|
DRAINAGE LYMPH NODE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761P1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.64 |
| Max. Negotiated Rate |
$400.00 |
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.18
|
|
|
DRAINAGE LYMPH NODE(T
|
Facility
|
IP
|
$5,426.50
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761T1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.44 |
| Max. Negotiated Rate |
$5,209.44 |
| Rate for Payer: Aetna Commercial |
$4,178.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,232.67
|
| Rate for Payer: Cash Price |
$2,713.25
|
| Rate for Payer: Cigna Commercial |
$4,504.00
|
| Rate for Payer: First Health Commercial |
$5,155.18
|
| Rate for Payer: Humana Commercial |
$4,612.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,449.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,004.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,627.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,069.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,085.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,682.22
|
| Rate for Payer: PHCS Commercial |
$5,209.44
|
| Rate for Payer: United Healthcare All Payer |
$4,775.32
|
|
|
DRAINAGE LYMPH NODE(T
|
Facility
|
OP
|
$5,426.50
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761T1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.44 |
| Max. Negotiated Rate |
$5,209.44 |
| Rate for Payer: Aetna Commercial |
$4,178.40
|
| Rate for Payer: Anthem Medicaid |
$1,866.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,232.67
|
| 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 |
$2,713.25
|
| Rate for Payer: Cash Price |
$2,713.25
|
| Rate for Payer: Cigna Commercial |
$4,504.00
|
| Rate for Payer: First Health Commercial |
$5,155.18
|
| Rate for Payer: Humana Commercial |
$4,612.52
|
| Rate for Payer: Humana KY Medicaid |
$1,866.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,885.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,449.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,004.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,903.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,069.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,085.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,682.22
|
| Rate for Payer: PHCS Commercial |
$5,209.44
|
| Rate for Payer: United Healthcare All Payer |
$4,775.32
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 40800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Professional
|
Both
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$4,352.00 |
| Rate for Payer: Aetna Commercial |
$626.66
|
| Rate for Payer: Anthem Medicaid |
$229.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,352.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$621.82
|
| Rate for Payer: Healthspan PPO |
$528.47
|
| Rate for Payer: Humana Medicaid |
$229.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.64
|
| Rate for Payer: Molina Healthcare Passport |
$229.06
|
| Rate for Payer: Multiplan PHCS |
$2,611.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,046.40
|
| Rate for Payer: UHCCP Medicaid |
$1,523.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.35
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Facility
|
IP
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.76 |
| Max. Negotiated Rate |
$4,177.92 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.12
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Facility
|
OP
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.76 |
| Max. Negotiated Rate |
$4,177.92 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem Medicaid |
$1,496.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Humana KY Medicaid |
$1,496.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.12
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
DRAINAGE OF ABSCESS PAROTID(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761P1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$626.66 |
| Rate for Payer: Aetna Commercial |
$626.66
|
| Rate for Payer: Anthem Medicaid |
$229.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$621.82
|
| Rate for Payer: Healthspan PPO |
$528.47
|
| Rate for Payer: Humana Medicaid |
$229.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.64
|
| Rate for Payer: Molina Healthcare Passport |
$229.06
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.35
|
|
|
DRAINAGE OF ABSCESS PAROTID(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761T1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
DRAINAGE OF ABSCESS PAROTID(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761T1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
DRAINAGE OF BONE LESION
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
DRAINAGE OF BONE LESION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,024.23 |
| Rate for Payer: Aetna Commercial |
$935.63
|
| Rate for Payer: Anthem Medicaid |
$406.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$1,024.23
|
| Rate for Payer: Healthspan PPO |
$847.48
|
| Rate for Payer: Humana Medicaid |
$406.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$790.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.28
|
| Rate for Payer: Molina Healthcare Passport |
$406.16
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.22
|
|
|
DRAINAGE OF BONE LESION
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.66 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$981.06
|
| Rate for Payer: First Health Commercial |
$1,122.90
|
| Rate for Payer: Humana Commercial |
$1,004.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$969.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$872.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,040.16
|
| Rate for Payer: Ohio Health Group HMO |
$886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.42
|
| Rate for Payer: PHCS Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare All Payer |
$1,040.16
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.66 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem Medicaid |
$406.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$981.06
|
| Rate for Payer: First Health Commercial |
$1,122.90
|
| Rate for Payer: Humana Commercial |
$1,004.70
|
| Rate for Payer: Humana KY Medicaid |
$406.49
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$410.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$969.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$872.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,040.16
|
| Rate for Payer: Ohio Health Group HMO |
$886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.42
|
| Rate for Payer: PHCS Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare All Payer |
$1,040.16
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$149.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.92
|
| Rate for Payer: Anthem Medicaid |
$45.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,182.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$386.49
|
| Rate for Payer: Healthspan PPO |
$299.62
|
| Rate for Payer: Humana Medicaid |
$45.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.36
|
| Rate for Payer: Molina Healthcare Passport |
$45.45
|
| Rate for Payer: Multiplan PHCS |
$709.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$827.40
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.90
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
45000302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.24
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
45000302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.24
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
DRAINAGE OF EYELID ABSCESS(P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761P2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna Commercial |
$149.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.92
|
| Rate for Payer: Anthem Medicaid |
$45.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.00
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$386.49
|
| Rate for Payer: Healthspan PPO |
$299.62
|
| Rate for Payer: Humana Medicaid |
$45.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.36
|
| Rate for Payer: Molina Healthcare Passport |
$45.45
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.90
|
|
|
DRAINAGE OF EYELID ABSCESS(T
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761T2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem Medicaid |
$219.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Humana KY Medicaid |
$219.06
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.47
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF EYELID ABSCESS(T
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761T2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.47
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.63 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.81
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.63 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem Medicaid |
$980.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Humana KY Medicaid |
$980.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$990.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.81
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
DRAINAGE OF FOREARM BURSA
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$2,851.00 |
| Rate for Payer: Aetna Commercial |
$536.10
|
| Rate for Payer: Anthem Medicaid |
$134.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,851.00
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$746.97
|
| Rate for Payer: Healthspan PPO |
$485.59
|
| Rate for Payer: Humana Medicaid |
$134.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Passport |
$134.33
|
| Rate for Payer: Multiplan PHCS |
$1,710.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,995.70
|
| Rate for Payer: UHCCP Medicaid |
$997.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.67
|
|
|
DRAINAGE OF FOREARM BURSA(P
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761P0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna Commercial |
$536.10
|
| Rate for Payer: Anthem Medicaid |
$134.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$910.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$746.97
|
| Rate for Payer: Healthspan PPO |
$485.59
|
| Rate for Payer: Humana Medicaid |
$134.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Passport |
$134.33
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$637.00
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.67
|
|
