|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$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 Medicaid |
$463.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,052.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$674.50
|
| 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: Humana KY Medicaid |
$463.92
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$468.64
|
| 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 |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.23
|
| 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
|
Facility
|
IP
|
$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 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 SIMPLE
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.47 |
| Max. Negotiated Rate |
$1,170.24 |
| Rate for Payer: Aetna Commercial |
$938.63
|
| Rate for Payer: Anthem Medicaid |
$419.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$609.50
|
| Rate for Payer: Cash Price |
$609.50
|
| Rate for Payer: Cigna Commercial |
$1,011.77
|
| Rate for Payer: First Health Commercial |
$1,158.05
|
| Rate for Payer: Humana Commercial |
$1,036.15
|
| Rate for Payer: Humana KY Medicaid |
$419.21
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$423.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$999.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.72
|
| Rate for Payer: Ohio Health Group HMO |
$914.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.89
|
| Rate for Payer: PHCS Commercial |
$1,170.24
|
| Rate for Payer: United Healthcare All Payer |
$1,072.72
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$135.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,219.00
|
| Rate for Payer: Cash Price |
$609.50
|
| Rate for Payer: Cash Price |
$609.50
|
| Rate for Payer: Cigna Commercial |
$234.29
|
| Rate for Payer: Healthspan PPO |
$178.46
|
| Rate for Payer: Humana Medicaid |
$55.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.57
|
| Rate for Payer: Molina Healthcare Passport |
$55.46
|
| Rate for Payer: Multiplan PHCS |
$731.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.30
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.01
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.47 |
| Max. Negotiated Rate |
$1,170.24 |
| Rate for Payer: Aetna Commercial |
$938.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.82
|
| Rate for Payer: Cash Price |
$609.50
|
| Rate for Payer: Cigna Commercial |
$1,011.77
|
| Rate for Payer: First Health Commercial |
$1,158.05
|
| Rate for Payer: Humana Commercial |
$1,036.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$999.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.72
|
| Rate for Payer: Ohio Health Group HMO |
$914.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.89
|
| Rate for Payer: PHCS Commercial |
$1,170.24
|
| Rate for Payer: United Healthcare All Payer |
$1,072.72
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
45000019
|
|
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
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
45000019
|
|
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 SIMPLE(P
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761P0010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$135.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$234.29
|
| Rate for Payer: Healthspan PPO |
$178.46
|
| Rate for Payer: Humana Medicaid |
$55.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.57
|
| Rate for Payer: Molina Healthcare Passport |
$55.46
|
| Rate for Payer: Multiplan PHCS |
$141.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.20
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.01
|
|
|
I&D PILONIDAL CYST SIMPLE(T
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761T0010
|
|
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 SIMPLE(T
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761T0010
|
|
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 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 RECTAL ABCESS UNDER ANESTH
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$571.27 |
| Rate for Payer: Aetna Commercial |
$571.27
|
| Rate for Payer: Anthem Medicaid |
$173.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$511.90
|
| Rate for Payer: Healthspan PPO |
$481.76
|
| Rate for Payer: Humana Medicaid |
$173.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.06
|
| Rate for Payer: Molina Healthcare Passport |
$173.59
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.33
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
761P1911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$571.27 |
| Rate for Payer: Aetna Commercial |
$571.27
|
| Rate for Payer: Anthem Medicaid |
$173.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$511.90
|
| Rate for Payer: Healthspan PPO |
$481.76
|
| Rate for Payer: Humana Medicaid |
$173.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.06
|
| Rate for Payer: Molina Healthcare Passport |
$173.59
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.33
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761T0494
|
|
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 UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$3,925.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.25 |
| Max. Negotiated Rate |
$3,768.00 |
| Rate for Payer: Aetna Commercial |
$3,022.25
|
| Rate for Payer: Anthem Medicaid |
$1,349.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,061.50
|
| 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 |
$1,962.50
|
| Rate for Payer: Cash Price |
$1,962.50
|
| Rate for Payer: Cigna Commercial |
$3,257.75
|
| Rate for Payer: First Health Commercial |
$3,728.75
|
| Rate for Payer: Humana Commercial |
$3,336.25
|
| Rate for Payer: Humana KY Medicaid |
$1,349.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,363.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,218.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,896.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,376.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,943.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.75
|
| Rate for Payer: PHCS Commercial |
$3,768.00
|
| Rate for Payer: United Healthcare All Payer |
$3,454.00
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761P0494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$314.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.74
|
| Rate for Payer: Anthem Medicaid |
$130.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$462.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$344.08
|
| Rate for Payer: Healthspan PPO |
$440.90
|
| Rate for Payer: Humana Medicaid |
$130.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.20
|
| Rate for Payer: Molina Healthcare Passport |
$130.59
|
| Rate for Payer: Multiplan PHCS |
$277.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$323.40
|
| Rate for Payer: UHCCP Medicaid |
$116.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.90
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
45000116
|
|
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 UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761T0494
|
|
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 UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$3,925.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.25 |
| Max. Negotiated Rate |
$3,768.00 |
| Rate for Payer: Aetna Commercial |
$3,022.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,061.50
|
| Rate for Payer: Cash Price |
$1,962.50
|
| Rate for Payer: Cigna Commercial |
$3,257.75
|
| Rate for Payer: First Health Commercial |
$3,728.75
|
| Rate for Payer: Humana Commercial |
$3,336.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,218.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,896.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,177.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,943.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.75
|
| Rate for Payer: PHCS Commercial |
$3,768.00
|
| Rate for Payer: United Healthcare All Payer |
$3,454.00
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
45000116
|
|
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 UP ARM OR ELBOW DP ABS/HEM
|
Professional
|
Both
|
$3,925.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$3,925.00 |
| Rate for Payer: Aetna Commercial |
$314.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.74
|
| Rate for Payer: Anthem Medicaid |
$130.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,925.00
|
| Rate for Payer: Cash Price |
$1,962.50
|
| Rate for Payer: Cash Price |
$1,962.50
|
| Rate for Payer: Cigna Commercial |
$344.08
|
| Rate for Payer: Healthspan PPO |
$440.90
|
| Rate for Payer: Humana Medicaid |
$130.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.20
|
| Rate for Payer: Molina Healthcare Passport |
$130.59
|
| Rate for Payer: Multiplan PHCS |
$2,355.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,747.50
|
| Rate for Payer: UHCCP Medicaid |
$116.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.90
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
45000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
45000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761T0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
