|
I&D ABCESS COMPLICATED(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761P0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$247.65 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Ambetter Exchange |
$172.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$91.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.50
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$247.65
|
| Rate for Payer: Healthspan PPO |
$211.67
|
| Rate for Payer: Humana Medicaid |
$91.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$198.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.23
|
| Rate for Payer: Molina Healthcare Passport |
$91.40
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.70
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.08
|
|
|
I&D ABCESS COMPLICATED(T
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761T0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABCESS COMPLICATED(T
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
761T0009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I & D ABSCESS
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
I & D ABSCESS
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
I & D ABSCESS
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
76100887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$661.08 |
| Rate for Payer: Aetna Commercial |
$562.34
|
| Rate for Payer: Ambetter Exchange |
$367.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.10
|
| Rate for Payer: Anthem Medicaid |
$203.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.96
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: Healthspan PPO |
$661.08
|
| Rate for Payer: Humana Medicaid |
$203.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.26
|
| Rate for Payer: Molina Healthcare Passport |
$203.20
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.71
|
| Rate for Payer: UHCCP Medicaid |
$212.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.47
|
|
|
I&D ABSCESS DEEP FOREARM
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
I&D ABSCESS DEEP FOREARM
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
I&D ABSCESS DEEP FOREARM
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$848.98 |
| Rate for Payer: Aetna Commercial |
$725.96
|
| Rate for Payer: Ambetter Exchange |
$632.08
|
| Rate for Payer: Anthem Medicaid |
$207.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$632.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$632.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$758.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$848.98
|
| Rate for Payer: Healthspan PPO |
$657.56
|
| Rate for Payer: Humana Medicaid |
$207.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$632.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.34
|
| Rate for Payer: Molina Healthcare Passport |
$207.20
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.70
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$632.08
|
|
|
I&D ABSCESS DEEP FOREARM(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
761P0568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$848.98 |
| Rate for Payer: Aetna Commercial |
$725.96
|
| Rate for Payer: Ambetter Exchange |
$632.08
|
| Rate for Payer: Anthem Medicaid |
$207.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$632.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$632.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$758.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$848.98
|
| Rate for Payer: Healthspan PPO |
$657.56
|
| Rate for Payer: Humana Medicaid |
$207.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$632.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.34
|
| Rate for Payer: Molina Healthcare Passport |
$207.20
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$821.70
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$632.08
|
|
|
I & D ABSCESS(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
761P0887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$661.08 |
| Rate for Payer: Aetna Commercial |
$562.34
|
| Rate for Payer: Ambetter Exchange |
$367.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$202.10
|
| Rate for Payer: Anthem Medicaid |
$203.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.96
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: Healthspan PPO |
$661.08
|
| Rate for Payer: Humana Medicaid |
$203.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.26
|
| Rate for Payer: Molina Healthcare Passport |
$203.20
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.71
|
| Rate for Payer: UHCCP Medicaid |
$212.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.47
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem Medicaid |
$234.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Humana KY Medicaid |
$234.20
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$236.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABSCESS SIMPLE
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna Commercial |
$132.90
|
| Rate for Payer: Ambetter Exchange |
$99.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.75
|
| Rate for Payer: Anthem Medicaid |
$45.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.40
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: Healthspan PPO |
$122.10
|
| Rate for Payer: Humana Medicaid |
$45.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.55
|
| Rate for Payer: Molina Healthcare Passport |
$45.64
|
| Rate for Payer: Multiplan PHCS |
$408.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.35
|
| Rate for Payer: UHCCP Medicaid |
$62.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.50
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.30 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
I&D ABSCESS SIMPLE
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
45000016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABSCESS SIMPLE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761P0008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Aetna Commercial |
$132.90
|
| Rate for Payer: Ambetter Exchange |
$99.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.75
|
| Rate for Payer: Anthem Medicaid |
$45.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.40
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: Healthspan PPO |
$122.10
|
| Rate for Payer: Humana Medicaid |
$45.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.55
|
| Rate for Payer: Molina Healthcare Passport |
$45.64
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.35
|
| Rate for Payer: UHCCP Medicaid |
$62.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.50
|
|
|
I&D ABSCESS SIMPLE(T
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761T0008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABSCESS SIMPLE(T
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
761T0008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
IDARUBICIN 10MG/10ML VIAL
|
Facility
|
IP
|
$245.78
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25003912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.71
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$233.49
|
| Rate for Payer: Humana Commercial |
$208.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$201.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$181.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$216.29
|
| Rate for Payer: Ohio Health Group HMO |
$184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.59
|
| Rate for Payer: PHCS Commercial |
$235.95
|
| Rate for Payer: United Healthcare All Payer |
$216.29
|
|
|
IDARUBICIN 10MG/10ML VIAL
|
Facility
|
OP
|
$245.78
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25003912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Aetna Commercial |
$189.25
|
| Rate for Payer: Anthem Medicaid |
$84.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.71
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: First Health Commercial |
$233.49
|
| Rate for Payer: Humana Commercial |
$208.91
|
| Rate for Payer: Humana KY Medicaid |
$84.52
|
| Rate for Payer: Kentucky WC Medicaid |
$85.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$201.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$181.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$216.29
|
| Rate for Payer: Ohio Health Group HMO |
$184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.59
|
| Rate for Payer: PHCS Commercial |
$235.95
|
| Rate for Payer: United Healthcare All Payer |
$216.29
|
|
|
IDARUBICIN 1MG/ML [5MG VIAL]
|
Facility
|
OP
|
$215.25
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25002631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$165.74
|
| Rate for Payer: Anthem Medicaid |
$74.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.90
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cigna Commercial |
$178.66
|
| Rate for Payer: First Health Commercial |
$204.49
|
| Rate for Payer: Humana Commercial |
$182.96
|
| Rate for Payer: Humana KY Medicaid |
$74.02
|
| Rate for Payer: Kentucky WC Medicaid |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.42
|
| Rate for Payer: Ohio Health Group HMO |
$161.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.52
|
| Rate for Payer: PHCS Commercial |
$206.64
|
| Rate for Payer: United Healthcare All Payer |
$189.42
|
|
|
IDARUBICIN 1MG/ML [5MG VIAL]
|
Facility
|
IP
|
$215.25
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
25002631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$165.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.90
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cigna Commercial |
$178.66
|
| Rate for Payer: First Health Commercial |
$204.49
|
| Rate for Payer: Humana Commercial |
$182.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.42
|
| Rate for Payer: Ohio Health Group HMO |
$161.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.52
|
| Rate for Payer: PHCS Commercial |
$206.64
|
| Rate for Payer: United Healthcare All Payer |
$189.42
|
|
