|
I & D OF ABSCESS
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
45000327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Humana KY Medicaid |
$116.58
|
| Rate for Payer: Kentucky WC Medicaid |
$117.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.91
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
I & D OF ABSCESS
|
Facility
|
OP
|
$336.00
|
|
| Hospital Charge Code |
76102555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem Medicaid |
$115.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Humana KY Medicaid |
$115.55
|
| Rate for Payer: Kentucky WC Medicaid |
$116.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.84
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
I & D OF ABSCESS
|
Facility
|
IP
|
$336.00
|
|
| Hospital Charge Code |
76102555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.84
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
I & D OF ABSCESS
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
45000327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.91
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
OP
|
$1,486.00
|
|
| Hospital Charge Code |
76102559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$1,426.56 |
| Rate for Payer: Aetna Commercial |
$1,144.22
|
| Rate for Payer: Anthem Medicaid |
$511.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,159.08
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$1,233.38
|
| Rate for Payer: First Health Commercial |
$1,411.70
|
| Rate for Payer: Humana Commercial |
$1,263.10
|
| Rate for Payer: Humana KY Medicaid |
$511.04
|
| Rate for Payer: Kentucky WC Medicaid |
$516.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,218.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,096.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$521.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,307.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,114.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.34
|
| Rate for Payer: PHCS Commercial |
$1,426.56
|
| Rate for Payer: United Healthcare All Payer |
$1,307.68
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
IP
|
$1,549.00
|
|
| Hospital Charge Code |
45000331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.70 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,192.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.22
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$1,285.67
|
| Rate for Payer: First Health Commercial |
$1,471.55
|
| Rate for Payer: Humana Commercial |
$1,316.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.81
|
| Rate for Payer: PHCS Commercial |
$1,487.04
|
| Rate for Payer: United Healthcare All Payer |
$1,363.12
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
IP
|
$1,486.00
|
|
| Hospital Charge Code |
76102559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$445.80 |
| Max. Negotiated Rate |
$1,426.56 |
| Rate for Payer: Aetna Commercial |
$1,144.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,159.08
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$1,233.38
|
| Rate for Payer: First Health Commercial |
$1,411.70
|
| Rate for Payer: Humana Commercial |
$1,263.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,218.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,096.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,307.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,114.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.34
|
| Rate for Payer: PHCS Commercial |
$1,426.56
|
| Rate for Payer: United Healthcare All Payer |
$1,307.68
|
|
|
I & D OF HEMATOMA/FLUID
|
Facility
|
OP
|
$1,549.00
|
|
| Hospital Charge Code |
45000331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.70 |
| Max. Negotiated Rate |
$1,487.04 |
| Rate for Payer: Aetna Commercial |
$1,192.73
|
| Rate for Payer: Anthem Medicaid |
$532.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.22
|
| Rate for Payer: Cash Price |
$774.50
|
| Rate for Payer: Cigna Commercial |
$1,285.67
|
| Rate for Payer: First Health Commercial |
$1,471.55
|
| Rate for Payer: Humana Commercial |
$1,316.65
|
| Rate for Payer: Humana KY Medicaid |
$532.70
|
| Rate for Payer: Kentucky WC Medicaid |
$538.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.81
|
| Rate for Payer: PHCS Commercial |
$1,487.04
|
| Rate for Payer: United Healthcare All Payer |
$1,363.12
|
|
|
I&D OF THENAR SPACE,PALM
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 26989
|
| Hospital Charge Code |
76103029
|
|
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 |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| 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 |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$984.75
|
|
|
I & D PELVIC/HIP AREA
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.90 |
| Max. Negotiated Rate |
$983.78 |
| Rate for Payer: Aetna Commercial |
$891.61
|
| Rate for Payer: Ambetter Exchange |
$639.75
|
| Rate for Payer: Anthem Medicaid |
$293.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$639.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$639.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$767.70
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$983.78
|
| Rate for Payer: Healthspan PPO |
$807.61
|
| Rate for Payer: Humana Medicaid |
$293.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$639.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.78
|
| Rate for Payer: Molina Healthcare Passport |
$293.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$831.67
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$639.75
|
|
|
I & D PELVIC/HIP AREA
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
I & D PELVIC/HIP AREA
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
76100759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
I & D PELVIC/HIP AREA(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
761P0759
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.90 |
| Max. Negotiated Rate |
$983.78 |
| Rate for Payer: Aetna Commercial |
$891.61
|
| Rate for Payer: Ambetter Exchange |
$639.75
|
| Rate for Payer: Anthem Medicaid |
$293.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$639.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$639.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$767.70
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$983.78
|
| Rate for Payer: Healthspan PPO |
$807.61
|
| Rate for Payer: Humana Medicaid |
$293.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$639.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.78
|
| Rate for Payer: Molina Healthcare Passport |
$293.90
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$831.67
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$639.75
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
45000269
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
45000269
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.80 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$1,296.96 |
| Rate for Payer: Aetna Commercial |
$1,040.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.78
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,121.33
|
| Rate for Payer: First Health Commercial |
$1,283.45
|
| Rate for Payer: Humana Commercial |
$1,148.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$997.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.19
|
| Rate for Payer: PHCS Commercial |
$1,296.96
|
| Rate for Payer: United Healthcare All Payer |
$1,188.88
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Professional
|
Both
|
$1,351.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$810.60 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Ambetter Exchange |
$95.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.82
|
| Rate for Payer: Anthem Medicaid |
$52.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.04
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$201.81
|
| Rate for Payer: Humana Medicaid |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.26
|
| Rate for Payer: Molina Healthcare Passport |
$52.22
|
| Rate for Payer: Multiplan PHCS |
$810.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.63
|
| Rate for Payer: UHCCP Medicaid |
$80.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.87
|
|
|
I&D PERIANAL ABSCES SIMPLE
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
76101912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.61 |
| Max. Negotiated Rate |
$1,296.96 |
| Rate for Payer: Aetna Commercial |
$1,040.27
|
| Rate for Payer: Anthem Medicaid |
$464.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cash Price |
$675.50
|
| Rate for Payer: Cigna Commercial |
$1,121.33
|
| Rate for Payer: First Health Commercial |
$1,283.45
|
| Rate for Payer: Humana Commercial |
$1,148.35
|
| Rate for Payer: Humana KY Medicaid |
$464.61
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$469.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$997.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.19
|
| Rate for Payer: PHCS Commercial |
$1,296.96
|
| Rate for Payer: United Healthcare All Payer |
$1,188.88
|
|
|
I&D PERIANAL ABSCES SIMPLE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
761P1912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Ambetter Exchange |
$95.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.82
|
| Rate for Payer: Anthem Medicaid |
$52.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.04
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$201.81
|
| Rate for Payer: Humana Medicaid |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.26
|
| Rate for Payer: Molina Healthcare Passport |
$52.22
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.63
|
| Rate for Payer: UHCCP Medicaid |
$80.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.87
|
|
|
I&D PERIANAL ABSCES SIMPLE(T
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
761T1912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.80 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
I&D PERIANAL ABSCES SIMPLE(T
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
761T1912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
I & D PERITONSILLAR
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$579.84 |
| Rate for Payer: Aetna Commercial |
$465.08
|
| Rate for Payer: Anthem Medicaid |
$207.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$501.32
|
| Rate for Payer: First Health Commercial |
$573.80
|
| Rate for Payer: Humana Commercial |
$513.40
|
| Rate for Payer: Humana KY Medicaid |
$207.72
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$209.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$495.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$531.52
|
| Rate for Payer: Ohio Health Group HMO |
$453.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$483.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$525.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.76
|
| Rate for Payer: PHCS Commercial |
$579.84
|
| Rate for Payer: United Healthcare All Payer |
$531.52
|
|
|
I & D PERITONSILLAR
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$579.84 |
| Rate for Payer: Aetna Commercial |
$465.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.12
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$501.32
|
| Rate for Payer: First Health Commercial |
$573.80
|
| Rate for Payer: Humana Commercial |
$513.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$495.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$445.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$531.52
|
| Rate for Payer: Ohio Health Group HMO |
$453.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$483.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$525.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.76
|
| Rate for Payer: PHCS Commercial |
$579.84
|
| Rate for Payer: United Healthcare All Payer |
$531.52
|
|
|
I & D PERITONSILLAR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
45000262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
I & D PERITONSILLAR
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
76101696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$362.40 |
| Rate for Payer: Aetna Commercial |
$193.84
|
| Rate for Payer: Ambetter Exchange |
$128.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.98
|
| Rate for Payer: Anthem Medicaid |
$71.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$153.79
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$248.86
|
| Rate for Payer: Healthspan PPO |
$217.63
|
| Rate for Payer: Humana Medicaid |
$71.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$175.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.73
|
| Rate for Payer: Molina Healthcare Passport |
$71.30
|
| Rate for Payer: Multiplan PHCS |
$362.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.61
|
| Rate for Payer: UHCCP Medicaid |
$114.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.16
|
|
