|
| Rate for Payer: Anthem Medicaid |
$207.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$501.32
|
| Rate for Payer: First Health Commercial |
$573.80
|
| Rate for Payer: Humana Commercial |
$513.40
|
| Rate for Payer: Humana KY Medicaid |
$207.72
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$209.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$495.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$531.52
|
| Rate for Payer: Ohio Health Group HMO |
$453.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.24
|
| Rate for Payer: PHCS Commercial |
$579.84
|
| Rate for Payer: United Healthcare All Payer |
$531.52
|
|
|
I & D PERITONSILLAR(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761P1696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$193.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.98
|
| Rate for Payer: Anthem Medicaid |
$59.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$248.86
|
| Rate for Payer: Healthspan PPO |
$217.63
|
| Rate for Payer: Humana Medicaid |
$59.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.10
|
| Rate for Payer: Molina Healthcare Passport |
$59.90
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$114.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.50
|
|
|
I & D PERITONSILLAR(T
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761T1696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
I & D PERITONSILLAR(T
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761T1696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
761T0011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
761P0011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$238.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.38
|
| Rate for Payer: Anthem Medicaid |
$89.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$366.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$360.82
|
| Rate for Payer: Healthspan PPO |
$283.46
|
| Rate for Payer: Humana Medicaid |
$89.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.98
|
| Rate for Payer: Molina Healthcare Passport |
$89.20
|
| Rate for Payer: Multiplan PHCS |
$219.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.20
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.09
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
76100011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.37 |
| Max. Negotiated Rate |
$1,295.04 |
| Rate for Payer: Aetna Commercial |
$1,038.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,052.22
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cigna Commercial |
$1,119.67
|
| Rate for Payer: First Health Commercial |
$1,281.55
|
| Rate for Payer: Humana Commercial |
$1,146.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,106.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$995.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,187.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,011.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.19
|
| Rate for Payer: PHCS Commercial |
$1,295.04
|
| Rate for Payer: United Healthcare All Payer |
$1,187.12
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
76100011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Aetna Commercial |
$238.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.38
|
| Rate for Payer: Anthem Medicaid |
$89.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,349.00
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cigna Commercial |
$360.82
|
| Rate for Payer: Healthspan PPO |
$283.46
|
| Rate for Payer: Humana Medicaid |
$89.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.98
|
| Rate for Payer: Molina Healthcare Passport |
$89.20
|
| Rate for Payer: Multiplan PHCS |
$809.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$944.30
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.09
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.73
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
