|
DRAINAGE OF BONE LESION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 27303
|
| Hospital Charge Code |
76102816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,024.23 |
| Rate for Payer: Aetna Commercial |
$935.63
|
| Rate for Payer: Ambetter Exchange |
$612.64
|
| Rate for Payer: Anthem Medicaid |
$406.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$735.17
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$1,024.23
|
| Rate for Payer: Healthspan PPO |
$847.48
|
| Rate for Payer: Humana Medicaid |
$406.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$790.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.28
|
| Rate for Payer: Molina Healthcare Passport |
$406.16
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$796.43
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.64
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$709.20 |
| Rate for Payer: Aetna Commercial |
$149.37
|
| Rate for Payer: Ambetter Exchange |
$107.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.92
|
| Rate for Payer: Anthem Medicaid |
$52.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.82
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$386.49
|
| Rate for Payer: Healthspan PPO |
$299.62
|
| Rate for Payer: Humana Medicaid |
$52.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.06
|
| Rate for Payer: Molina Healthcare Passport |
$52.02
|
| Rate for Payer: Multiplan PHCS |
$709.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.56
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.35
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.21 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem Medicaid |
$406.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$981.06
|
| Rate for Payer: First Health Commercial |
$1,122.90
|
| Rate for Payer: Humana Commercial |
$1,004.70
|
| Rate for Payer: Humana KY Medicaid |
$406.49
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$410.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$969.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$872.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,040.16
|
| Rate for Payer: Ohio Health Group HMO |
$886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.58
|
| Rate for Payer: PHCS Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare All Payer |
$1,040.16
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
45000302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
76102387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,134.72 |
| Rate for Payer: Aetna Commercial |
$910.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.96
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$981.06
|
| Rate for Payer: First Health Commercial |
$1,122.90
|
| Rate for Payer: Humana Commercial |
$1,004.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$969.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$872.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,040.16
|
| Rate for Payer: Ohio Health Group HMO |
$886.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.58
|
| Rate for Payer: PHCS Commercial |
$1,134.72
|
| Rate for Payer: United Healthcare All Payer |
$1,040.16
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
45000302
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.06 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem Medicaid |
$219.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Humana KY Medicaid |
$219.06
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF EYELID ABSCESS(P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761P2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$386.49 |
| Rate for Payer: Aetna Commercial |
$149.37
|
| Rate for Payer: Ambetter Exchange |
$107.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.92
|
| Rate for Payer: Anthem Medicaid |
$52.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.82
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$386.49
|
| Rate for Payer: Healthspan PPO |
$299.62
|
| Rate for Payer: Humana Medicaid |
$52.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.06
|
| Rate for Payer: Molina Healthcare Passport |
$52.02
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.56
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.35
|
|
|
DRAINAGE OF EYELID ABSCESS(T
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761T2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.06 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem Medicaid |
$219.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Humana KY Medicaid |
$219.06
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF EYELID ABSCESS(T
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
761T2387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.30 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
DRAINAGE OF FOREARM BURSA
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$1,710.60 |
| Rate for Payer: Aetna Commercial |
$536.10
|
| Rate for Payer: Ambetter Exchange |
$353.69
|
| Rate for Payer: Anthem Medicaid |
$134.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$353.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$353.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$424.43
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$746.97
|
| Rate for Payer: Healthspan PPO |
$485.59
|
| Rate for Payer: Humana Medicaid |
$134.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$353.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Passport |
$134.33
|
| Rate for Payer: Multiplan PHCS |
$1,710.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$459.80
|
| Rate for Payer: UHCCP Medicaid |
$997.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$353.69
|
|
|
DRAINAGE OF FOREARM BURSA
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
76100569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.46 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem Medicaid |
$980.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Humana KY Medicaid |
$980.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$990.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
DRAINAGE OF FOREARM BURSA(P
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761P0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$746.97 |
| Rate for Payer: Aetna Commercial |
$536.10
|
| Rate for Payer: Ambetter Exchange |
$353.69
|
| Rate for Payer: Anthem Medicaid |
$134.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$353.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$353.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$424.43
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$746.97
|
| Rate for Payer: Healthspan PPO |
$485.59
|
| Rate for Payer: Humana Medicaid |
$134.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$353.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.02
|
| Rate for Payer: Molina Healthcare Passport |
$134.33
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$459.80
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$353.69
|
|
|
DRAINAGE OF FOREARM BURSA(T
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761T0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.30 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DRAINAGE OF FOREARM BURSA(T
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
761T0569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.51 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DRAINAGE OF HIP JOINT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DRAINAGE OF HIP JOINT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
76100763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,536.18 |
| Rate for Payer: Aetna Commercial |
$1,408.85
|
| Rate for Payer: Ambetter Exchange |
$890.65
|
| Rate for Payer: Anthem Medicaid |
$706.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$890.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,068.78
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,536.18
|
| Rate for Payer: Healthspan PPO |
$1,276.12
|
| Rate for Payer: Humana Medicaid |
$706.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,169.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$890.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.40
|
| Rate for Payer: Molina Healthcare Passport |
$706.27
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,157.85
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$890.65
|
|
|
DRAINAGE OF HIP JOINT(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27030
|
| Hospital Charge Code |
761P0763
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,536.18 |
| Rate for Payer: Aetna Commercial |
$1,408.85
|
| Rate for Payer: Ambetter Exchange |
$890.65
|
| Rate for Payer: Anthem Medicaid |
$706.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$890.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,068.78
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,536.18
|
| Rate for Payer: Healthspan PPO |
$1,276.12
|
| Rate for Payer: Humana Medicaid |
$706.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,169.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$890.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.40
|
| Rate for Payer: Molina Healthcare Passport |
$706.27
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,157.85
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$890.65
|
|
|
DRAINAGE OF HYDROCELE
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Ambetter Exchange |
$79.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.12
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.57
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$193.24
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| Rate for Payer: Multiplan PHCS |
$982.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.53
|
| Rate for Payer: UHCCP Medicaid |
$55.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.64
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.31 |
| Max. Negotiated Rate |
$1,572.48 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem Medicaid |
$563.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Humana KY Medicaid |
$563.31
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$569.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$574.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.22
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
DRAINAGE OF HYDROCELE
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
76102142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$1,572.48 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.22
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
DRAINAGE OF HYDROCELE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761P2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$137.48
|
| Rate for Payer: Ambetter Exchange |
$79.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.12
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.57
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$193.24
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.53
|
| Rate for Payer: UHCCP Medicaid |
$55.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.64
|
|
|
DRAINAGE OF HYDROCELE(T
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761T2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$1,188.48 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Humana KY Medicaid |
$425.75
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$430.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.22
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
|
DRAINAGE OF HYDROCELE(T
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 55000
|
| Hospital Charge Code |
761T2142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.40 |
| Max. Negotiated Rate |
$1,188.48 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.22
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
