|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.44 |
| Max. Negotiated Rate |
$1,056.72 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$754.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$754.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,056.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$754.80
|
| Rate for Payer: Humana Medicare Advantage |
$754.80
|
| Rate for Payer: Kentucky WC Medicaid |
$762.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$905.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Ambetter Exchange |
$84.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$84.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$84.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.82
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$57.26
|
| Rate for Payer: Healthspan PPO |
$134.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$84.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.02
|
| Rate for Payer: Multiplan PHCS |
$165.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.23
|
| Rate for Payer: UHCCP Medicaid |
$96.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$84.02
|
|
|
INTRAORAL BIOPSY OF MAX SINU(P
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
761P1160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$471.10 |
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$403.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$471.10
|
| Rate for Payer: UHCCP Medicaid |
$235.55
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Facility
|
IP
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.99 |
| Max. Negotiated Rate |
$3,827.18 |
| Rate for Payer: Aetna Commercial |
$3,069.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.59
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cigna Commercial |
$3,308.92
|
| Rate for Payer: First Health Commercial |
$3,787.32
|
| Rate for Payer: Humana Commercial |
$3,388.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,189.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.79
|
| Rate for Payer: PHCS Commercial |
$3,827.18
|
| Rate for Payer: United Healthcare All Payer |
$3,508.25
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Facility
|
OP
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$3,827.18 |
| Rate for Payer: Aetna Commercial |
$3,069.72
|
| Rate for Payer: Anthem Medicaid |
$1,371.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cigna Commercial |
$3,308.92
|
| Rate for Payer: First Health Commercial |
$3,787.32
|
| Rate for Payer: Humana Commercial |
$3,388.65
|
| Rate for Payer: Humana KY Medicaid |
$1,371.01
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,189.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.79
|
| Rate for Payer: PHCS Commercial |
$3,827.18
|
| Rate for Payer: United Healthcare All Payer |
$3,508.25
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Professional
|
Both
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,790.66 |
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,391.99
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,790.66
|
| Rate for Payer: UHCCP Medicaid |
$1,395.33
|
|
|
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 |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$2,650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,882.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,286.42
|
| 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 |
$994.10 |
| 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 |
$2,650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,882.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,286.42
|
| 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
|
$950.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761P1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$386.74
|
| Rate for Payer: Ambetter Exchange |
$247.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.29
|
| Rate for Payer: Anthem Medicaid |
$123.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.76
|
| 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 |
$123.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.31
|
| Rate for Payer: Molina Healthcare Passport |
$123.83
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.49
|
| Rate for Payer: UHCCP Medicaid |
$200.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.30
|
|
|
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 |
$522.00 |
| Rate for Payer: Aetna Commercial |
$420.17
|
| Rate for Payer: Ambetter Exchange |
$269.67
|
| 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 Individual/Medicaid |
$269.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$269.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$323.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$269.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.67
|
| 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 |
$350.57
|
| Rate for Payer: UHCCP Medicaid |
$203.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$269.67
|
|
|
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 |
$300.00 |
| Rate for Payer: Aetna Commercial |
$178.24
|
| Rate for Payer: Ambetter Exchange |
$109.86
|
| 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 Individual/Medicaid |
$109.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$109.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.86
|
| 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 |
$142.82
|
| Rate for Payer: UHCCP Medicaid |
$100.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.86
|
|
|
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 |
$87.60 |
| 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 |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
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 |
$100.42 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| 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 |
$189.90 |
| 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 |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| 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
|
$4,352.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761T1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,305.60 |
| Max. Negotiated Rate |
$4,177.92 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,786.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.88
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
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 |
$217.69 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| 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
|
$4,352.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
761T1645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.65 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem Medicaid |
$1,496.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Humana KY Medicaid |
$1,496.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,786.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.88
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
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 |
$475.20 |
| Rate for Payer: Aetna Commercial |
$178.24
|
| Rate for Payer: Ambetter Exchange |
$109.86
|
| 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 Individual/Medicaid |
$109.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$109.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.86
|
| 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 |
$142.82
|
| Rate for Payer: UHCCP Medicaid |
$100.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.86
|
|
|
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 |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$546.48
|
| Rate for Payer: PHCS Commercial |
$760.32
|
| Rate for Payer: United Healthcare All Payer |
$696.96
|
|
|
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 |
$470.54 |
| 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 |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,172.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| 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 |
$470.54
|
| 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 |
$564.65
|
| 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 |
$1,202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,307.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.07
|
| Rate for Payer: PHCS Commercial |
$1,442.88
|
| Rate for Payer: United Healthcare All Payer |
$1,322.64
|
|
|
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 |
$901.80 |
| Rate for Payer: Aetna Commercial |
$420.17
|
| Rate for Payer: Ambetter Exchange |
$269.67
|
| 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 Individual/Medicaid |
$269.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$269.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$323.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$269.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.67
|
| 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 |
$350.57
|
| Rate for Payer: UHCCP Medicaid |
$203.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$269.67
|
|
|
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 |
$450.90 |
| 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 |
$1,202.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,307.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.07
|
| Rate for Payer: PHCS Commercial |
$1,442.88
|
| Rate for Payer: United Healthcare All Payer |
$1,322.64
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$5,302.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$3,181.20 |
| Rate for Payer: Aetna Commercial |
$386.74
|
| Rate for Payer: Ambetter Exchange |
$247.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.29
|
| Rate for Payer: Anthem Medicaid |
$123.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.76
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: Healthspan PPO |
$431.76
|
| Rate for Payer: Humana Medicaid |
$123.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$339.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.31
|
| Rate for Payer: Molina Healthcare Passport |
$123.83
|
| Rate for Payer: Multiplan PHCS |
$3,181.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.49
|
| Rate for Payer: UHCCP Medicaid |
$200.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.30
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,590.60 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,612.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,658.38
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
