|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
45000289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$982.08 |
| Rate for Payer: Aetna Commercial |
$787.71
|
| Rate for Payer: Anthem Medicaid |
$351.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$797.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$849.09
|
| Rate for Payer: First Health Commercial |
$971.85
|
| Rate for Payer: Humana Commercial |
$869.55
|
| Rate for Payer: Humana KY Medicaid |
$351.81
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$355.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$838.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$754.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$358.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$900.24
|
| Rate for Payer: Ohio Health Group HMO |
$767.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$705.87
|
| Rate for Payer: PHCS Commercial |
$982.08
|
| Rate for Payer: United Healthcare All Payer |
$900.24
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
45000289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem Medicaid |
$197.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Humana KY Medicaid |
$197.05
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$199.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.90 |
| Max. Negotiated Rate |
$982.08 |
| Rate for Payer: Aetna Commercial |
$787.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$797.94
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$849.09
|
| Rate for Payer: First Health Commercial |
$971.85
|
| Rate for Payer: Humana Commercial |
$869.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$838.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$754.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$900.24
|
| Rate for Payer: Ohio Health Group HMO |
$767.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$705.87
|
| Rate for Payer: PHCS Commercial |
$982.08
|
| Rate for Payer: United Healthcare All Payer |
$900.24
|
|
|
I&D BARTHOLINS GLAND ABSCES
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
76102155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Aetna Commercial |
$138.28
|
| Rate for Payer: Ambetter Exchange |
$102.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.62
|
| Rate for Payer: Anthem Medicaid |
$63.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.52
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$203.93
|
| Rate for Payer: Healthspan PPO |
$178.47
|
| Rate for Payer: Humana Medicaid |
$63.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.22
|
| Rate for Payer: Molina Healthcare Passport |
$63.94
|
| Rate for Payer: Multiplan PHCS |
$613.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.81
|
| Rate for Payer: UHCCP Medicaid |
$60.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.93
|
|
|
I&D BARTHOLINS GLAND ABSCES(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761P2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$138.28
|
| Rate for Payer: Ambetter Exchange |
$102.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.62
|
| Rate for Payer: Anthem Medicaid |
$63.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.52
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$203.93
|
| Rate for Payer: Healthspan PPO |
$178.47
|
| Rate for Payer: Humana Medicaid |
$63.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.22
|
| Rate for Payer: Molina Healthcare Passport |
$63.94
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.81
|
| Rate for Payer: UHCCP Medicaid |
$60.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.93
|
|
|
I&D BARTHOLINS GLAND ABSCES(T
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761T2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
I&D BARTHOLINS GLAND ABSCES(T
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
761T2155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem Medicaid |
$197.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Humana KY Medicaid |
$197.05
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$199.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.37
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$640.70 |
| Rate for Payer: Aetna Commercial |
$570.85
|
| Rate for Payer: Ambetter Exchange |
$133.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.81
|
| Rate for Payer: Anthem Medicaid |
$178.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.65
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$619.26
|
| Rate for Payer: Healthspan PPO |
$640.70
|
| Rate for Payer: Humana Medicaid |
$178.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.27
|
| Rate for Payer: Molina Healthcare Passport |
$178.70
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.95
|
| Rate for Payer: UHCCP Medicaid |
$138.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.04
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
761P0964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$640.70 |
| Rate for Payer: Aetna Commercial |
$570.85
|
| Rate for Payer: Ambetter Exchange |
$133.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.81
|
| Rate for Payer: Anthem Medicaid |
$178.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.65
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$619.26
|
| Rate for Payer: Healthspan PPO |
$640.70
|
| Rate for Payer: Humana Medicaid |
$178.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.27
|
| Rate for Payer: Molina Healthcare Passport |
$178.70
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.95
|
| Rate for Payer: UHCCP Medicaid |
$138.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.04
|
|
|
I&D BEL FASC FOOT 1 BURS SPACE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 28002
|
| Hospital Charge Code |
76100964
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$925.68 |
| Rate for Payer: Aetna Commercial |
$850.63
|
| Rate for Payer: Ambetter Exchange |
$244.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.42
|
| Rate for Payer: Anthem Medicaid |
$328.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$244.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$244.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$293.44
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$925.68
|
| Rate for Payer: Healthspan PPO |
$895.56
|
| Rate for Payer: Humana Medicaid |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.56
|
| Rate for Payer: Molina Healthcare Passport |
$328.00
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.89
|
| Rate for Payer: UHCCP Medicaid |
$261.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$244.53
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
I&D BEL FASC FOOT MULT AREAS
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
76100965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Humana KY Medicaid |
$261.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
I&D BEL FASC FOOT MULT AREAS(P
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
761P0965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$925.68 |
| Rate for Payer: Aetna Commercial |
$850.63
|
| Rate for Payer: Ambetter Exchange |
$244.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.42
|
| Rate for Payer: Anthem Medicaid |
$328.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$244.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$244.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$293.44
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$925.68
|
| Rate for Payer: Healthspan PPO |
$895.56
|
| Rate for Payer: Humana Medicaid |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.56
|
| Rate for Payer: Molina Healthcare Passport |
$328.00
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.89
|
| Rate for Payer: UHCCP Medicaid |
$261.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$331.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$244.53
|
|
|
I&D DEEP ABSCESS FOOT
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D DEEP ABSCESS FOOT
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
I&D DEEP ABSCESS FOOT
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102887
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
|
|
I&D DEEP ABSCESS HAND
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 DEEP ABSCESS HAND
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Anthem Medicaid |
$975.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$975.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$994.50
|
| Rate for Payer: Molina Healthcare Passport |
$975.00
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$984.75
|
|
|
I&D DEEP ABSCESS HAND
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76102873
|
|
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 DEEP KNEE OR THIGH
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.20 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.06
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
I&D DEEP KNEE OR THIGH
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.59 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$720.26
|
| Rate for Payer: Ambetter Exchange |
$485.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$261.28
|
| Rate for Payer: Anthem Medicaid |
$250.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$485.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$485.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$582.54
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$779.99
|
| Rate for Payer: Healthspan PPO |
$838.56
|
| Rate for Payer: Humana Medicaid |
$250.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$485.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$485.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Molina Healthcare Passport |
$250.59
|
| Rate for Payer: Multiplan PHCS |
$704.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$631.09
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$485.45
|
|
|
I&D DEEP KNEE OR THIGH
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
76100808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.74 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| 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 |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.06
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
