|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
IP
|
$3,596.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
76101678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,078.80 |
| Max. Negotiated Rate |
$3,452.16 |
| Rate for Payer: Aetna Commercial |
$2,768.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,804.88
|
| Rate for Payer: Cash Price |
$1,798.00
|
| Rate for Payer: Cigna Commercial |
$2,984.68
|
| Rate for Payer: First Health Commercial |
$3,416.20
|
| Rate for Payer: Humana Commercial |
$3,056.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,948.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,653.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,164.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,697.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,876.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,128.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.24
|
| Rate for Payer: PHCS Commercial |
$3,452.16
|
| Rate for Payer: United Healthcare All Payer |
$3,164.48
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
45000260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$3,116.16 |
| Rate for Payer: Aetna Commercial |
$2,499.42
|
| Rate for Payer: Anthem Medicaid |
$1,116.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$2,694.18
|
| Rate for Payer: First Health Commercial |
$3,083.70
|
| Rate for Payer: Humana Commercial |
$2,759.10
|
| Rate for Payer: Humana KY Medicaid |
$1,116.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,824.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.74
|
| Rate for Payer: PHCS Commercial |
$3,116.16
|
| Rate for Payer: United Healthcare All Payer |
$2,856.48
|
|
|
DRAIN ABSCES PAROTID SIMPLE
|
Professional
|
Both
|
$3,596.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
76101678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$2,157.60 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Ambetter Exchange |
$146.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.65
|
| Rate for Payer: Anthem Medicaid |
$83.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.14
|
| Rate for Payer: Cash Price |
$1,798.00
|
| Rate for Payer: Cash Price |
$1,798.00
|
| Rate for Payer: Cigna Commercial |
$276.56
|
| Rate for Payer: Healthspan PPO |
$241.30
|
| Rate for Payer: Humana Medicaid |
$83.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.51
|
| Rate for Payer: Molina Healthcare Passport |
$83.83
|
| Rate for Payer: Multiplan PHCS |
$2,157.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.81
|
| Rate for Payer: UHCCP Medicaid |
$128.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.78
|
|
|
DRAIN ABSCES PAROTID SIMPLE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761P1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$276.56 |
| Rate for Payer: Aetna Commercial |
$218.16
|
| Rate for Payer: Ambetter Exchange |
$146.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.65
|
| Rate for Payer: Anthem Medicaid |
$83.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.14
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$276.56
|
| Rate for Payer: Healthspan PPO |
$241.30
|
| Rate for Payer: Humana Medicaid |
$83.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.51
|
| Rate for Payer: Molina Healthcare Passport |
$83.83
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.81
|
| Rate for Payer: UHCCP Medicaid |
$128.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.78
|
|
|
DRAIN ABSCES PAROTID SIMPLE(T
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761T1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$973.80 |
| Max. Negotiated Rate |
$3,116.16 |
| Rate for Payer: Aetna Commercial |
$2,499.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.88
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$2,694.18
|
| Rate for Payer: First Health Commercial |
$3,083.70
|
| Rate for Payer: Humana Commercial |
$2,759.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,824.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.74
|
| Rate for Payer: PHCS Commercial |
$3,116.16
|
| Rate for Payer: United Healthcare All Payer |
$2,856.48
|
|
|
DRAIN ABSCES PAROTID SIMPLE(T
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
HCPCS 42300
|
| Hospital Charge Code |
761T1678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$3,116.16 |
| Rate for Payer: Aetna Commercial |
$2,499.42
|
| Rate for Payer: Anthem Medicaid |
$1,116.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$2,694.18
|
| Rate for Payer: First Health Commercial |
$3,083.70
|
| Rate for Payer: Humana Commercial |
$2,759.10
|
| Rate for Payer: Humana KY Medicaid |
$1,116.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,824.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.74
|
| Rate for Payer: PHCS Commercial |
$3,116.16
|
| Rate for Payer: United Healthcare All Payer |
$2,856.48
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
45000261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.97 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
45000261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76101680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
DRAIN ABSCESSUBMAXILSUBLINGULO
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76101680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
45000256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
45000256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
76101667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
DRAIN ABSECS PALATE UVULA
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
76101667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
45000205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem Medicaid |
$107.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Humana KY Medicaid |
$107.64
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DRAINAGE ABSCESS NASAL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$310.93 |
| Rate for Payer: Aetna Commercial |
$166.12
|
| Rate for Payer: Ambetter Exchange |
$114.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.89
|
| Rate for Payer: Anthem Medicaid |
$57.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.34
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$310.93
|
| Rate for Payer: Healthspan PPO |
$260.14
|
| Rate for Payer: Humana Medicaid |
$57.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.42
|
| Rate for Payer: Molina Healthcare Passport |
$57.27
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.78
|
| Rate for Payer: UHCCP Medicaid |
$67.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.45
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
76101117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DRAINAGE ABSCESS NASAL
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
45000205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DRAINAGE ABSCESS NASAL(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
761P1117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$310.93 |
| Rate for Payer: Aetna Commercial |
$166.12
|
| Rate for Payer: Ambetter Exchange |
$114.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.89
|
| Rate for Payer: Anthem Medicaid |
$57.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.34
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$310.93
|
| Rate for Payer: Healthspan PPO |
$260.14
|
| Rate for Payer: Humana Medicaid |
$57.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.42
|
| Rate for Payer: Molina Healthcare Passport |
$57.27
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.78
|
| Rate for Payer: UHCCP Medicaid |
$67.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.45
|
|
|
DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
|
Facility
|
OP
|
$658.76
|
|
|
Service Code
|
CPT 30020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
45000133
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Ambetter Exchange |
$132.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.33
|
| Rate for Payer: Anthem Medicaid |
$57.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.23
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$427.24
|
| Rate for Payer: Healthspan PPO |
$306.49
|
| Rate for Payer: Humana Medicaid |
$57.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.97
|
| Rate for Payer: Molina Healthcare Passport |
$57.81
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.50
|
| Rate for Payer: UHCCP Medicaid |
$75.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.69
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
761T0651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
761P0651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Ambetter Exchange |
$132.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.33
|
| Rate for Payer: Anthem Medicaid |
$57.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.23
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$427.24
|
| Rate for Payer: Healthspan PPO |
$306.49
|
| Rate for Payer: Humana Medicaid |
$57.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.97
|
| Rate for Payer: Molina Healthcare Passport |
$57.81
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.50
|
| Rate for Payer: UHCCP Medicaid |
$75.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.69
|
|
