|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761P0494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$440.90 |
| Rate for Payer: Aetna Commercial |
$314.42
|
| Rate for Payer: Ambetter Exchange |
$205.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.74
|
| Rate for Payer: Anthem Medicaid |
$130.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.06
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$344.08
|
| Rate for Payer: Healthspan PPO |
$440.90
|
| Rate for Payer: Humana Medicaid |
$130.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.20
|
| Rate for Payer: Molina Healthcare Passport |
$130.59
|
| Rate for Payer: Multiplan PHCS |
$277.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.64
|
| Rate for Payer: UHCCP Medicaid |
$116.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.88
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
45000116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,075.20 |
| Max. Negotiated Rate |
$3,440.64 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,867.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.96
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
45000116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,232.54 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem Medicaid |
$1,232.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| 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 |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Humana KY Medicaid |
$1,232.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,257.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,867.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.96
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
IP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761T0494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.20 |
| Max. Negotiated Rate |
$3,440.64 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,867.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.96
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
761T0494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,232.54 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem Medicaid |
$1,232.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| 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 |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Humana KY Medicaid |
$1,232.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,257.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,867.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,472.96
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Professional
|
Both
|
$4,046.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$2,427.60 |
| Rate for Payer: Aetna Commercial |
$314.42
|
| Rate for Payer: Ambetter Exchange |
$205.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.74
|
| Rate for Payer: Anthem Medicaid |
$130.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$205.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$205.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.06
|
| Rate for Payer: Cash Price |
$2,023.00
|
| Rate for Payer: Cash Price |
$2,023.00
|
| Rate for Payer: Cigna Commercial |
$344.08
|
| Rate for Payer: Healthspan PPO |
$440.90
|
| Rate for Payer: Humana Medicaid |
$130.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$205.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.20
|
| Rate for Payer: Molina Healthcare Passport |
$130.59
|
| Rate for Payer: Multiplan PHCS |
$2,427.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.64
|
| Rate for Payer: UHCCP Medicaid |
$116.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$205.88
|
|
|
I&D UP ARM OR ELBOW DP ABS/HEM
|
Facility
|
OP
|
$4,046.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,391.42 |
| Max. Negotiated Rate |
$3,884.16 |
| Rate for Payer: Aetna Commercial |
$3,115.42
|
| Rate for Payer: Anthem Medicaid |
$1,391.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,155.88
|
| 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 |
$2,023.00
|
| 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: Humana KY Medicaid |
$1,391.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,405.58
|
| 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 |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,419.34
|
| 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
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761P0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$340.55 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Ambetter Exchange |
$152.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.37
|
| Rate for Payer: Anthem Medicaid |
$70.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.70
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Healthspan PPO |
$340.55
|
| Rate for Payer: Humana Medicaid |
$70.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.03
|
| Rate for Payer: Molina Healthcare Passport |
$70.62
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.93
|
| Rate for Payer: UHCCP Medicaid |
$86.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.25
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761T0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Ambetter Exchange |
$152.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.37
|
| Rate for Payer: Anthem Medicaid |
$70.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.70
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Healthspan PPO |
$340.55
|
| Rate for Payer: Humana Medicaid |
$70.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.03
|
| Rate for Payer: Molina Healthcare Passport |
$70.62
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.93
|
| Rate for Payer: UHCCP Medicaid |
$86.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.25
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
45000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.14 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761T0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
45000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$730.20 |
| Rate for Payer: Aetna Commercial |
$158.47
|
| Rate for Payer: Ambetter Exchange |
$118.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.25
|
| Rate for Payer: Anthem Medicaid |
$64.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$118.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$118.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.57
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cigna Commercial |
$162.24
|
| Rate for Payer: Healthspan PPO |
$156.55
|
| Rate for Payer: Humana Medicaid |
$64.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$118.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.12
|
| Rate for Payer: Molina Healthcare Passport |
$64.82
|
| Rate for Payer: Multiplan PHCS |
$730.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.45
|
| Rate for Payer: UHCCP Medicaid |
$72.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$118.81
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
45000288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem Medicaid |
$263.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Humana KY Medicaid |
$263.77
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$266.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.23
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.10 |
| Max. Negotiated Rate |
$1,168.32 |
| Rate for Payer: Aetna Commercial |
$937.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$949.26
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cigna Commercial |
$1,010.11
|
| Rate for Payer: First Health Commercial |
$1,156.15
|
| Rate for Payer: Humana Commercial |
$1,034.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$997.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$898.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,070.96
|
| Rate for Payer: Ohio Health Group HMO |
$912.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,058.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$839.73
|
| Rate for Payer: PHCS Commercial |
$1,168.32
|
| Rate for Payer: United Healthcare All Payer |
$1,070.96
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,168.32 |
| Rate for Payer: Aetna Commercial |
$937.09
|
| Rate for Payer: Anthem Medicaid |
$418.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$949.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cash Price |
$608.50
|
| Rate for Payer: Cigna Commercial |
$1,010.11
|
| Rate for Payer: First Health Commercial |
$1,156.15
|
| Rate for Payer: Humana Commercial |
$1,034.45
|
| Rate for Payer: Humana KY Medicaid |
$418.53
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$422.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$997.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$898.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,070.96
|
| Rate for Payer: Ohio Health Group HMO |
$912.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,058.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$839.73
|
| Rate for Payer: PHCS Commercial |
$1,168.32
|
| Rate for Payer: United Healthcare All Payer |
$1,070.96
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
45000288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.23
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
I&D VULVA PERINEAL ABSCESS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761P2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$158.47
|
| Rate for Payer: Ambetter Exchange |
$118.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.25
|
| Rate for Payer: Anthem Medicaid |
$64.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$118.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$118.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.57
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$162.24
|
| Rate for Payer: Healthspan PPO |
$156.55
|
| Rate for Payer: Humana Medicaid |
$64.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$118.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.12
|
| Rate for Payer: Molina Healthcare Passport |
$64.82
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.45
|
| Rate for Payer: UHCCP Medicaid |
$72.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$118.81
|
|
|
I&D VULVA PERINEAL ABSCESS(T
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761T2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem Medicaid |
$263.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Humana KY Medicaid |
$263.77
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$266.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.23
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
I&D VULVA PERINEAL ABSCESS(T
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761T2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.23
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
IFEX (IFOSFAMIDE) 1GM/20ML
|
Facility
|
IP
|
$200.23
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
25002629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$192.22 |
| Rate for Payer: Aetna Commercial |
$154.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.18
|
| Rate for Payer: Cash Price |
$100.11
|
| Rate for Payer: Cigna Commercial |
$166.19
|
| Rate for Payer: First Health Commercial |
$190.22
|
| Rate for Payer: Humana Commercial |
$170.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.20
|
| Rate for Payer: Ohio Health Group HMO |
$150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.16
|
| Rate for Payer: PHCS Commercial |
$192.22
|
| Rate for Payer: United Healthcare All Payer |
$176.20
|
|
|
IFEX (IFOSFAMIDE) 1GM/20ML
|
Facility
|
OP
|
$200.23
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
25002629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$192.22 |
| Rate for Payer: Aetna Commercial |
$154.18
|
| Rate for Payer: Anthem Medicaid |
$68.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.18
|
| Rate for Payer: Cash Price |
$100.11
|
| Rate for Payer: Cigna Commercial |
$166.19
|
| Rate for Payer: First Health Commercial |
$190.22
|
| Rate for Payer: Humana Commercial |
$170.20
|
| Rate for Payer: Humana KY Medicaid |
$68.86
|
| Rate for Payer: Kentucky WC Medicaid |
$69.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.20
|
| Rate for Payer: Ohio Health Group HMO |
$150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.16
|
| Rate for Payer: PHCS Commercial |
$192.22
|
| Rate for Payer: United Healthcare All Payer |
$176.20
|
|
