|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
45000133
|
|
Hospital Revenue Code
|
450
|
| 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
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
761T0651
|
|
Hospital Revenue Code
|
761
|
| 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
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
76100651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
DRAINAGE LYMPH NODE
|
Facility
|
IP
|
$5,827.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,748.10 |
| Max. Negotiated Rate |
$5,593.92 |
| Rate for Payer: Aetna Commercial |
$4,486.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,545.06
|
| Rate for Payer: Cash Price |
$2,913.50
|
| Rate for Payer: Cigna Commercial |
$4,836.41
|
| Rate for Payer: First Health Commercial |
$5,535.65
|
| Rate for Payer: Humana Commercial |
$4,952.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,778.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,300.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,748.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,370.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,069.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,020.63
|
| Rate for Payer: PHCS Commercial |
$5,593.92
|
| Rate for Payer: United Healthcare All Payer |
$5,127.76
|
|
|
DRAINAGE LYMPH NODE
|
Facility
|
OP
|
$5,827.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,003.91 |
| Max. Negotiated Rate |
$5,593.92 |
| Rate for Payer: Aetna Commercial |
$4,486.79
|
| Rate for Payer: Anthem Medicaid |
$2,003.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,545.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,913.50
|
| Rate for Payer: Cash Price |
$2,913.50
|
| Rate for Payer: Cigna Commercial |
$4,836.41
|
| Rate for Payer: First Health Commercial |
$5,535.65
|
| Rate for Payer: Humana Commercial |
$4,952.95
|
| Rate for Payer: Humana KY Medicaid |
$2,003.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,024.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,778.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,300.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,044.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,127.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,370.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,069.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,020.63
|
| Rate for Payer: PHCS Commercial |
$5,593.92
|
| Rate for Payer: United Healthcare All Payer |
$5,127.76
|
|
|
DRAINAGE LYMPH NODE
|
Professional
|
Both
|
$5,827.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
76101591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$3,496.20 |
| Rate for Payer: Aetna Commercial |
$259.67
|
| Rate for Payer: Ambetter Exchange |
$198.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.32
|
| Rate for Payer: Anthem Medicaid |
$61.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$238.01
|
| Rate for Payer: Cash Price |
$2,913.50
|
| Rate for Payer: Cash Price |
$2,913.50
|
| Rate for Payer: Cigna Commercial |
$243.83
|
| Rate for Payer: Healthspan PPO |
$301.35
|
| Rate for Payer: Humana Medicaid |
$61.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.65
|
| Rate for Payer: Molina Healthcare Passport |
$61.42
|
| Rate for Payer: Multiplan PHCS |
$3,496.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.84
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.34
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
IP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,221.30 |
| Max. Negotiated Rate |
$3,908.16 |
| Rate for Payer: Aetna Commercial |
$3,134.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,175.38
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$3,378.93
|
| Rate for Payer: First Health Commercial |
$3,867.45
|
| Rate for Payer: Humana Commercial |
$3,460.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,338.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,004.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,221.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,582.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,053.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,541.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.99
|
| Rate for Payer: PHCS Commercial |
$3,908.16
|
| Rate for Payer: United Healthcare All Payer |
$3,582.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Professional
|
Both
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.74 |
| Max. Negotiated Rate |
$2,442.60 |
| Rate for Payer: Aetna Commercial |
$669.83
|
| Rate for Payer: Ambetter Exchange |
$471.53
|
| Rate for Payer: Anthem Medicaid |
$185.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$471.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$471.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$565.84
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$628.12
|
| Rate for Payer: Healthspan PPO |
$535.59
|
| Rate for Payer: Humana Medicaid |
$185.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$471.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.45
|
| Rate for Payer: Molina Healthcare Passport |
$185.74
|
| Rate for Payer: Multiplan PHCS |
$2,442.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.99
|
| Rate for Payer: UHCCP Medicaid |
$1,424.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$471.53
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761T1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.30 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761P1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.74 |
| Max. Negotiated Rate |
$669.83 |
| Rate for Payer: Aetna Commercial |
$669.83
|
| Rate for Payer: Ambetter Exchange |
$471.53
|
| Rate for Payer: Anthem Medicaid |
$185.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$471.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$471.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$565.84
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$628.12
|
| Rate for Payer: Healthspan PPO |
$535.59
|
| Rate for Payer: Humana Medicaid |
$185.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$471.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.45
|
| Rate for Payer: Molina Healthcare Passport |
$185.74
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.99
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$471.53
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
OP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
76101592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,400.02 |
| Max. Negotiated Rate |
$3,908.16 |
| Rate for Payer: Aetna Commercial |
$3,134.67
|
| Rate for Payer: Anthem Medicaid |
$1,400.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,175.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cash Price |
$2,035.50
|
| Rate for Payer: Cigna Commercial |
$3,378.93
|
| Rate for Payer: First Health Commercial |
$3,867.45
|
| Rate for Payer: Humana Commercial |
$3,460.35
|
| Rate for Payer: Humana KY Medicaid |
$1,400.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,414.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,338.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,004.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,428.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,582.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,053.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,541.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.99
|
| Rate for Payer: PHCS Commercial |
$3,908.16
|
| Rate for Payer: United Healthcare All Payer |
$3,582.48
|
|
|
DRAINAGE LYMPH NODE; EXTENSIVE
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 38305
|
| Hospital Charge Code |
761T1592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAINAGE LYMPH NODE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761P1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$301.35 |
| Rate for Payer: Aetna Commercial |
$259.67
|
| Rate for Payer: Ambetter Exchange |
$198.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.32
|
| Rate for Payer: Anthem Medicaid |
$61.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$238.01
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$243.83
|
| Rate for Payer: Healthspan PPO |
$301.35
|
| Rate for Payer: Humana Medicaid |
$61.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.65
|
| Rate for Payer: Molina Healthcare Passport |
$61.42
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.84
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.34
|
|
|
DRAINAGE LYMPH NODE(T
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761T1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,866.35 |
| Max. Negotiated Rate |
$5,209.92 |
| Rate for Payer: Aetna Commercial |
$4,178.79
|
| Rate for Payer: Anthem Medicaid |
$1,866.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,713.50
|
| Rate for Payer: Cash Price |
$2,713.50
|
| Rate for Payer: Cigna Commercial |
$4,504.41
|
| Rate for Payer: First Health Commercial |
$5,155.65
|
| Rate for Payer: Humana Commercial |
$4,612.95
|
| Rate for Payer: Humana KY Medicaid |
$1,866.35
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,885.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,903.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.63
|
| Rate for Payer: PHCS Commercial |
$5,209.92
|
| Rate for Payer: United Healthcare All Payer |
$4,775.76
|
|
|
DRAINAGE LYMPH NODE(T
|
Facility
|
IP
|
$5,427.00
|
|
|
Service Code
|
HCPCS 38300
|
| Hospital Charge Code |
761T1591
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,628.10 |
| Max. Negotiated Rate |
$5,209.92 |
| Rate for Payer: Aetna Commercial |
$4,178.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.06
|
| Rate for Payer: Cash Price |
$2,713.50
|
| Rate for Payer: Cigna Commercial |
$4,504.41
|
| Rate for Payer: First Health Commercial |
$5,155.65
|
| Rate for Payer: Humana Commercial |
$4,612.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.63
|
| Rate for Payer: PHCS Commercial |
$5,209.92
|
| Rate for Payer: United Healthcare All Payer |
$4,775.76
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$910.14
|
|
|
Service Code
|
CPT 40800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Facility
|
OP
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.65 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem Medicaid |
$1,496.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Humana KY Medicaid |
$1,496.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,786.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.88
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Facility
|
IP
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,305.60 |
| Max. Negotiated Rate |
$4,177.92 |
| Rate for Payer: Aetna Commercial |
$3,351.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.56
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$3,612.16
|
| Rate for Payer: First Health Commercial |
$4,134.40
|
| Rate for Payer: Humana Commercial |
$3,699.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,786.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.88
|
| Rate for Payer: PHCS Commercial |
$4,177.92
|
| Rate for Payer: United Healthcare All Payer |
$3,829.76
|
|
|
DRAINAGE OF ABSCESS PAROTID
|
Professional
|
Both
|
$4,352.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
76101679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$2,611.20 |
| Rate for Payer: Aetna Commercial |
$626.66
|
| Rate for Payer: Ambetter Exchange |
$409.51
|
| Rate for Payer: Anthem Medicaid |
$229.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.41
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cash Price |
$2,176.00
|
| Rate for Payer: Cigna Commercial |
$621.82
|
| Rate for Payer: Healthspan PPO |
$528.47
|
| Rate for Payer: Humana Medicaid |
$229.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.64
|
| Rate for Payer: Molina Healthcare Passport |
$229.06
|
| Rate for Payer: Multiplan PHCS |
$2,611.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.36
|
| Rate for Payer: UHCCP Medicaid |
$1,523.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.51
|
|
|
DRAINAGE OF ABSCESS PAROTID(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761P1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$626.66 |
| Rate for Payer: Aetna Commercial |
$626.66
|
| Rate for Payer: Ambetter Exchange |
$409.51
|
| Rate for Payer: Anthem Medicaid |
$229.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.41
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$621.82
|
| Rate for Payer: Healthspan PPO |
$528.47
|
| Rate for Payer: Humana Medicaid |
$229.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$556.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.64
|
| Rate for Payer: Molina Healthcare Passport |
$229.06
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.36
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.51
|
|
|
DRAINAGE OF ABSCESS PAROTID(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761T1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
DRAINAGE OF ABSCESS PAROTID(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42305
|
| Hospital Charge Code |
761T1679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
DRAINAGE OF BONE LESION
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
DRAINAGE OF BONE LESION
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
