|
MARCAINE W/EPINEPH 0.25% 30ML
|
Professional
|
Both
|
$116.74
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$81.72 |
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Multiplan PHCS |
$70.04
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.72
|
| Rate for Payer: UHCCP Medicaid |
$40.86
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$116.74
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$116.74
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.5% 3 30ML
|
Facility
|
IP
|
$78.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003203
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna Commercial |
$60.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.43
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna Commercial |
$65.37
|
| Rate for Payer: First Health Commercial |
$74.82
|
| Rate for Payer: Humana Commercial |
$66.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.31
|
| Rate for Payer: Ohio Health Group HMO |
$59.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.34
|
| Rate for Payer: PHCS Commercial |
$75.61
|
| Rate for Payer: United Healthcare All Payer |
$69.31
|
|
|
MARCAINE W/EPINEPH 0.5% 3 30ML
|
Facility
|
OP
|
$78.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003203
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna Commercial |
$60.65
|
| Rate for Payer: Anthem Medicaid |
$27.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.43
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna Commercial |
$65.37
|
| Rate for Payer: First Health Commercial |
$74.82
|
| Rate for Payer: Humana Commercial |
$66.95
|
| Rate for Payer: Humana KY Medicaid |
$27.09
|
| Rate for Payer: Kentucky WC Medicaid |
$27.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.31
|
| Rate for Payer: Ohio Health Group HMO |
$59.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.34
|
| Rate for Payer: PHCS Commercial |
$75.61
|
| Rate for Payer: United Healthcare All Payer |
$69.31
|
|
|
MARCON DECOMPRESSION SET
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
MARCON DECOMPRESSION SET
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem Medicaid |
$662.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Humana KY Medicaid |
$662.70
|
| Rate for Payer: Kentucky WC Medicaid |
$669.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
MARINOL 5 MG CAPSULE
|
Facility
|
IP
|
$63.10
|
|
|
Service Code
|
NDC 42858086806
|
| Hospital Charge Code |
25000942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$60.58 |
| Rate for Payer: Aetna Commercial |
$48.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.22
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: Cigna Commercial |
$52.37
|
| Rate for Payer: First Health Commercial |
$59.95
|
| Rate for Payer: Humana Commercial |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.53
|
| Rate for Payer: Ohio Health Group HMO |
$47.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.54
|
| Rate for Payer: PHCS Commercial |
$60.58
|
| Rate for Payer: United Healthcare All Payer |
$55.53
|
|
|
MARINOL 5 MG CAPSULE
|
Facility
|
OP
|
$63.10
|
|
|
Service Code
|
NDC 42858086806
|
| Hospital Charge Code |
25000942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$60.58 |
| Rate for Payer: Aetna Commercial |
$48.59
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.22
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: Cigna Commercial |
$52.37
|
| Rate for Payer: First Health Commercial |
$59.95
|
| Rate for Payer: Humana Commercial |
$53.63
|
| Rate for Payer: Humana KY Medicaid |
$21.70
|
| Rate for Payer: Kentucky WC Medicaid |
$21.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.53
|
| Rate for Payer: Ohio Health Group HMO |
$47.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.54
|
| Rate for Payer: PHCS Commercial |
$60.58
|
| Rate for Payer: United Healthcare All Payer |
$55.53
|
|
|
MARKING PIG 5F 100CM
|
Facility
|
IP
|
$1,543.94
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.18 |
| Max. Negotiated Rate |
$1,482.18 |
| Rate for Payer: Aetna Commercial |
$1,188.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.27
|
| Rate for Payer: Cash Price |
$771.97
|
| Rate for Payer: Cigna Commercial |
$1,281.47
|
| Rate for Payer: First Health Commercial |
$1,466.74
|
| Rate for Payer: Humana Commercial |
$1,312.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,343.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,065.32
|
| Rate for Payer: PHCS Commercial |
$1,482.18
|
| Rate for Payer: United Healthcare All Payer |
$1,358.67
|
|
|
MARKING PIG 5F 100CM
|
Facility
|
OP
|
$1,543.94
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.18 |
| Max. Negotiated Rate |
$1,482.18 |
| Rate for Payer: Aetna Commercial |
$1,188.83
|
| Rate for Payer: Anthem Medicaid |
$530.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.27
|
| Rate for Payer: Cash Price |
$771.97
|
| Rate for Payer: Cigna Commercial |
$1,281.47
|
| Rate for Payer: First Health Commercial |
$1,466.74
|
| Rate for Payer: Humana Commercial |
$1,312.35
|
| Rate for Payer: Humana KY Medicaid |
$530.96
|
| Rate for Payer: Kentucky WC Medicaid |
$536.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,343.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,065.32
|
| Rate for Payer: PHCS Commercial |
$1,482.18
|
| Rate for Payer: United Healthcare All Payer |
$1,358.67
|
|
|
MARKING PIG 5F 65CM
|
Facility
|
IP
|
$1,543.94
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.18 |
| Max. Negotiated Rate |
$1,482.18 |
| Rate for Payer: Aetna Commercial |
$1,188.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.27
|
| Rate for Payer: Cash Price |
$771.97
|
| Rate for Payer: Cigna Commercial |
$1,281.47
|
| Rate for Payer: First Health Commercial |
$1,466.74
|
| Rate for Payer: Humana Commercial |
$1,312.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,343.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,065.32
|
| Rate for Payer: PHCS Commercial |
$1,482.18
|
| Rate for Payer: United Healthcare All Payer |
$1,358.67
|
|
|
MARKING PIG 5F 65CM
|
Facility
|
OP
|
$1,543.94
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.18 |
| Max. Negotiated Rate |
$1,482.18 |
| Rate for Payer: Aetna Commercial |
$1,188.83
|
| Rate for Payer: Anthem Medicaid |
$530.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.27
|
| Rate for Payer: Cash Price |
$771.97
|
| Rate for Payer: Cigna Commercial |
$1,281.47
|
| Rate for Payer: First Health Commercial |
$1,466.74
|
| Rate for Payer: Humana Commercial |
$1,312.35
|
| Rate for Payer: Humana KY Medicaid |
$530.96
|
| Rate for Payer: Kentucky WC Medicaid |
$536.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,343.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,065.32
|
| Rate for Payer: PHCS Commercial |
$1,482.18
|
| Rate for Payer: United Healthcare All Payer |
$1,358.67
|
|
|
MARSUP BARTHOLIN CYST
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
MARSUP BARTHOLIN CYST
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$276.56
|
| Rate for Payer: Ambetter Exchange |
$172.37
|
| Rate for Payer: Anthem Medicaid |
$165.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.84
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$270.50
|
| Rate for Payer: Healthspan PPO |
$267.78
|
| Rate for Payer: Humana Medicaid |
$165.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.35
|
| Rate for Payer: Molina Healthcare Passport |
$165.05
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.08
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.37
|
|
|
MARSUP BARTHOLIN CYST
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
MARSUP BARTHOLIN CYST(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
761P2156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$276.56
|
| Rate for Payer: Ambetter Exchange |
$172.37
|
| Rate for Payer: Anthem Medicaid |
$165.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.84
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$270.50
|
| Rate for Payer: Healthspan PPO |
$267.78
|
| Rate for Payer: Humana Medicaid |
$165.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.35
|
| Rate for Payer: Molina Healthcare Passport |
$165.05
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.08
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.37
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
761P1687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$434.44 |
| Rate for Payer: Aetna Commercial |
$322.90
|
| Rate for Payer: Ambetter Exchange |
$219.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$162.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.86
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.44
|
| Rate for Payer: Healthspan PPO |
$383.35
|
| Rate for Payer: Humana Medicaid |
$162.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.42
|
| Rate for Payer: Molina Healthcare Passport |
$162.18
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.84
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.88
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| 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 |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
MARSUPIALIZATION SALIVARY CYST
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 42409
|
| Hospital Charge Code |
76101687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$434.44 |
| Rate for Payer: Aetna Commercial |
$322.90
|
| Rate for Payer: Ambetter Exchange |
$219.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.19
|
| Rate for Payer: Anthem Medicaid |
$162.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.86
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.44
|
| Rate for Payer: Healthspan PPO |
$383.35
|
| Rate for Payer: Humana Medicaid |
$162.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.42
|
| Rate for Payer: Molina Healthcare Passport |
$162.18
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.84
|
| Rate for Payer: UHCCP Medicaid |
$167.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.88
|
|
|
MASSAGE - 15 MIN 1
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
43000015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
MASSAGE - 15 MIN 1
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
43000015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
MASSAGE - 15 MINUTES
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
