|
INCAL BX SKN EA SEP/ADDL(T
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 11107
|
| Hospital Charge Code |
761T0036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.78
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
INCAL BX SKN SINGLE LES
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
76102569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Ambetter Exchange |
$53.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.78
|
| Rate for Payer: Anthem Medicaid |
$114.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.86
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$238.40
|
| Rate for Payer: Humana Medicaid |
$114.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.86
|
| Rate for Payer: Molina Healthcare Passport |
$114.57
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.19
|
| Rate for Payer: UHCCP Medicaid |
$40.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.22
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
76102569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
76102569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
INCAL BX SKN SINGLE LES(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
761P2569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$238.40 |
| Rate for Payer: Ambetter Exchange |
$53.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.78
|
| Rate for Payer: Anthem Medicaid |
$114.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.86
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$238.40
|
| Rate for Payer: Humana Medicaid |
$114.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.86
|
| Rate for Payer: Molina Healthcare Passport |
$114.57
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.19
|
| Rate for Payer: UHCCP Medicaid |
$40.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.22
|
|
|
INCAL BX SKN SINGLE LES(T
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
761T2569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
INCAL BX SKN SINGLE LES(T
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
761T2569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
INCARC OBTURATOR HERNIA RPR
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
76102043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,690.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
INCARC OBTURATOR HERNIA RPR
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
76102043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
|
|
INCARC OBTURATOR HERNIA RPR
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
76102043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$842.55 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.55
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,690.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
INCARC OBTURATOR HERNIA RPR(P
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
761P2043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
|
|
INC/DRAINAGE DEEP ABSCESS
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,092.50 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Aetna Commercial |
$5,370.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cigna Commercial |
$5,789.25
|
| Rate for Payer: First Health Commercial |
$6,626.25
|
| Rate for Payer: Humana Commercial |
$5,928.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,068.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,812.75
|
| Rate for Payer: PHCS Commercial |
$6,696.00
|
| Rate for Payer: United Healthcare All Payer |
$6,138.00
|
|
|
INC/DRAINAGE DEEP ABSCESS
|
Facility
|
OP
|
$6,975.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,398.70 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Aetna Commercial |
$5,370.75
|
| Rate for Payer: Anthem Medicaid |
$2,398.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.50
|
| 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 |
$3,487.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cigna Commercial |
$5,789.25
|
| Rate for Payer: First Health Commercial |
$6,626.25
|
| Rate for Payer: Humana Commercial |
$5,928.75
|
| Rate for Payer: Humana KY Medicaid |
$2,398.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,423.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,446.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,068.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,812.75
|
| Rate for Payer: PHCS Commercial |
$6,696.00
|
| Rate for Payer: United Healthcare All Payer |
$6,138.00
|
|
|
INC/DRAINAGE DEEP ABSCESS
|
Professional
|
Both
|
$6,975.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.42 |
| Max. Negotiated Rate |
$4,185.00 |
| Rate for Payer: Aetna Commercial |
$447.77
|
| Rate for Payer: Ambetter Exchange |
$319.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.30
|
| Rate for Payer: Anthem Medicaid |
$158.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.98
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cigna Commercial |
$492.32
|
| Rate for Payer: Healthspan PPO |
$545.20
|
| Rate for Payer: Humana Medicaid |
$158.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.59
|
| Rate for Payer: Molina Healthcare Passport |
$158.42
|
| Rate for Payer: Multiplan PHCS |
$4,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.97
|
| Rate for Payer: UHCCP Medicaid |
$179.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.98
|
|
|
INC/DRAINAGE DEEP ABSCESS(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
761P0390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.42 |
| Max. Negotiated Rate |
$545.20 |
| Rate for Payer: Aetna Commercial |
$447.77
|
| Rate for Payer: Ambetter Exchange |
$319.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.30
|
| Rate for Payer: Anthem Medicaid |
$158.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.98
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$492.32
|
| Rate for Payer: Healthspan PPO |
$545.20
|
| Rate for Payer: Humana Medicaid |
$158.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.59
|
| Rate for Payer: Molina Healthcare Passport |
$158.42
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.97
|
| Rate for Payer: UHCCP Medicaid |
$179.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.98
|
|
|
INC/DRAINAGE DEEP ABSCESS(T
|
Facility
|
IP
|
$6,375.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
761T0390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$6,120.00 |
| Rate for Payer: Aetna Commercial |
$4,908.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,972.50
|
| Rate for Payer: Cash Price |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$5,291.25
|
| Rate for Payer: First Health Commercial |
$6,056.25
|
| Rate for Payer: Humana Commercial |
$5,418.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,227.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,704.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,610.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,546.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,398.75
|
| Rate for Payer: PHCS Commercial |
$6,120.00
|
| Rate for Payer: United Healthcare All Payer |
$5,610.00
|
|
|
INC/DRAINAGE DEEP ABSCESS(T
|
Facility
|
OP
|
$6,375.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
761T0390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,192.36 |
| Max. Negotiated Rate |
$6,120.00 |
| Rate for Payer: Aetna Commercial |
$4,908.75
|
| Rate for Payer: Anthem Medicaid |
$2,192.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,972.50
|
| 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 |
$3,187.50
|
| Rate for Payer: Cash Price |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$5,291.25
|
| Rate for Payer: First Health Commercial |
$6,056.25
|
| Rate for Payer: Humana Commercial |
$5,418.75
|
| Rate for Payer: Humana KY Medicaid |
$2,192.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,214.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,227.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,704.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,236.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,610.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,546.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,398.75
|
| Rate for Payer: PHCS Commercial |
$6,120.00
|
| Rate for Payer: United Healthcare All Payer |
$5,610.00
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$217.82
|
| Rate for Payer: Ambetter Exchange |
$158.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.35
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$158.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$158.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.44
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$207.57
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$158.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.31
|
| Rate for Payer: UHCCP Medicaid |
$112.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.70
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem Medicaid |
$128.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Humana KY Medicaid |
$128.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$130.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
761P1874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.22 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$217.82
|
| Rate for Payer: Ambetter Exchange |
$158.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.35
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$158.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$158.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.44
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$207.57
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$158.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.31
|
| Rate for Payer: UHCCP Medicaid |
$112.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.70
|
|
|
INC & DRAINAGE SUBMUCOSAL RECT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
76101874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.51 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna Commercial |
$757.04
|
| Rate for Payer: Ambetter Exchange |
$544.78
|
| Rate for Payer: Anthem Medicaid |
$211.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$653.74
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$676.11
|
| Rate for Payer: Healthspan PPO |
$638.43
|
| Rate for Payer: Humana Medicaid |
$211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$707.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$544.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.74
|
| Rate for Payer: Molina Healthcare Passport |
$211.51
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$708.21
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.78
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
76101875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
INC/DRAIN DEEP SUP RECT ABSCES
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 45020
|
| Hospital Charge Code |
761P1875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.51 |
| Max. Negotiated Rate |
$757.04 |
| Rate for Payer: Aetna Commercial |
$757.04
|
| Rate for Payer: Ambetter Exchange |
$544.78
|
| Rate for Payer: Anthem Medicaid |
$211.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$653.74
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$676.11
|
| Rate for Payer: Healthspan PPO |
$638.43
|
| Rate for Payer: Humana Medicaid |
$211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$707.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$544.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.74
|
| Rate for Payer: Molina Healthcare Passport |
$211.51
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$708.21
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.78
|
|
