|
DRAINAGE OF FOREARM BURSA(T
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761T0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.33 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DRAINAGE OF FOREARM BURSA(T
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761T0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.33 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| 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 |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DRAINAGE OF HIP JOINT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,408.85
|
| Rate for Payer: Anthem Medicaid |
$706.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,536.18
|
| Rate for Payer: Healthspan PPO |
$1,276.12
|
| Rate for Payer: Humana Medicaid |
$706.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,169.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.40
|
| Rate for Payer: Molina Healthcare Passport |
$706.27
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.33
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DRAINAGE OF HIP JOINT(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
761P0763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,408.85
|
| Rate for Payer: Anthem Medicaid |
$706.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,536.18
|
| Rate for Payer: Healthspan PPO |
$1,276.12
|
| Rate for Payer: Humana Medicaid |
$706.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,169.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.40
|
| Rate for Payer: Molina Healthcare Passport |
$706.27
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.33
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.06 |
| Max. Negotiated Rate |
$1,499.52 |
| Rate for Payer: Aetna Commercial |
$1,202.74
|
| Rate for Payer: Anthem Medicaid |
$537.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: First Health Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial |
$1,327.70
|
| Rate for Payer: Humana KY Medicaid |
$537.17
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$542.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.22
|
| Rate for Payer: PHCS Commercial |
$1,499.52
|
| Rate for Payer: United Healthcare All Payer |
$1,374.56
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.06 |
| Max. Negotiated Rate |
$1,499.52 |
| Rate for Payer: Aetna Commercial |
$1,202.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.36
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: First Health Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial |
$1,327.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.22
|
| Rate for Payer: PHCS Commercial |
$1,499.52
|
| Rate for Payer: United Healthcare All Payer |
$1,374.56
|
|
|
DRAINAGE OF HYDROCELE
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$1,562.00 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.12
|
| Rate for Payer: Anthem Medicaid |
$48.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,562.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$193.24
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$48.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.27
|
| Rate for Payer: Molina Healthcare Passport |
$48.30
|
| Rate for Payer: Multiplan PHCS |
$937.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,093.40
|
| Rate for Payer: UHCCP Medicaid |
$55.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.78
|
|
|
DRAINAGE OF HYDROCELE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761P2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.12
|
| Rate for Payer: Anthem Medicaid |
$48.30
|
| 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 |
$193.24
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$48.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.27
|
| Rate for Payer: Molina Healthcare Passport |
$48.30
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$55.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.78
|
|
|
DRAINAGE OF HYDROCELE(T
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761T2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.22
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
DRAINAGE OF HYDROCELE(T
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761T2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem Medicaid |
$399.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Humana KY Medicaid |
$399.61
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$403.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.22
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$2,597.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$2,597.00 |
| Rate for Payer: Aetna Commercial |
$313.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.59
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$397.32
|
| Rate for Payer: Healthspan PPO |
$355.86
|
| Rate for Payer: Humana Medicaid |
$99.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$280.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.45
|
| Rate for Payer: Molina Healthcare Passport |
$99.46
|
| Rate for Payer: Multiplan PHCS |
$1,558.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.90
|
| Rate for Payer: UHCCP Medicaid |
$164.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.45
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.12
|
| Rate for Payer: Anthem Medicaid |
$169.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$788.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$482.51
|
| Rate for Payer: Healthspan PPO |
$416.11
|
| Rate for Payer: Humana Medicaid |
$169.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.28
|
| Rate for Payer: Molina Healthcare Passport |
$169.88
|
| Rate for Payer: Multiplan PHCS |
$472.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$551.60
|
| Rate for Payer: UHCCP Medicaid |
$178.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.58
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem Medicaid |
$270.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| 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 |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Humana KY Medicaid |
$270.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.28
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$2,597.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$2,493.12 |
| Rate for Payer: Aetna Commercial |
$1,999.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,025.66
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$2,155.51
|
| Rate for Payer: First Health Commercial |
$2,467.15
|
| Rate for Payer: Humana Commercial |
$2,207.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,129.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,916.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$779.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,285.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.07
|
| Rate for Payer: PHCS Commercial |
$2,493.12
|
| Rate for Payer: United Healthcare All Payer |
$2,285.36
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$2,597.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$2,493.12 |
| Rate for Payer: Aetna Commercial |
$1,999.69
|
| Rate for Payer: Anthem Medicaid |
$893.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,025.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$2,155.51
|
| Rate for Payer: First Health Commercial |
$2,467.15
|
| Rate for Payer: Humana Commercial |
$2,207.45
|
| Rate for Payer: Humana KY Medicaid |
$893.11
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$902.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,129.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,916.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$911.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,285.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.07
|
| Rate for Payer: PHCS Commercial |
$2,493.12
|
| Rate for Payer: United Healthcare All Payer |
$2,285.36
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.28
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
DRAINAGE OF MOUTH LESION(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761P1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$313.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.59
|
| Rate for Payer: Anthem Medicaid |
$99.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$397.32
|
| Rate for Payer: Healthspan PPO |
$355.86
|
| Rate for Payer: Humana Medicaid |
$99.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$280.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.45
|
| Rate for Payer: Molina Healthcare Passport |
$99.46
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$164.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.45
|
|
|
DRAINAGE OF MOUTH LESION(T
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761T1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.61 |
| Max. Negotiated Rate |
$1,629.12 |
| Rate for Payer: Aetna Commercial |
$1,306.69
|
| Rate for Payer: Anthem Medicaid |
$583.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,323.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,408.51
|
| Rate for Payer: First Health Commercial |
$1,612.15
|
| Rate for Payer: Humana Commercial |
$1,442.45
|
| Rate for Payer: Humana KY Medicaid |
$583.60
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$589.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,391.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,252.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$595.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,493.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,272.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.07
|
| Rate for Payer: PHCS Commercial |
$1,629.12
|
| Rate for Payer: United Healthcare All Payer |
$1,493.36
|
|
|
DRAINAGE OF MOUTH LESION(T
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761T1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.61 |
| Max. Negotiated Rate |
$1,629.12 |
| Rate for Payer: Aetna Commercial |
$1,306.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,323.66
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,408.51
|
| Rate for Payer: First Health Commercial |
$1,612.15
|
| Rate for Payer: Humana Commercial |
$1,442.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,391.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,252.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,493.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,272.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$220.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.07
|
| Rate for Payer: PHCS Commercial |
$1,629.12
|
| Rate for Payer: United Healthcare All Payer |
$1,493.36
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$607.80
|
| Rate for Payer: Anthem Medicaid |
$363.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$582.32
|
| Rate for Payer: Healthspan PPO |
$588.50
|
| Rate for Payer: Humana Medicaid |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$371.08
|
| Rate for Payer: Molina Healthcare Passport |
$363.80
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.44
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
DRAINAGE OF OVARIAN CYST(S)(P
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
761P2260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$607.80
|
| Rate for Payer: Anthem Medicaid |
$363.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$582.32
|
| Rate for Payer: Healthspan PPO |
$588.50
|
| Rate for Payer: Humana Medicaid |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$371.08
|
| Rate for Payer: Molina Healthcare Passport |
$363.80
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.44
|
|
