|
DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 26025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DRAINAGE OF PALM BURSA
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$592.11
|
| Rate for Payer: Anthem Medicaid |
$266.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$657.54
|
| Rate for Payer: Healthspan PPO |
$536.33
|
| Rate for Payer: Humana Medicaid |
$266.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.52
|
| Rate for Payer: Molina Healthcare Passport |
$266.20
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.86
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DRAINAGE OF PALM BURSA(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
761P0654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$592.11
|
| Rate for Payer: Anthem Medicaid |
$266.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$657.54
|
| Rate for Payer: Healthspan PPO |
$536.33
|
| Rate for Payer: Humana Medicaid |
$266.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.52
|
| Rate for Payer: Molina Healthcare Passport |
$266.20
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.86
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DRAINAGE OF PALM BURSAS
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.78 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$701.54
|
| Rate for Payer: Anthem Medicaid |
$334.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Healthspan PPO |
$635.45
|
| Rate for Payer: Humana Medicaid |
$334.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.48
|
| Rate for Payer: Molina Healthcare Passport |
$334.78
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.13
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DRAINAGE OF PALM BURSAS(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
761P0655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.78 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$701.54
|
| Rate for Payer: Anthem Medicaid |
$334.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Healthspan PPO |
$635.45
|
| Rate for Payer: Humana Medicaid |
$334.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.48
|
| Rate for Payer: Molina Healthcare Passport |
$334.78
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.13
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761P1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.25 |
| Max. Negotiated Rate |
$2,281.70 |
| Rate for Payer: Aetna Commercial |
$2,281.70
|
| Rate for Payer: Anthem Medicaid |
$417.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,138.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$2,123.60
|
| Rate for Payer: Healthspan PPO |
$1,924.20
|
| Rate for Payer: Humana Medicaid |
$417.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,029.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.60
|
| Rate for Payer: Molina Healthcare Passport |
$417.25
|
| Rate for Payer: Multiplan PHCS |
$1,282.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,496.60
|
| Rate for Payer: UHCCP Medicaid |
$748.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.42
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
IP
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.32 |
| Max. Negotiated Rate |
$6,360.48 |
| Rate for Payer: Aetna Commercial |
$5,101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.89
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cigna Commercial |
$5,499.16
|
| Rate for Payer: First Health Commercial |
$6,294.22
|
| Rate for Payer: Humana Commercial |
$5,631.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,969.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,053.90
|
| Rate for Payer: PHCS Commercial |
$6,360.48
|
| Rate for Payer: United Healthcare All Payer |
$5,830.44
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761T1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.38 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$3,455.38
|
| Rate for Payer: Anthem Medicaid |
$1,543.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.25
|
| Rate for Payer: Cash Price |
$2,243.75
|
| Rate for Payer: Cigna Commercial |
$3,724.62
|
| Rate for Payer: First Health Commercial |
$4,263.12
|
| Rate for Payer: Humana Commercial |
$3,814.38
|
| Rate for Payer: Humana KY Medicaid |
$1,543.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,679.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,574.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$897.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,391.12
|
| Rate for Payer: PHCS Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Payer |
$3,949.00
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
OP
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.32 |
| Max. Negotiated Rate |
$6,360.48 |
| Rate for Payer: Aetna Commercial |
$5,101.64
|
| Rate for Payer: Anthem Medicaid |
$2,278.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.89
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cigna Commercial |
$5,499.16
|
| Rate for Payer: First Health Commercial |
$6,294.22
|
| Rate for Payer: Humana Commercial |
$5,631.68
|
| Rate for Payer: Humana KY Medicaid |
$2,278.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,301.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,324.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,969.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,053.90
|
| Rate for Payer: PHCS Commercial |
$6,360.48
|
| Rate for Payer: United Healthcare All Payer |
$5,830.44
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Professional
|
Both
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.25 |
| Max. Negotiated Rate |
$6,625.50 |
| Rate for Payer: Aetna Commercial |
$2,281.70
|
| Rate for Payer: Anthem Medicaid |
$417.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,625.50
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cigna Commercial |
$2,123.60
|
| Rate for Payer: Healthspan PPO |
$1,924.20
|
| Rate for Payer: Humana Medicaid |
$417.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,029.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.60
|
| Rate for Payer: Molina Healthcare Passport |
$417.25
|
| Rate for Payer: Multiplan PHCS |
$3,975.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,637.85
|
| Rate for Payer: UHCCP Medicaid |
$2,318.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.42
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761T1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.38 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$3,455.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.25
|
| Rate for Payer: Cash Price |
$2,243.75
|
| Rate for Payer: Cigna Commercial |
$3,724.62
|
| Rate for Payer: First Health Commercial |
$4,263.12
|
| Rate for Payer: Humana Commercial |
$3,814.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,679.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$897.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,391.12
|
| Rate for Payer: PHCS Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Payer |
$3,949.00
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$178.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.85
|
| Rate for Payer: Anthem Medicaid |
$61.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Healthspan PPO |
$188.08
|
| Rate for Payer: Humana Medicaid |
$61.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.26
|
| Rate for Payer: Molina Healthcare Passport |
$61.04
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$111.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.65
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
DRAINAGE OF SALIVARY GLAND (P
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761P2666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$178.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.85
|
| Rate for Payer: Anthem Medicaid |
$61.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Healthspan PPO |
$188.08
|
| Rate for Payer: Humana Medicaid |
$61.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.26
|
| Rate for Payer: Molina Healthcare Passport |
$61.04
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.00
|
| Rate for Payer: UHCCP Medicaid |
$111.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.65
|
|
|
DRAINAGE OF SALIVARY GLAND (T
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761T2666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
DRAINAGE OF SALIVARY GLAND (T
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761T2666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Professional
|
Both
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$3,172.71 |
| Rate for Payer: Aetna Commercial |
$257.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.68
|
| Rate for Payer: Anthem Medicaid |
$78.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,172.71
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$230.90
|
| Rate for Payer: Healthspan PPO |
$329.33
|
| Rate for Payer: Humana Medicaid |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.73
|
| Rate for Payer: Molina Healthcare Passport |
$78.17
|
| Rate for Payer: Multiplan PHCS |
$1,903.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,220.90
|
| Rate for Payer: UHCCP Medicaid |
$106.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.95
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
IP
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.45 |
| Max. Negotiated Rate |
$3,045.80 |
| Rate for Payer: Aetna Commercial |
$2,442.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,474.71
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$2,633.35
|
| Rate for Payer: First Health Commercial |
$3,014.07
|
| Rate for Payer: Humana Commercial |
$2,696.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,601.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,341.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,791.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,379.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.54
|
| Rate for Payer: PHCS Commercial |
$3,045.80
|
| Rate for Payer: United Healthcare All Payer |
$2,791.98
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
OP
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.45 |
| Max. Negotiated Rate |
$3,045.80 |
| Rate for Payer: Aetna Commercial |
$2,442.99
|
| Rate for Payer: Anthem Medicaid |
$1,091.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,474.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$2,633.35
|
| Rate for Payer: First Health Commercial |
$3,014.07
|
| Rate for Payer: Humana Commercial |
$2,696.80
|
| Rate for Payer: Humana KY Medicaid |
$1,091.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,601.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,341.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,791.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,379.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.54
|
| Rate for Payer: PHCS Commercial |
$3,045.80
|
| Rate for Payer: United Healthcare All Payer |
$2,791.98
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
45000287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
