|
PULSAR STENT 6.0*100CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*100CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*150CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*150CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*30CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*30CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*40CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 6.0*40CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76100015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Ambetter Exchange |
$90.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$45.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.68
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$45.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.05
|
| Rate for Payer: Molina Healthcare Passport |
$45.15
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.74
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.57
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76100015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.42 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76102854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76102854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Ambetter Exchange |
$90.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$45.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.68
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$45.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.05
|
| Rate for Payer: Molina Healthcare Passport |
$45.15
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.74
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.57
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76100015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
PUNC ASPIR ABSCSS HEMA CYST
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
76102854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(P
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761P2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$164.40 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Ambetter Exchange |
$90.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$45.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.68
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$45.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.05
|
| Rate for Payer: Molina Healthcare Passport |
$45.15
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.74
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.57
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(P
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761P0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$164.40 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Ambetter Exchange |
$90.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.28
|
| Rate for Payer: Anthem Medicaid |
$45.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.68
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$164.40
|
| Rate for Payer: Healthspan PPO |
$139.61
|
| Rate for Payer: Humana Medicaid |
$45.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.05
|
| Rate for Payer: Molina Healthcare Passport |
$45.15
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.74
|
| Rate for Payer: UHCCP Medicaid |
$50.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.57
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.42 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T0015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.42 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNC ASPIR ABSCSS HEMA CYST(T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
761T2854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.97
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$503.04 |
| Rate for Payer: Aetna Commercial |
$403.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$408.72
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$434.92
|
| Rate for Payer: First Health Commercial |
$497.80
|
| Rate for Payer: Humana Commercial |
$445.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$429.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$461.12
|
| Rate for Payer: Ohio Health Group HMO |
$393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.56
|
| Rate for Payer: PHCS Commercial |
$503.04
|
| Rate for Payer: United Healthcare All Payer |
$461.12
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$503.04 |
| Rate for Payer: Aetna Commercial |
$403.48
|
| Rate for Payer: Anthem Medicaid |
$180.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$408.72
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$434.92
|
| Rate for Payer: First Health Commercial |
$497.80
|
| Rate for Payer: Humana Commercial |
$445.40
|
| Rate for Payer: Humana KY Medicaid |
$180.20
|
| Rate for Payer: Kentucky WC Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$429.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$461.12
|
| Rate for Payer: Ohio Health Group HMO |
$393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.56
|
| Rate for Payer: PHCS Commercial |
$503.04
|
| Rate for Payer: United Healthcare All Payer |
$461.12
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
76102568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$314.40 |
| Rate for Payer: Ambetter Exchange |
$23.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$46.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.72
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$96.98
|
| Rate for Payer: Humana Medicaid |
$46.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.59
|
| Rate for Payer: Molina Healthcare Passport |
$46.66
|
| Rate for Payer: Multiplan PHCS |
$314.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.11
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.93
|
|
