|
DRAIN ABSECS PALATE UVULA
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
45000256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
76101667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
45000256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
45000205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
DRAINAGE ABSCESS NASAL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$166.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.89
|
| Rate for Payer: Anthem Medicaid |
$49.49
|
| 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 |
$310.93
|
| Rate for Payer: Healthspan PPO |
$260.14
|
| Rate for Payer: Humana Medicaid |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.48
|
| Rate for Payer: Molina Healthcare Passport |
$49.49
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$67.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.98
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
45000205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DRAINAGE ABSCESS NASAL(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
761P1117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$166.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.89
|
| Rate for Payer: Anthem Medicaid |
$49.49
|
| 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 |
$310.93
|
| Rate for Payer: Healthspan PPO |
$260.14
|
| Rate for Payer: Humana Medicaid |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.48
|
| Rate for Payer: Molina Healthcare Passport |
$49.49
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$67.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.98
|
|
|
DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
|
Facility
|
OP
|
$666.11
|
|
|
Service Code
|
CPT 30020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.79 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
45000133
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem Medicaid |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Humana KY Medicaid |
$198.09
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$200.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.56
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
45000133
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.56
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.33
|
| Rate for Payer: Anthem Medicaid |
$51.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$427.24
|
| Rate for Payer: Healthspan PPO |
$306.49
|
| Rate for Payer: Humana Medicaid |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.40
|
| Rate for Payer: Molina Healthcare Passport |
$51.37
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$75.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.88
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
761P0651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.37 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.33
|
| Rate for Payer: Anthem Medicaid |
$51.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$427.24
|
| Rate for Payer: Healthspan PPO |
$306.49
|
| Rate for Payer: Humana Medicaid |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.40
|
| Rate for Payer: Molina Healthcare Passport |
$51.37
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$75.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.88
|
|
|
DRAINAGE LYMPH NODE
|
Professional
|
Both
|
$5,826.50
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.64 |
| Max. Negotiated Rate |
$5,826.50 |
| Rate for Payer: Aetna Commercial |
$259.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.32
|
| Rate for Payer: Anthem Medicaid |
$53.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,826.50
|
| Rate for Payer: Cash Price |
$2,913.25
|
| Rate for Payer: Cash Price |
$2,913.25
|
| Rate for Payer: Cigna Commercial |
$243.83
|
| Rate for Payer: Healthspan PPO |
$301.35
|
| Rate for Payer: Humana Medicaid |
$53.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.71
|
| Rate for Payer: Molina Healthcare Passport |
$53.64
|
| Rate for Payer: Multiplan PHCS |
$3,495.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,078.55
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.18
|
|
|
DRAINAGE LYMPH NODE
|
Facility
|
OP
|
$5,826.50
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.44 |
| Max. Negotiated Rate |
$5,593.44 |
| Rate for Payer: Aetna Commercial |
$4,486.40
|
| Rate for Payer: Anthem Medicaid |
$2,003.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,913.25
|
| Rate for Payer: Cash Price |
$2,913.25
|
| Rate for Payer: Cigna Commercial |
$4,836.00
|
| Rate for Payer: First Health Commercial |
$5,535.18
|
| Rate for Payer: Humana Commercial |
$4,952.52
|
| Rate for Payer: Humana KY Medicaid |
$2,003.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,024.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,043.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.22
|
| Rate for Payer: PHCS Commercial |
$5,593.44
|
| Rate for Payer: United Healthcare All Payer |
$5,127.32
|
|
|
DRAINAGE LYMPH NODE
|
Facility
|
IP
|
$5,826.50
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.44 |
| Max. Negotiated Rate |
$5,593.44 |
| Rate for Payer: Aetna Commercial |
$4,486.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,544.67
|
| Rate for Payer: Cash Price |
$2,913.25
|
| Rate for Payer: Cigna Commercial |
$4,836.00
|
| Rate for Payer: First Health Commercial |
$5,535.18
|
| Rate for Payer: Humana Commercial |
$4,952.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,777.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,299.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,747.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,369.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,165.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,806.22
|
| Rate for Payer: PHCS Commercial |
$5,593.44
|
| Rate for Payer: United Healthcare All Payer |
$5,127.32
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
OP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.23 |
| Max. Negotiated Rate |
$3,908.16 |
| Rate for Payer: Aetna Commercial |
$3,134.67
|
| Rate for Payer: Anthem Medicaid |
$1,400.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,175.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$3,378.93
|
| Rate for Payer: First Health Commercial |
$3,867.45
|
| Rate for Payer: Humana Commercial |
$3,460.35
|
| Rate for Payer: Humana KY Medicaid |
$1,400.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,414.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,338.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,004.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,428.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,582.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,053.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.01
|
| Rate for Payer: PHCS Commercial |
$3,908.16
|
| Rate for Payer: United Healthcare All Payer |
$3,582.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761T1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
IP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.23 |
| Max. Negotiated Rate |
$3,908.16 |
| Rate for Payer: Aetna Commercial |
$3,134.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,175.38
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$3,378.93
|
| Rate for Payer: First Health Commercial |
$3,867.45
|
| Rate for Payer: Humana Commercial |
$3,460.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,338.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,004.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,221.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,582.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,053.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.01
|
| Rate for Payer: PHCS Commercial |
$3,908.16
|
| Rate for Payer: United Healthcare All Payer |
$3,582.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Professional
|
Both
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.74 |
| Max. Negotiated Rate |
$4,071.00 |
| Rate for Payer: Aetna Commercial |
$669.83
|
| Rate for Payer: Anthem Medicaid |
$185.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,071.00
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$628.12
|
| Rate for Payer: Healthspan PPO |
$535.59
|
| Rate for Payer: Humana Medicaid |
$185.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.45
|
| Rate for Payer: Molina Healthcare Passport |
$185.74
|
| Rate for Payer: Multiplan PHCS |
$2,442.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,849.70
|
| Rate for Payer: UHCCP Medicaid |
$1,424.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.60
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761T1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761P1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.74 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$669.83
|
| Rate for Payer: Anthem Medicaid |
$185.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$628.12
|
| Rate for Payer: Healthspan PPO |
$535.59
|
| Rate for Payer: Humana Medicaid |
$185.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.45
|
| Rate for Payer: Molina Healthcare Passport |
$185.74
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.60
|
|
