|
DRAIN ABSCESCYSTDENTOALVEOLAR
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
76101665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$822.72 |
| Rate for Payer: Aetna Commercial |
$659.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$668.46
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Cigna Commercial |
$711.31
|
| Rate for Payer: First Health Commercial |
$814.15
|
| Rate for Payer: Humana Commercial |
$728.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$702.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$632.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$754.16
|
| Rate for Payer: Ohio Health Group HMO |
$642.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.67
|
| Rate for Payer: PHCS Commercial |
$822.72
|
| Rate for Payer: United Healthcare All Payer |
$754.16
|
|
|
DRAIN ABSCESCYSTDENTOALVEOLAR
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
45000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
DRAIN ABSCESCYSTDENTOALVEOLA(T
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
761T1665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem Medicaid |
$174.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Humana KY Medicaid |
$174.36
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$176.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
DRAIN ABSCESCYSTDENTOALVEOLA(T
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
761T1665
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
76101629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$1,079.04 |
| Rate for Payer: Aetna Commercial |
$865.48
|
| Rate for Payer: Anthem Medicaid |
$386.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$932.92
|
| Rate for Payer: First Health Commercial |
$1,067.80
|
| Rate for Payer: Humana Commercial |
$955.40
|
| Rate for Payer: Humana KY Medicaid |
$386.54
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$390.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.12
|
| Rate for Payer: Ohio Health Group HMO |
$843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.44
|
| Rate for Payer: PHCS Commercial |
$1,079.04
|
| Rate for Payer: United Healthcare All Payer |
$989.12
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
45000247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
761T1629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
76101629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$1,079.04 |
| Rate for Payer: Aetna Commercial |
$865.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.72
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$932.92
|
| Rate for Payer: First Health Commercial |
$1,067.80
|
| Rate for Payer: Humana Commercial |
$955.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.12
|
| Rate for Payer: Ohio Health Group HMO |
$843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.44
|
| Rate for Payer: PHCS Commercial |
$1,079.04
|
| Rate for Payer: United Healthcare All Payer |
$989.12
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
761T1629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
761P1629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$252.31 |
| Rate for Payer: Aetna Commercial |
$177.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.75
|
| Rate for Payer: Anthem Medicaid |
$44.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$252.31
|
| Rate for Payer: Healthspan PPO |
$228.23
|
| Rate for Payer: Humana Medicaid |
$44.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.38
|
| Rate for Payer: Molina Healthcare Passport |
$44.49
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$90.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.93
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
45000247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
DRAIN ABSCESCYSTHEMAMOUTHSMPLE
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
76101629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna Commercial |
$177.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.75
|
| Rate for Payer: Anthem Medicaid |
$44.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,124.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$252.31
|
| Rate for Payer: Healthspan PPO |
$228.23
|
| Rate for Payer: Humana Medicaid |
$44.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.38
|
| Rate for Payer: Molina Healthcare Passport |
$44.49
|
| Rate for Payer: Multiplan PHCS |
$674.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$786.80
|
| Rate for Payer: UHCCP Medicaid |
$90.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.93
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
OP
|
$3,595.20
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
76101678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.38 |
| Max. Negotiated Rate |
$3,451.39 |
| Rate for Payer: Aetna Commercial |
$2,768.30
|
| Rate for Payer: Anthem Medicaid |
$1,236.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,804.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cigna Commercial |
$2,984.02
|
| Rate for Payer: First Health Commercial |
$3,415.44
|
| Rate for Payer: Humana Commercial |
$3,055.92
|
| Rate for Payer: Humana KY Medicaid |
$1,236.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,948.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,653.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,114.51
|
| Rate for Payer: PHCS Commercial |
$3,451.39
|
| Rate for Payer: United Healthcare All Payer |
$3,163.78
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
45000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
IP
|
$3,595.20
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
76101678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.38 |
| Max. Negotiated Rate |
$3,451.39 |
| Rate for Payer: Aetna Commercial |
$2,768.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,804.26
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cigna Commercial |
$2,984.02
|
| Rate for Payer: First Health Commercial |
$3,415.44
|
| Rate for Payer: Humana Commercial |
$3,055.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,948.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,653.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,114.51
|
| Rate for Payer: PHCS Commercial |
$3,451.39
|
| Rate for Payer: United Healthcare All Payer |
$3,163.78
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Professional
|
Both
|
$3,595.20
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
76101678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.65
|
| Rate for Payer: Anthem Medicaid |
$70.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,595.20
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cigna Commercial |
$276.56
|
| Rate for Payer: Healthspan PPO |
$241.30
|
| Rate for Payer: Humana Medicaid |
$70.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.38
|
| Rate for Payer: Molina Healthcare Passport |
$70.96
|
| Rate for Payer: Multiplan PHCS |
$2,157.12
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,516.64
|
| Rate for Payer: UHCCP Medicaid |
$128.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.67
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
45000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem Medicaid |
$692.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Humana KY Medicaid |
$692.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$700.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
DRAIN ABSCES PAROTID SIMPLE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761P1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.65
|
| Rate for Payer: Anthem Medicaid |
$70.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$276.56
|
| Rate for Payer: Healthspan PPO |
$241.30
|
| Rate for Payer: Humana Medicaid |
$70.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.38
|
| Rate for Payer: Molina Healthcare Passport |
$70.96
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$128.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.67
|
|
|
DRAIN ABSCES PAROTID SIMPLE(T
|
Facility
|
OP
|
$3,245.20
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761T1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.88 |
| Max. Negotiated Rate |
$3,115.39 |
| Rate for Payer: Aetna Commercial |
$2,498.80
|
| Rate for Payer: Anthem Medicaid |
$1,116.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cigna Commercial |
$2,693.52
|
| Rate for Payer: First Health Commercial |
$3,082.94
|
| Rate for Payer: Humana Commercial |
$2,758.42
|
| Rate for Payer: Humana KY Medicaid |
$1,116.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.01
|
| Rate for Payer: PHCS Commercial |
$3,115.39
|
| Rate for Payer: United Healthcare All Payer |
$2,855.78
|
|
|
DRAIN ABSCES PAROTID SIMPLE(T
|
Facility
|
IP
|
$3,245.20
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761T1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.88 |
| Max. Negotiated Rate |
$3,115.39 |
| Rate for Payer: Aetna Commercial |
$2,498.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.26
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cigna Commercial |
$2,693.52
|
| Rate for Payer: First Health Commercial |
$3,082.94
|
| Rate for Payer: Humana Commercial |
$2,758.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.01
|
| Rate for Payer: PHCS Commercial |
$3,115.39
|
| Rate for Payer: United Healthcare All Payer |
$2,855.78
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
45000261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
45000261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76101680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76101680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
76101667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
