|
INTRAORAL BIOPSY OF MAX SINU(T
|
Facility
|
OP
|
$3,313.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
761T1160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$3,181.10 |
| Rate for Payer: Aetna Commercial |
$2,551.51
|
| Rate for Payer: Anthem Medicaid |
$1,139.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$1,656.83
|
| Rate for Payer: Cash Price |
$1,656.83
|
| Rate for Payer: Cigna Commercial |
$2,750.33
|
| Rate for Payer: First Health Commercial |
$3,147.97
|
| Rate for Payer: Humana Commercial |
$2,816.60
|
| Rate for Payer: Humana KY Medicaid |
$1,139.56
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,151.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.23
|
| Rate for Payer: PHCS Commercial |
$3,181.10
|
| Rate for Payer: United Healthcare All Payer |
$2,916.01
|
|
|
INTRAORAL BIOPSY OF MAX SINU(T
|
Facility
|
IP
|
$3,313.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
761T1160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.77 |
| Max. Negotiated Rate |
$3,181.10 |
| Rate for Payer: Aetna Commercial |
$2,551.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.65
|
| Rate for Payer: Cash Price |
$1,656.83
|
| Rate for Payer: Cigna Commercial |
$2,750.33
|
| Rate for Payer: First Health Commercial |
$3,147.97
|
| Rate for Payer: Humana Commercial |
$2,816.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.23
|
| Rate for Payer: PHCS Commercial |
$3,181.10
|
| Rate for Payer: United Healthcare All Payer |
$2,916.01
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
761P1646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.48 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$420.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.48
|
| Rate for Payer: Anthem Medicaid |
$195.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$517.91
|
| Rate for Payer: Healthspan PPO |
$459.50
|
| Rate for Payer: Humana Medicaid |
$195.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$369.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Molina Healthcare Passport |
$195.34
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$203.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.29
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
761P1644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$178.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.58
|
| Rate for Payer: Anthem Medicaid |
$53.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$277.51
|
| Rate for Payer: Healthspan PPO |
$254.12
|
| Rate for Payer: Humana Medicaid |
$53.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.92
|
| Rate for Payer: Molina Healthcare Passport |
$53.84
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$100.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.38
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761P1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$386.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.29
|
| Rate for Payer: Anthem Medicaid |
$109.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: Healthspan PPO |
$431.76
|
| Rate for Payer: Humana Medicaid |
$109.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$111.80
|
| Rate for Payer: Molina Healthcare Passport |
$109.61
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$200.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$110.71
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761T1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.65 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$841.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.55
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761T1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.65 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$841.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.55
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
761T1644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
761T1646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
761T1646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
761T1644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
76101644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$178.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.58
|
| Rate for Payer: Anthem Medicaid |
$53.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$792.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$277.51
|
| Rate for Payer: Healthspan PPO |
$254.12
|
| Rate for Payer: Humana Medicaid |
$53.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.92
|
| Rate for Payer: Molina Healthcare Passport |
$53.84
|
| Rate for Payer: Multiplan PHCS |
$475.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$554.40
|
| Rate for Payer: UHCCP Medicaid |
$100.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.38
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
76101644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$760.32 |
| Rate for Payer: Aetna Commercial |
$609.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.76
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$657.36
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: Humana Commercial |
$673.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$649.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$584.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.96
|
| Rate for Payer: Ohio Health Group HMO |
$594.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.52
|
| Rate for Payer: PHCS Commercial |
$760.32
|
| Rate for Payer: United Healthcare All Payer |
$696.96
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$1,503.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
76101646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$1,442.88 |
| Rate for Payer: Aetna Commercial |
$1,157.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,172.34
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna Commercial |
$1,247.49
|
| Rate for Payer: First Health Commercial |
$1,427.85
|
| Rate for Payer: Humana Commercial |
$1,277.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,232.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,322.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,127.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.93
|
| Rate for Payer: PHCS Commercial |
$1,442.88
|
| Rate for Payer: United Healthcare All Payer |
$1,322.64
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$5,155.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.15 |
| Max. Negotiated Rate |
$4,948.80 |
| Rate for Payer: Aetna Commercial |
$3,969.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,020.90
|
| Rate for Payer: Cash Price |
$2,577.50
|
| Rate for Payer: Cigna Commercial |
$4,278.65
|
| Rate for Payer: First Health Commercial |
$4,897.25
|
| Rate for Payer: Humana Commercial |
$4,381.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,227.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,804.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,546.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,536.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.05
|
| Rate for Payer: PHCS Commercial |
$4,948.80
|
| Rate for Payer: United Healthcare All Payer |
$4,536.40
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$5,155.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.15 |
| Max. Negotiated Rate |
$4,948.80 |
| Rate for Payer: Aetna Commercial |
$3,969.35
|
| Rate for Payer: Anthem Medicaid |
$1,772.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,020.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,577.50
|
| Rate for Payer: Cash Price |
$2,577.50
|
| Rate for Payer: Cigna Commercial |
$4,278.65
|
| Rate for Payer: First Health Commercial |
$4,897.25
|
| Rate for Payer: Humana Commercial |
$4,381.75
|
| Rate for Payer: Humana KY Medicaid |
$1,772.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,790.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,227.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,804.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,808.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,536.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.05
|
| Rate for Payer: PHCS Commercial |
$4,948.80
|
| Rate for Payer: United Healthcare All Payer |
$4,536.40
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
76101646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$1,442.88 |
| Rate for Payer: Aetna Commercial |
$1,157.31
|
| Rate for Payer: Anthem Medicaid |
$516.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,172.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna Commercial |
$1,247.49
|
| Rate for Payer: First Health Commercial |
$1,427.85
|
| Rate for Payer: Humana Commercial |
$1,277.55
|
| Rate for Payer: Humana KY Medicaid |
$516.88
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$522.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,232.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,322.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,127.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.93
|
| Rate for Payer: PHCS Commercial |
$1,442.88
|
| Rate for Payer: United Healthcare All Payer |
$1,322.64
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
76101644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$760.32 |
| Rate for Payer: Aetna Commercial |
$609.84
|
| Rate for Payer: Anthem Medicaid |
$272.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$657.36
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: Humana Commercial |
$673.20
|
| Rate for Payer: Humana KY Medicaid |
$272.37
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$275.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$649.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$584.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.96
|
| Rate for Payer: Ohio Health Group HMO |
$594.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.52
|
| Rate for Payer: PHCS Commercial |
$760.32
|
| Rate for Payer: United Healthcare All Payer |
$696.96
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 41009
|
| Hospital Charge Code |
76101646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.48 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Aetna Commercial |
$420.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$193.48
|
| Rate for Payer: Anthem Medicaid |
$195.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,503.00
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna Commercial |
$517.91
|
| Rate for Payer: Healthspan PPO |
$459.50
|
| Rate for Payer: Humana Medicaid |
$195.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$369.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.25
|
| Rate for Payer: Molina Healthcare Passport |
$195.34
|
| Rate for Payer: Multiplan PHCS |
$901.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,052.10
|
| Rate for Payer: UHCCP Medicaid |
$203.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.29
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$5,155.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$5,155.00 |
| Rate for Payer: Aetna Commercial |
$386.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.29
|
| Rate for Payer: Anthem Medicaid |
$109.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,155.00
|
| Rate for Payer: Cash Price |
$2,577.50
|
| Rate for Payer: Cash Price |
$2,577.50
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: Healthspan PPO |
$431.76
|
| Rate for Payer: Humana Medicaid |
$109.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$111.80
|
| Rate for Payer: Molina Healthcare Passport |
$109.61
|
| Rate for Payer: Multiplan PHCS |
$3,093.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,608.50
|
| Rate for Payer: UHCCP Medicaid |
$200.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$110.71
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
OP
|
$6,330.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.90 |
| Max. Negotiated Rate |
$6,076.80 |
| Rate for Payer: Aetna Commercial |
$4,874.10
|
| Rate for Payer: Anthem Medicaid |
$2,176.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,937.40
|
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Cigna Commercial |
$5,253.90
|
| Rate for Payer: First Health Commercial |
$6,013.50
|
| Rate for Payer: Humana Commercial |
$5,380.50
|
| Rate for Payer: Humana KY Medicaid |
$2,176.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,199.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,190.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,671.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,899.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,220.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,962.30
|
| Rate for Payer: PHCS Commercial |
$6,076.80
|
| Rate for Payer: United Healthcare All Payer |
$5,570.40
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$250.38 |
| Max. Negotiated Rate |
$1,848.96 |
| Rate for Payer: Aetna Commercial |
$1,483.02
|
| Rate for Payer: Anthem Medicaid |
$662.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.28
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cigna Commercial |
$1,598.58
|
| Rate for Payer: First Health Commercial |
$1,829.70
|
| Rate for Payer: Humana Commercial |
$1,637.10
|
| Rate for Payer: Humana KY Medicaid |
$662.35
|
| Rate for Payer: Kentucky WC Medicaid |
$669.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.06
|
| Rate for Payer: PHCS Commercial |
$1,848.96
|
| Rate for Payer: United Healthcare All Payer |
$1,694.88
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Professional
|
Both
|
$6,330.00
|
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,215.50 |
| Max. Negotiated Rate |
$6,330.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$6,330.00
|
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Multiplan PHCS |
$3,798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,431.00
|
| Rate for Payer: UHCCP Medicaid |
$2,215.50
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
IP
|
$6,330.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.90 |
| Max. Negotiated Rate |
$6,076.80 |
| Rate for Payer: Aetna Commercial |
$4,874.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,937.40
|
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Cigna Commercial |
$5,253.90
|
| Rate for Payer: First Health Commercial |
$6,013.50
|
| Rate for Payer: Humana Commercial |
$5,380.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,190.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,671.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,899.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,962.30
|
| Rate for Payer: PHCS Commercial |
$6,076.80
|
| Rate for Payer: United Healthcare All Payer |
$5,570.40
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$250.38 |
| Max. Negotiated Rate |
$1,848.96 |
| Rate for Payer: Aetna Commercial |
$1,483.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.28
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cigna Commercial |
$1,598.58
|
| Rate for Payer: First Health Commercial |
$1,829.70
|
| Rate for Payer: Humana Commercial |
$1,637.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.06
|
| Rate for Payer: PHCS Commercial |
$1,848.96
|
| Rate for Payer: United Healthcare All Payer |
$1,694.88
|
|
