|
DRAIN/INJ JOINT/BURSA W/O U(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761P0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$60.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.63
|
| Rate for Payer: Anthem Medicaid |
$26.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$85.63
|
| Rate for Payer: Healthspan PPO |
$71.66
|
| Rate for Payer: Humana Medicaid |
$26.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.42
|
| Rate for Payer: Molina Healthcare Passport |
$26.88
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$26.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.15
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
45000089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$60.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.63
|
| Rate for Payer: Anthem Medicaid |
$26.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$591.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$85.63
|
| Rate for Payer: Healthspan PPO |
$71.66
|
| Rate for Payer: Humana Medicaid |
$26.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.42
|
| Rate for Payer: Molina Healthcare Passport |
$26.88
|
| Rate for Payer: Multiplan PHCS |
$354.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.70
|
| Rate for Payer: UHCCP Medicaid |
$26.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.15
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
45000089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem Medicaid |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Humana KY Medicaid |
$203.24
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$205.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
DRAIN/INJ JOINT/BURSA W/O U(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761T0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
DRAIN/INJ JOINT/BURSA W/O U(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761T0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
DRAIN OPEN LUNG LESION
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.01 |
| Max. Negotiated Rate |
$1,801.92 |
| Rate for Payer: Aetna Commercial |
$1,445.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,557.91
|
| Rate for Payer: First Health Commercial |
$1,783.15
|
| Rate for Payer: Humana Commercial |
$1,595.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.87
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
|
DRAIN OPEN LUNG LESION
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.80 |
| Max. Negotiated Rate |
$1,877.00 |
| Rate for Payer: Aetna Commercial |
$1,838.28
|
| Rate for Payer: Anthem Medicaid |
$591.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,877.00
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,716.85
|
| Rate for Payer: Healthspan PPO |
$1,435.28
|
| Rate for Payer: Humana Medicaid |
$591.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.64
|
| Rate for Payer: Molina Healthcare Passport |
$591.80
|
| Rate for Payer: Multiplan PHCS |
$1,126.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,313.90
|
| Rate for Payer: UHCCP Medicaid |
$656.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.72
|
|
|
DRAIN OPEN LUNG LESION
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.01 |
| Max. Negotiated Rate |
$1,801.92 |
| Rate for Payer: Aetna Commercial |
$1,445.29
|
| Rate for Payer: Anthem Medicaid |
$645.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,557.91
|
| Rate for Payer: First Health Commercial |
$1,783.15
|
| Rate for Payer: Humana Commercial |
$1,595.45
|
| Rate for Payer: Humana KY Medicaid |
$645.50
|
| Rate for Payer: Kentucky WC Medicaid |
$652.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.87
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
|
DRAIN OPEN LUNG LESION(P
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
761P1181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.80 |
| Max. Negotiated Rate |
$1,877.00 |
| Rate for Payer: Aetna Commercial |
$1,838.28
|
| Rate for Payer: Anthem Medicaid |
$591.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,877.00
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,716.85
|
| Rate for Payer: Healthspan PPO |
$1,435.28
|
| Rate for Payer: Humana Medicaid |
$591.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.64
|
| Rate for Payer: Molina Healthcare Passport |
$591.80
|
| Rate for Payer: Multiplan PHCS |
$1,126.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,313.90
|
| Rate for Payer: UHCCP Medicaid |
$656.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.72
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.42 |
| Max. Negotiated Rate |
$2,144.64 |
| Rate for Payer: Aetna Commercial |
$1,720.18
|
| Rate for Payer: Anthem Medicaid |
$768.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,742.52
|
| 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 |
$1,117.00
|
| Rate for Payer: Cash Price |
$1,117.00
|
| Rate for Payer: Cigna Commercial |
$1,854.22
|
| Rate for Payer: First Health Commercial |
$2,122.30
|
| Rate for Payer: Humana Commercial |
$1,898.90
|
| Rate for Payer: Humana KY Medicaid |
$768.27
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,831.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,648.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,965.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,675.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.54
|
| Rate for Payer: PHCS Commercial |
$2,144.64
|
| Rate for Payer: United Healthcare All Payer |
$1,965.92
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Professional
|
Both
|
$5,622.41
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$5,622.41 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.51
|
| Rate for Payer: Anthem Medicaid |
$174.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,622.41
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cigna Commercial |
$355.84
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$174.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.93
|
| Rate for Payer: Molina Healthcare Passport |
$174.44
|
| Rate for Payer: Multiplan PHCS |
$3,373.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,935.69
|
| Rate for Payer: UHCCP Medicaid |
$173.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.18
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Facility
|
OP
|
$5,622.41
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.91 |
| Max. Negotiated Rate |
$5,397.51 |
| Rate for Payer: Aetna Commercial |
$4,329.26
|
| Rate for Payer: Anthem Medicaid |
$1,933.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.48
|
| 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 |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cigna Commercial |
$4,666.60
|
| Rate for Payer: First Health Commercial |
$5,341.29
|
| Rate for Payer: Humana Commercial |
$4,779.05
|
| Rate for Payer: Humana KY Medicaid |
$1,933.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,953.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,972.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.95
|
| Rate for Payer: PHCS Commercial |
$5,397.51
|
| Rate for Payer: United Healthcare All Payer |
$4,947.72
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.42 |
| Max. Negotiated Rate |
$2,144.64 |
| Rate for Payer: Aetna Commercial |
$1,720.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,742.52
|
| Rate for Payer: Cash Price |
$1,117.00
|
| Rate for Payer: Cigna Commercial |
$1,854.22
|
| Rate for Payer: First Health Commercial |
$2,122.30
|
| Rate for Payer: Humana Commercial |
$1,898.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,831.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,648.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,965.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,675.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.54
|
| Rate for Payer: PHCS Commercial |
$2,144.64
|
| Rate for Payer: United Healthcare All Payer |
$1,965.92
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Facility
|
IP
|
$5,622.41
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$730.91 |
| Max. Negotiated Rate |
$5,397.51 |
| Rate for Payer: Aetna Commercial |
$4,329.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.48
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cigna Commercial |
$4,666.60
|
| Rate for Payer: First Health Commercial |
$5,341.29
|
| Rate for Payer: Humana Commercial |
$4,779.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.95
|
| Rate for Payer: PHCS Commercial |
$5,397.51
|
| Rate for Payer: United Healthcare All Payer |
$4,947.72
|
|
|
DRAIN PELVIC ABSCES BY CATH (P
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761P1997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.51
|
| Rate for Payer: Anthem Medicaid |
$174.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$905.00
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$355.84
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$174.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.93
|
| Rate for Payer: Molina Healthcare Passport |
$174.44
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$633.50
|
| Rate for Payer: UHCCP Medicaid |
$173.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.18
|
|
|
DRAIN PELVIC ABSCES BY CATH(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761P1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.51
|
| Rate for Payer: Anthem Medicaid |
$174.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$355.84
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$174.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.93
|
| Rate for Payer: Molina Healthcare Passport |
$174.44
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$173.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.18
|
|
|
DRAIN PELVIC ABSCES BY CATH (T
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.42 |
| Max. Negotiated Rate |
$2,144.64 |
| Rate for Payer: Aetna Commercial |
$1,720.18
|
| Rate for Payer: Anthem Medicaid |
$768.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,742.52
|
| 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 |
$1,117.00
|
| Rate for Payer: Cash Price |
$1,117.00
|
| Rate for Payer: Cigna Commercial |
$1,854.22
|
| Rate for Payer: First Health Commercial |
$2,122.30
|
| Rate for Payer: Humana Commercial |
$1,898.90
|
| Rate for Payer: Humana KY Medicaid |
$768.27
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,831.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,648.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,965.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,675.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.54
|
| Rate for Payer: PHCS Commercial |
$2,144.64
|
| Rate for Payer: United Healthcare All Payer |
$1,965.92
|
|
|
DRAIN PELVIC ABSCES BY CATH (T
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.42 |
| Max. Negotiated Rate |
$2,144.64 |
| Rate for Payer: Aetna Commercial |
$1,720.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,742.52
|
| Rate for Payer: Cash Price |
$1,117.00
|
| Rate for Payer: Cigna Commercial |
$1,854.22
|
| Rate for Payer: First Health Commercial |
$2,122.30
|
| Rate for Payer: Humana Commercial |
$1,898.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,831.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,648.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,965.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,675.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.54
|
| Rate for Payer: PHCS Commercial |
$2,144.64
|
| Rate for Payer: United Healthcare All Payer |
$1,965.92
|
|
|
DRAIN PELVIC ABSCES BY CATH(T
|
Facility
|
IP
|
$3,922.41
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.91 |
| Max. Negotiated Rate |
$3,765.51 |
| Rate for Payer: Aetna Commercial |
$3,020.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,059.48
|
| Rate for Payer: Cash Price |
$1,961.20
|
| Rate for Payer: Cigna Commercial |
$3,255.60
|
| Rate for Payer: First Health Commercial |
$3,726.29
|
| Rate for Payer: Humana Commercial |
$3,334.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,216.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,894.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,451.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,941.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.95
|
| Rate for Payer: PHCS Commercial |
$3,765.51
|
| Rate for Payer: United Healthcare All Payer |
$3,451.72
|
|
|
DRAIN PELVIC ABSCES BY CATH(T
|
Facility
|
OP
|
$3,922.41
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.91 |
| Max. Negotiated Rate |
$3,765.51 |
| Rate for Payer: Aetna Commercial |
$3,020.26
|
| Rate for Payer: Anthem Medicaid |
$1,348.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,059.48
|
| 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 |
$1,961.20
|
| Rate for Payer: Cash Price |
$1,961.20
|
| Rate for Payer: Cigna Commercial |
$3,255.60
|
| Rate for Payer: First Health Commercial |
$3,726.29
|
| Rate for Payer: Humana Commercial |
$3,334.05
|
| Rate for Payer: Humana KY Medicaid |
$1,348.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,216.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,894.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,451.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,941.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.95
|
| Rate for Payer: PHCS Commercial |
$3,765.51
|
| Rate for Payer: United Healthcare All Payer |
$3,451.72
|
|
|
DRAIN RETROPERITONEAL ABSCES(P
|
Professional
|
Both
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
761P1978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.71 |
| Max. Negotiated Rate |
$1,591.53 |
| Rate for Payer: Aetna Commercial |
$1,591.53
|
| Rate for Payer: Anthem Medicaid |
$482.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,491.00
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,483.31
|
| Rate for Payer: Healthspan PPO |
$1,342.17
|
| Rate for Payer: Humana Medicaid |
$482.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.36
|
| Rate for Payer: Molina Healthcare Passport |
$482.71
|
| Rate for Payer: Multiplan PHCS |
$894.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,043.70
|
| Rate for Payer: UHCCP Medicaid |
$521.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.54
|
|
|
DRAIN RETROPERITONEAL ABSCESS
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
76101978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$1,431.36 |
| Rate for Payer: Aetna Commercial |
$1,148.07
|
| Rate for Payer: Anthem Medicaid |
$512.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.98
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,237.53
|
| Rate for Payer: First Health Commercial |
$1,416.45
|
| Rate for Payer: Humana Commercial |
$1,267.35
|
| Rate for Payer: Humana KY Medicaid |
$512.75
|
| Rate for Payer: Kentucky WC Medicaid |
$517.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$523.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,312.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.21
|
| Rate for Payer: PHCS Commercial |
$1,431.36
|
| Rate for Payer: United Healthcare All Payer |
$1,312.08
|
|
