|
I & D PERITONSILLAR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
45000262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$152.00
|
| 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: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| 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 |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| 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(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761P1696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$248.86 |
| 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 |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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 |
$180.00
|
| 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
|
|
|
I & D PERITONSILLAR(T
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761T1696
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
761T1696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$152.00
|
| 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: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| 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 |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| 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 PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
761T0011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.05 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.27
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
761P0011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$360.82 |
| Rate for Payer: Aetna Commercial |
$238.89
|
| Rate for Payer: Ambetter Exchange |
$161.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.38
|
| Rate for Payer: Anthem Medicaid |
$104.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$161.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$161.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$194.17
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$360.82
|
| Rate for Payer: Healthspan PPO |
$283.46
|
| Rate for Payer: Humana Medicaid |
$104.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$161.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.16
|
| Rate for Payer: Molina Healthcare Passport |
$104.08
|
| Rate for Payer: Multiplan PHCS |
$219.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.35
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$161.81
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
76100011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.70 |
| Max. Negotiated Rate |
$1,295.04 |
| Rate for Payer: Aetna Commercial |
$1,038.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,052.22
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cigna Commercial |
$1,119.67
|
| Rate for Payer: First Health Commercial |
$1,281.55
|
| Rate for Payer: Humana Commercial |
$1,146.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,106.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$995.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,187.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,011.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,173.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.81
|
| Rate for Payer: PHCS Commercial |
$1,295.04
|
| Rate for Payer: United Healthcare All Payer |
$1,187.12
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
76100011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.92 |
| Max. Negotiated Rate |
$1,295.04 |
| Rate for Payer: Aetna Commercial |
$1,038.73
|
| Rate for Payer: Anthem Medicaid |
$463.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,052.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cigna Commercial |
$1,119.67
|
| Rate for Payer: First Health Commercial |
$1,281.55
|
| Rate for Payer: Humana Commercial |
$1,146.65
|
| Rate for Payer: Humana KY Medicaid |
$463.92
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$468.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,106.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$995.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,187.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,011.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,173.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.81
|
| Rate for Payer: PHCS Commercial |
$1,295.04
|
| Rate for Payer: United Healthcare All Payer |
$1,187.12
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
76100011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.38 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Aetna Commercial |
$238.89
|
| Rate for Payer: Ambetter Exchange |
$161.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.38
|
| Rate for Payer: Anthem Medicaid |
$104.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$161.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$161.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$194.17
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cash Price |
$674.50
|
| Rate for Payer: Cigna Commercial |
$360.82
|
| Rate for Payer: Healthspan PPO |
$283.46
|
| Rate for Payer: Humana Medicaid |
$104.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$161.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.16
|
| Rate for Payer: Molina Healthcare Passport |
$104.08
|
| Rate for Payer: Multiplan PHCS |
$809.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.35
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$161.81
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
761T0011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.90 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.27
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.90 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.27
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$338.05 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$756.91
|
| Rate for Payer: Anthem Medicaid |
$338.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$766.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$815.89
|
| Rate for Payer: First Health Commercial |
$933.85
|
| Rate for Payer: Humana Commercial |
$835.55
|
| Rate for Payer: Humana KY Medicaid |
$338.05
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$341.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$806.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$725.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$865.04
|
| Rate for Payer: Ohio Health Group HMO |
$737.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.27
|
| Rate for Payer: PHCS Commercial |
$943.68
|
| Rate for Payer: United Healthcare All Payer |
$865.04
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
45000019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$1,004.16 |
| Rate for Payer: Aetna Commercial |
$805.42
|
| Rate for Payer: Anthem Medicaid |
$359.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$815.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cigna Commercial |
$868.18
|
| Rate for Payer: First Health Commercial |
$993.70
|
| Rate for Payer: Humana Commercial |
$889.10
|
| Rate for Payer: Humana KY Medicaid |
$359.72
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$363.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$857.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$366.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$920.48
|
| Rate for Payer: Ohio Health Group HMO |
$784.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.74
|
| Rate for Payer: PHCS Commercial |
$1,004.16
|
| Rate for Payer: United Healthcare All Payer |
$920.48
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
45000019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,004.16 |
| Rate for Payer: Aetna Commercial |
$805.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$815.88
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cigna Commercial |
$868.18
|
| Rate for Payer: First Health Commercial |
$993.70
|
| Rate for Payer: Humana Commercial |
$889.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$857.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$920.48
|
| Rate for Payer: Ohio Health Group HMO |
$784.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.74
|
| Rate for Payer: PHCS Commercial |
$1,004.16
|
| Rate for Payer: United Healthcare All Payer |
$920.48
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.60 |
| Max. Negotiated Rate |
$1,230.72 |
| Rate for Payer: Aetna Commercial |
$987.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$999.96
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$1,064.06
|
| Rate for Payer: First Health Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial |
$1,089.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,051.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$946.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,128.16
|
| Rate for Payer: Ohio Health Group HMO |
$961.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$884.58
|
| Rate for Payer: PHCS Commercial |
$1,230.72
|
| Rate for Payer: United Healthcare All Payer |
$1,128.16
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.88 |
| Max. Negotiated Rate |
$1,230.72 |
| Rate for Payer: Aetna Commercial |
$987.14
|
| Rate for Payer: Anthem Medicaid |
$440.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$999.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$1,064.06
|
| Rate for Payer: First Health Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial |
$1,089.70
|
| Rate for Payer: Humana KY Medicaid |
$440.88
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$445.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,051.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$946.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,128.16
|
| Rate for Payer: Ohio Health Group HMO |
$961.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$884.58
|
| Rate for Payer: PHCS Commercial |
$1,230.72
|
| Rate for Payer: United Healthcare All Payer |
$1,128.16
|
|
|
I&D PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$769.20 |
| Rate for Payer: Aetna Commercial |
$135.40
|
| Rate for Payer: Ambetter Exchange |
$98.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$62.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.96
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$234.29
|
| Rate for Payer: Healthspan PPO |
$178.46
|
| Rate for Payer: Humana Medicaid |
$62.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.40
|
| Rate for Payer: Molina Healthcare Passport |
$62.16
|
| Rate for Payer: Multiplan PHCS |
$769.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.79
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.30
|
|
|
I&D PILONIDAL CYST SIMPLE(P
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761P0010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$234.29 |
| Rate for Payer: Aetna Commercial |
$135.40
|
| Rate for Payer: Ambetter Exchange |
$98.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$62.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.96
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$234.29
|
| Rate for Payer: Healthspan PPO |
$178.46
|
| Rate for Payer: Humana Medicaid |
$62.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.40
|
| Rate for Payer: Molina Healthcare Passport |
$62.16
|
| Rate for Payer: Multiplan PHCS |
$141.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.79
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.30
|
|
|
I&D PILONIDAL CYST SIMPLE(T
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761T0010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$1,004.16 |
| Rate for Payer: Aetna Commercial |
$805.42
|
| Rate for Payer: Anthem Medicaid |
$359.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$815.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cigna Commercial |
$868.18
|
| Rate for Payer: First Health Commercial |
$993.70
|
| Rate for Payer: Humana Commercial |
$889.10
|
| Rate for Payer: Humana KY Medicaid |
$359.72
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$363.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$857.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$366.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$920.48
|
| Rate for Payer: Ohio Health Group HMO |
$784.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.74
|
| Rate for Payer: PHCS Commercial |
$1,004.16
|
| Rate for Payer: United Healthcare All Payer |
$920.48
|
|
|
I&D PILONIDAL CYST SIMPLE(T
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
761T0010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,004.16 |
| Rate for Payer: Aetna Commercial |
$805.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$815.88
|
| Rate for Payer: Cash Price |
$523.00
|
| Rate for Payer: Cigna Commercial |
$868.18
|
| Rate for Payer: First Health Commercial |
$993.70
|
| Rate for Payer: Humana Commercial |
$889.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$857.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$771.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$920.48
|
| Rate for Payer: Ohio Health Group HMO |
$784.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.74
|
| Rate for Payer: PHCS Commercial |
$1,004.16
|
| Rate for Payer: United Healthcare All Payer |
$920.48
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
761P1911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$571.27 |
| Rate for Payer: Aetna Commercial |
$571.27
|
| Rate for Payer: Ambetter Exchange |
$416.34
|
| Rate for Payer: Anthem Medicaid |
$173.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.61
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$511.90
|
| Rate for Payer: Healthspan PPO |
$481.76
|
| Rate for Payer: Humana Medicaid |
$173.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.06
|
| Rate for Payer: Molina Healthcare Passport |
$173.59
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.24
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.34
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.99 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$571.27 |
| Rate for Payer: Aetna Commercial |
$571.27
|
| Rate for Payer: Ambetter Exchange |
$416.34
|
| Rate for Payer: Anthem Medicaid |
$173.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.61
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$511.90
|
| Rate for Payer: Healthspan PPO |
$481.76
|
| Rate for Payer: Humana Medicaid |
$173.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.06
|
| Rate for Payer: Molina Healthcare Passport |
$173.59
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.24
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.34
|
|
|
I/D RECTAL ABCESS UNDER ANESTH
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 46045
|
| Hospital Charge Code |
76101911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$4,046.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,213.80 |
| Max. Negotiated Rate |
$3,884.16 |
| Rate for Payer: Aetna Commercial |
$3,115.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,155.88
|
| Rate for Payer: Cash Price |
$2,023.00
|
| Rate for Payer: Cigna Commercial |
$3,358.18
|
| Rate for Payer: First Health Commercial |
$3,843.70
|
| Rate for Payer: Humana Commercial |
$3,439.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,317.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,985.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,213.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,560.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,034.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,520.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.74
|
| Rate for Payer: PHCS Commercial |
$3,884.16
|
| Rate for Payer: United Healthcare All Payer |
$3,560.48
|
|
