|
DRAIN APPENDIX ABSCESS OPEN(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
761P1868
|
|
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
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761P2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$226.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$79.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$289.71
|
| Rate for Payer: Healthspan PPO |
$261.76
|
| Rate for Payer: Humana Medicaid |
$79.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.74
|
| Rate for Payer: Molina Healthcare Passport |
$79.16
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.95
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(T
|
Facility
|
OP
|
$3,391.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761T2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.90 |
| Max. Negotiated Rate |
$3,255.84 |
| Rate for Payer: Aetna Commercial |
$2,611.46
|
| Rate for Payer: Anthem Medicaid |
$1,166.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.37
|
| 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 |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,695.75
|
| Rate for Payer: Cigna Commercial |
$2,814.94
|
| Rate for Payer: First Health Commercial |
$3,221.92
|
| Rate for Payer: Humana Commercial |
$2,882.78
|
| Rate for Payer: Humana KY Medicaid |
$1,166.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,178.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,781.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,051.36
|
| Rate for Payer: PHCS Commercial |
$3,255.84
|
| Rate for Payer: United Healthcare All Payer |
$2,984.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(T
|
Facility
|
IP
|
$3,391.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761T2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.90 |
| Max. Negotiated Rate |
$3,255.84 |
| Rate for Payer: Aetna Commercial |
$2,611.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.37
|
| Rate for Payer: Cash Price |
$1,695.75
|
| Rate for Payer: Cigna Commercial |
$2,814.94
|
| Rate for Payer: First Health Commercial |
$3,221.92
|
| Rate for Payer: Humana Commercial |
$2,882.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,781.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,051.36
|
| Rate for Payer: PHCS Commercial |
$3,255.84
|
| Rate for Payer: United Healthcare All Payer |
$2,984.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Facility
|
IP
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$3,687.84 |
| Rate for Payer: Aetna Commercial |
$2,957.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,996.37
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$3,188.44
|
| Rate for Payer: First Health Commercial |
$3,649.42
|
| Rate for Payer: Humana Commercial |
$3,265.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,150.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,835.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,152.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,881.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$768.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.86
|
| Rate for Payer: PHCS Commercial |
$3,687.84
|
| Rate for Payer: United Healthcare All Payer |
$3,380.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Facility
|
OP
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$3,687.84 |
| Rate for Payer: Aetna Commercial |
$2,957.96
|
| Rate for Payer: Anthem Medicaid |
$1,321.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,996.37
|
| 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 |
$1,920.75
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$3,188.44
|
| Rate for Payer: First Health Commercial |
$3,649.42
|
| Rate for Payer: Humana Commercial |
$3,265.28
|
| Rate for Payer: Humana KY Medicaid |
$1,321.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,334.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,150.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,835.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,347.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,881.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$768.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.86
|
| Rate for Payer: PHCS Commercial |
$3,687.84
|
| Rate for Payer: United Healthcare All Payer |
$3,380.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Professional
|
Both
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$3,841.50 |
| Rate for Payer: Aetna Commercial |
$226.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$79.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,841.50
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$289.71
|
| Rate for Payer: Healthspan PPO |
$261.76
|
| Rate for Payer: Humana Medicaid |
$79.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.74
|
| Rate for Payer: Molina Healthcare Passport |
$79.16
|
| Rate for Payer: Multiplan PHCS |
$2,304.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,689.05
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.95
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761T2403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
45000306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.44
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761T2403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
45000306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$200.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.89
|
| Rate for Payer: Anthem Medicaid |
$48.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,224.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$312.82
|
| Rate for Payer: Healthspan PPO |
$277.14
|
| Rate for Payer: Humana Medicaid |
$48.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.95
|
| Rate for Payer: Molina Healthcare Passport |
$48.97
|
| Rate for Payer: Multiplan PHCS |
$734.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.80
|
| Rate for Payer: UHCCP Medicaid |
$77.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.46
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761P2403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$200.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.89
|
| Rate for Payer: Anthem Medicaid |
$48.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$312.82
|
| Rate for Payer: Healthspan PPO |
$277.14
|
| Rate for Payer: Humana Medicaid |
$48.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.95
|
| Rate for Payer: Molina Healthcare Passport |
$48.97
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$77.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.46
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem Medicaid |
$420.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Humana KY Medicaid |
$420.93
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$425.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.44
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.34 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$262.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.34
|
| Rate for Payer: Anthem Medicaid |
$109.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$469.86
|
| Rate for Payer: Healthspan PPO |
$468.92
|
| Rate for Payer: Humana Medicaid |
$109.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.13
|
| Rate for Payer: Molina Healthcare Passport |
$109.93
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.03
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
45000134
|
|
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
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| 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 |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
45000134
|
|
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
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
DRAIN FNGR ABSCESS CMPLXFELO(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
761P0652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.34 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$262.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.34
|
| Rate for Payer: Anthem Medicaid |
$109.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$469.86
|
| Rate for Payer: Healthspan PPO |
$468.92
|
| Rate for Payer: Humana Medicaid |
$109.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.13
|
| Rate for Payer: Molina Healthcare Passport |
$109.93
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.03
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem Medicaid |
$323.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| 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 |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Humana KY Medicaid |
$323.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$326.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$329.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.40
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DRAIN HAND TENDON SHEATH
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$603.80
|
| Rate for Payer: Anthem Medicaid |
$232.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$940.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$669.87
|
| Rate for Payer: Healthspan PPO |
$546.91
|
| Rate for Payer: Humana Medicaid |
$232.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.40
|
| Rate for Payer: Molina Healthcare Passport |
$232.75
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.08
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.40
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DRAIN HAND TENDON SHEATH(P
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
761P0653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$603.80
|
| Rate for Payer: Anthem Medicaid |
$232.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$940.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$669.87
|
| Rate for Payer: Healthspan PPO |
$546.91
|
| Rate for Payer: Humana Medicaid |
$232.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.40
|
| Rate for Payer: Molina Healthcare Passport |
$232.75
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.08
|
|
