|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$1,599.00
|
| 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: 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 |
$615.00
|
| 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
|
|
|
DRAINAGE OF SCROTAL ABSCESS(P
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761P2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$815.00 |
| 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 |
$815.00
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| 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 |
$489.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$570.50
|
| Rate for Payer: UHCCP Medicaid |
$106.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.95
|
|
|
DRAINAGE OF SCROTAL ABSCESS(T
|
Facility
|
IP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761T2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.50 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$730.89
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF SCROTAL ABSCESS(T
|
Facility
|
OP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761T2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.50 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem Medicaid |
$810.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| 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 |
$1,178.86
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Humana KY Medicaid |
$810.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$819.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$827.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$730.89
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,184.24 |
| Rate for Payer: Aetna Commercial |
$1,184.24
|
| Rate for Payer: Anthem Medicaid |
$355.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,165.31
|
| Rate for Payer: Healthspan PPO |
$998.69
|
| Rate for Payer: Humana Medicaid |
$355.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.36
|
| Rate for Payer: Molina Healthcare Passport |
$355.25
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.80
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
DRAINAGE OF THROAT ABSCESS(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
761P1698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,184.24 |
| Rate for Payer: Aetna Commercial |
$1,184.24
|
| Rate for Payer: Anthem Medicaid |
$355.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,165.31
|
| Rate for Payer: Healthspan PPO |
$998.69
|
| Rate for Payer: Humana Medicaid |
$355.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.36
|
| Rate for Payer: Molina Healthcare Passport |
$355.25
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.80
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$2,052.48 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Anthem Medicaid |
$735.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.64
|
| 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 |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: First Health Commercial |
$2,031.10
|
| Rate for Payer: Humana Commercial |
$1,817.30
|
| Rate for Payer: Humana KY Medicaid |
$735.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$742.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.78
|
| Rate for Payer: PHCS Commercial |
$2,052.48
|
| Rate for Payer: United Healthcare All Payer |
$1,881.44
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
OP
|
$2,438.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$2,340.48 |
| Rate for Payer: Aetna Commercial |
$1,877.26
|
| Rate for Payer: Anthem Medicaid |
$838.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,901.64
|
| 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 |
$1,219.00
|
| Rate for Payer: Cash Price |
$1,219.00
|
| Rate for Payer: Cigna Commercial |
$2,023.54
|
| Rate for Payer: First Health Commercial |
$2,316.10
|
| Rate for Payer: Humana Commercial |
$2,072.30
|
| Rate for Payer: Humana KY Medicaid |
$838.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$846.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,999.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,799.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$855.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,145.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,828.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.78
|
| Rate for Payer: PHCS Commercial |
$2,340.48
|
| Rate for Payer: United Healthcare All Payer |
$2,145.44
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$2,052.48 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.64
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: First Health Commercial |
$2,031.10
|
| Rate for Payer: Humana Commercial |
$1,817.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.78
|
| Rate for Payer: PHCS Commercial |
$2,052.48
|
| Rate for Payer: United Healthcare All Payer |
$1,881.44
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
IP
|
$2,438.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$2,340.48 |
| Rate for Payer: Aetna Commercial |
$1,877.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,901.64
|
| Rate for Payer: Cash Price |
$1,219.00
|
| Rate for Payer: Cigna Commercial |
$2,023.54
|
| Rate for Payer: First Health Commercial |
$2,316.10
|
| Rate for Payer: Humana Commercial |
$2,072.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,999.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,799.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$731.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,145.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,828.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$487.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$755.78
|
| Rate for Payer: PHCS Commercial |
$2,340.48
|
| Rate for Payer: United Healthcare All Payer |
$2,145.44
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Professional
|
Both
|
$2,438.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$2,438.00 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$51.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,438.00
|
| Rate for Payer: Cash Price |
$1,219.00
|
| Rate for Payer: Cash Price |
$1,219.00
|
| Rate for Payer: Cigna Commercial |
$197.05
|
| Rate for Payer: Healthspan PPO |
$172.24
|
| Rate for Payer: Humana Medicaid |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.10
|
| Rate for Payer: Molina Healthcare Passport |
$51.08
|
| Rate for Payer: Multiplan PHCS |
$1,462.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,706.60
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.59
|
|
|
DRAINAGE TEMATOMA/FLUID(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761P0014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$51.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$197.05
|
| Rate for Payer: Healthspan PPO |
$172.24
|
| Rate for Payer: Humana Medicaid |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.10
|
| Rate for Payer: Molina Healthcare Passport |
$51.08
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.59
|
|
|
DRAINAGE TEMATOMA/FLUID(T
|
Facility
|
IP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761T0014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$2,052.48 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.64
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: First Health Commercial |
$2,031.10
|
| Rate for Payer: Humana Commercial |
$1,817.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.78
|
| Rate for Payer: PHCS Commercial |
$2,052.48
|
| Rate for Payer: United Healthcare All Payer |
$1,881.44
|
|
|
DRAINAGE TEMATOMA/FLUID(T
|
Facility
|
OP
|
$2,138.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761T0014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$2,052.48 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Anthem Medicaid |
$735.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.64
|
| 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 |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: First Health Commercial |
$2,031.10
|
| Rate for Payer: Humana Commercial |
$1,817.30
|
| Rate for Payer: Humana KY Medicaid |
$735.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$742.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.78
|
| Rate for Payer: PHCS Commercial |
$2,052.48
|
| Rate for Payer: United Healthcare All Payer |
$1,881.44
|
|
|
DRAINAGE W CATHETER
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.68 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Anthem Medicaid |
$135.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,052.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$251.00
|
| Rate for Payer: Healthspan PPO |
$208.94
|
| Rate for Payer: Humana Medicaid |
$135.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.61
|
| Rate for Payer: Molina Healthcare Passport |
$135.89
|
| Rate for Payer: Multiplan PHCS |
$1,231.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,436.40
|
| Rate for Payer: UHCCP Medicaid |
$718.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.25
|
|
|
DRAINAGE W CATHETER
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna Commercial |
$1,580.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.56
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$1,703.16
|
| Rate for Payer: First Health Commercial |
$1,949.40
|
| Rate for Payer: Humana Commercial |
$1,744.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.12
|
| Rate for Payer: PHCS Commercial |
$1,969.92
|
| Rate for Payer: United Healthcare All Payer |
$1,805.76
|
|
|
DRAINAGE W CATHETER
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna Commercial |
$1,580.04
|
| Rate for Payer: Anthem Medicaid |
$705.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.56
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$1,703.16
|
| Rate for Payer: First Health Commercial |
$1,949.40
|
| Rate for Payer: Humana Commercial |
$1,744.20
|
| Rate for Payer: Humana KY Medicaid |
$705.68
|
| Rate for Payer: Kentucky WC Medicaid |
$712.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.12
|
| Rate for Payer: PHCS Commercial |
$1,969.92
|
| Rate for Payer: United Healthcare All Payer |
$1,805.76
|
|
|
DRAINAGE W CATHETER(P
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402P0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.68 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Anthem Medicaid |
$135.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$251.00
|
| Rate for Payer: Healthspan PPO |
$208.94
|
| Rate for Payer: Humana Medicaid |
$135.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.61
|
| Rate for Payer: Molina Healthcare Passport |
$135.89
|
| Rate for Payer: Multiplan PHCS |
$228.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$266.00
|
| Rate for Payer: UHCCP Medicaid |
$133.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.25
|
|
|
DRAINAGE W CATHETER(T
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402T0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,605.12 |
| Rate for Payer: Aetna Commercial |
$1,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,304.16
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cigna Commercial |
$1,387.76
|
| Rate for Payer: First Health Commercial |
$1,588.40
|
| Rate for Payer: Humana Commercial |
$1,421.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,371.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,233.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,471.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.32
|
| Rate for Payer: PHCS Commercial |
$1,605.12
|
| Rate for Payer: United Healthcare All Payer |
$1,471.36
|
|
|
DRAINAGE W CATHETER(T
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402T0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,605.12 |
| Rate for Payer: Aetna Commercial |
$1,287.44
|
| Rate for Payer: Anthem Medicaid |
$575.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,304.16
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cigna Commercial |
$1,387.76
|
| Rate for Payer: First Health Commercial |
$1,588.40
|
| Rate for Payer: Humana Commercial |
$1,421.20
|
| Rate for Payer: Humana KY Medicaid |
$575.00
|
| Rate for Payer: Kentucky WC Medicaid |
$580.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,371.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,233.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$586.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,471.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.32
|
| Rate for Payer: PHCS Commercial |
$1,605.12
|
| Rate for Payer: United Healthcare All Payer |
$1,471.36
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.82 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,087.40
|
| Rate for Payer: Anthem Medicaid |
$366.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.61
|
| Rate for Payer: Healthspan PPO |
$917.03
|
| Rate for Payer: Humana Medicaid |
$366.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$981.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.16
|
| Rate for Payer: Molina Healthcare Passport |
$366.82
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.49
|
|
