|
INC & DRAINAGE SUBMUCOSAL RECT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.25
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
761P1874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$217.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.35
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$207.57
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$112.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem Medicaid |
$128.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| 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 |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Humana KY Medicaid |
$128.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$130.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.25
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$217.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.35
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$207.57
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$112.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
761P1875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.51 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna Commercial |
$757.04
|
| Rate for Payer: Anthem Medicaid |
$211.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$676.11
|
| Rate for Payer: Healthspan PPO |
$638.43
|
| Rate for Payer: Humana Medicaid |
$211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$707.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.74
|
| Rate for Payer: Molina Healthcare Passport |
$211.51
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.63
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.51 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna Commercial |
$757.04
|
| Rate for Payer: Anthem Medicaid |
$211.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$676.11
|
| Rate for Payer: Healthspan PPO |
$638.43
|
| Rate for Payer: Humana Medicaid |
$211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$707.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.74
|
| Rate for Payer: Molina Healthcare Passport |
$211.51
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.63
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
INC/DRAIN INTRAORAL APPROACH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$581.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.31
|
| Rate for Payer: Anthem Medicaid |
$132.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$571.66
|
| Rate for Payer: Healthspan PPO |
$552.53
|
| Rate for Payer: Humana Medicaid |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.28
|
| Rate for Payer: Molina Healthcare Passport |
$132.63
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$236.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.96
|
|
|
INC/DRAIN INTRAORAL APPROACH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INC/DRAIN INTRAORAL APPROACH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INC/DRAIN INTRAORAL APPROACH(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
761P1697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$581.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.31
|
| Rate for Payer: Anthem Medicaid |
$132.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$571.66
|
| Rate for Payer: Healthspan PPO |
$552.53
|
| Rate for Payer: Humana Medicaid |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.28
|
| Rate for Payer: Molina Healthcare Passport |
$132.63
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$236.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.96
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.72 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.21 |
| Max. Negotiated Rate |
$1,844.00 |
| Rate for Payer: Aetna Commercial |
$668.50
|
| Rate for Payer: Anthem Medicaid |
$262.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,844.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$753.46
|
| Rate for Payer: Healthspan PPO |
$605.52
|
| Rate for Payer: Humana Medicaid |
$262.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.45
|
| Rate for Payer: Molina Healthcare Passport |
$262.21
|
| Rate for Payer: Multiplan PHCS |
$1,106.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,290.80
|
| Rate for Payer: UHCCP Medicaid |
$645.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.83
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.72 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.72 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.72 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
IP
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.21 |
| Max. Negotiated Rate |
$6,308.04 |
| Rate for Payer: Aetna Commercial |
$5,059.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,125.29
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$5,453.83
|
| Rate for Payer: First Health Commercial |
$6,242.34
|
| Rate for Payer: Humana Commercial |
$5,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,388.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,849.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,971.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,782.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,928.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,314.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.97
|
| Rate for Payer: PHCS Commercial |
$6,308.04
|
| Rate for Payer: United Healthcare All Payer |
$5,782.37
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
OP
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$854.21 |
| Max. Negotiated Rate |
$6,308.04 |
| Rate for Payer: Aetna Commercial |
$5,059.58
|
| Rate for Payer: Anthem Medicaid |
$2,259.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,125.29
|
| 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 |
$3,285.44
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$5,453.83
|
| Rate for Payer: First Health Commercial |
$6,242.34
|
| Rate for Payer: Humana Commercial |
$5,585.25
|
| Rate for Payer: Humana KY Medicaid |
$2,259.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,282.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,388.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,849.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,305.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,782.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,928.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,314.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,036.97
|
| Rate for Payer: PHCS Commercial |
$6,308.04
|
| Rate for Payer: United Healthcare All Payer |
$5,782.37
|
|
|
INCISE BLADDER/DRAIN URETER
|
Professional
|
Both
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$6,570.88 |
| Rate for Payer: Aetna Commercial |
$749.07
|
| Rate for Payer: Anthem Medicaid |
$322.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,570.88
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$672.34
|
| Rate for Payer: Healthspan PPO |
$598.95
|
| Rate for Payer: Humana Medicaid |
$322.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.87
|
| Rate for Payer: Molina Healthcare Passport |
$322.42
|
| Rate for Payer: Multiplan PHCS |
$3,942.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,599.62
|
| Rate for Payer: UHCCP Medicaid |
$2,299.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.64
|
|
|
INCISE BLADDER/DRAIN URETER(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761P2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$749.07
|
| Rate for Payer: Anthem Medicaid |
$322.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$672.34
|
| Rate for Payer: Healthspan PPO |
$598.95
|
| Rate for Payer: Humana Medicaid |
$322.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.87
|
| Rate for Payer: Molina Healthcare Passport |
$322.42
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.64
|
|
|
INCISE BLADDER/DRAIN URETER(T
|
Facility
|
OP
|
$5,045.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761T2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$655.96 |
| Max. Negotiated Rate |
$4,844.04 |
| Rate for Payer: Aetna Commercial |
$3,885.33
|
| Rate for Payer: Anthem Medicaid |
$1,735.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.79
|
| 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 |
$2,522.94
|
| Rate for Payer: Cash Price |
$2,522.94
|
| Rate for Payer: Cigna Commercial |
$4,188.08
|
| Rate for Payer: First Health Commercial |
$4,793.59
|
| Rate for Payer: Humana Commercial |
$4,289.00
|
| Rate for Payer: Humana KY Medicaid |
$1,735.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,137.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,440.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,784.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.22
|
| Rate for Payer: PHCS Commercial |
$4,844.04
|
| Rate for Payer: United Healthcare All Payer |
$4,440.37
|
|
|
INCISE BLADDER/DRAIN URETER(T
|
Facility
|
IP
|
$5,045.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761T2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$655.96 |
| Max. Negotiated Rate |
$4,844.04 |
| Rate for Payer: Aetna Commercial |
$3,885.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.79
|
| Rate for Payer: Cash Price |
$2,522.94
|
| Rate for Payer: Cigna Commercial |
$4,188.08
|
| Rate for Payer: First Health Commercial |
$4,793.59
|
| Rate for Payer: Humana Commercial |
$4,289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,137.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,440.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,784.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.22
|
| Rate for Payer: PHCS Commercial |
$4,844.04
|
| Rate for Payer: United Healthcare All Payer |
$4,440.37
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
76100660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
76100660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
