|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.99 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem Medicaid |
$270.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| 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 |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Humana KY Medicaid |
$270.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$1,558.80 |
| Rate for Payer: Aetna Commercial |
$313.33
|
| Rate for Payer: Ambetter Exchange |
$189.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.59
|
| Rate for Payer: Anthem Medicaid |
$122.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$226.82
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$397.32
|
| Rate for Payer: Healthspan PPO |
$355.86
|
| Rate for Payer: Humana Medicaid |
$122.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$280.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.71
|
| Rate for Payer: Molina Healthcare Passport |
$122.26
|
| Rate for Payer: Multiplan PHCS |
$1,558.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.73
|
| Rate for Payer: UHCCP Medicaid |
$164.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.02
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.40 |
| Max. Negotiated Rate |
$2,494.08 |
| Rate for Payer: Aetna Commercial |
$2,000.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,026.44
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$2,156.34
|
| Rate for Payer: First Health Commercial |
$2,468.10
|
| Rate for Payer: Humana Commercial |
$2,208.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,130.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,917.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$779.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,286.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,792.62
|
| Rate for Payer: PHCS Commercial |
$2,494.08
|
| Rate for Payer: United Healthcare All Payer |
$2,286.24
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 41007
|
| Hospital Charge Code |
76102913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.88 |
| Max. Negotiated Rate |
$482.51 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Ambetter Exchange |
$210.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.12
|
| Rate for Payer: Anthem Medicaid |
$169.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$210.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$252.89
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$482.51
|
| Rate for Payer: Healthspan PPO |
$416.11
|
| Rate for Payer: Humana Medicaid |
$169.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$210.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.28
|
| Rate for Payer: Molina Healthcare Passport |
$169.88
|
| Rate for Payer: Multiplan PHCS |
$472.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.96
|
| Rate for Payer: UHCCP Medicaid |
$178.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.74
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
76101630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$2,494.08 |
| Rate for Payer: Aetna Commercial |
$2,000.46
|
| Rate for Payer: Anthem Medicaid |
$893.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,026.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$2,156.34
|
| Rate for Payer: First Health Commercial |
$2,468.10
|
| Rate for Payer: Humana Commercial |
$2,208.30
|
| Rate for Payer: Humana KY Medicaid |
$893.45
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$902.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,130.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,917.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,286.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,260.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,792.62
|
| Rate for Payer: PHCS Commercial |
$2,494.08
|
| Rate for Payer: United Healthcare All Payer |
$2,286.24
|
|
|
DRAINAGE OF MOUTH LESION(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761P1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$313.33
|
| Rate for Payer: Ambetter Exchange |
$189.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.59
|
| Rate for Payer: Anthem Medicaid |
$122.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$226.82
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$397.32
|
| Rate for Payer: Healthspan PPO |
$355.86
|
| Rate for Payer: Humana Medicaid |
$122.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$280.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.71
|
| Rate for Payer: Molina Healthcare Passport |
$122.26
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.73
|
| Rate for Payer: UHCCP Medicaid |
$164.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.02
|
|
|
DRAINAGE OF MOUTH LESION(T
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761T1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$1,630.08 |
| Rate for Payer: Aetna Commercial |
$1,307.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,324.44
|
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cigna Commercial |
$1,409.34
|
| Rate for Payer: First Health Commercial |
$1,613.10
|
| Rate for Payer: Humana Commercial |
$1,443.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,392.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,494.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,273.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,171.62
|
| Rate for Payer: PHCS Commercial |
$1,630.08
|
| Rate for Payer: United Healthcare All Payer |
$1,494.24
|
|
|
DRAINAGE OF MOUTH LESION(T
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
761T1630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,630.08 |
| Rate for Payer: Aetna Commercial |
$1,307.46
|
| Rate for Payer: Anthem Medicaid |
$583.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,324.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cigna Commercial |
$1,409.34
|
| Rate for Payer: First Health Commercial |
$1,613.10
|
| Rate for Payer: Humana Commercial |
$1,443.30
|
| Rate for Payer: Humana KY Medicaid |
$583.94
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$589.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,392.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$595.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,494.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,273.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,171.62
|
| Rate for Payer: PHCS Commercial |
$1,630.08
|
| Rate for Payer: United Healthcare All Payer |
$1,494.24
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.83 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$607.80
|
| Rate for Payer: Ambetter Exchange |
$402.84
|
| Rate for Payer: Anthem Medicaid |
$363.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.41
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$582.32
|
| Rate for Payer: Healthspan PPO |
$588.50
|
| Rate for Payer: Humana Medicaid |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$371.08
|
| Rate for Payer: Molina Healthcare Passport |
$363.80
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.69
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.84
|
|
|
DRAINAGE OF OVARIAN CYST(S)
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
76102260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
DRAINAGE OF OVARIAN CYST(S)(P
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
761P2260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$607.80
|
| Rate for Payer: Ambetter Exchange |
$402.84
|
| Rate for Payer: Anthem Medicaid |
$363.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.41
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$582.32
|
| Rate for Payer: Healthspan PPO |
$588.50
|
| Rate for Payer: Humana Medicaid |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$522.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$371.08
|
| Rate for Payer: Molina Healthcare Passport |
$363.80
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.69
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.84
|
|
|
DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DRAINAGE OF PALM BURSA
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$657.54 |
| Rate for Payer: Aetna Commercial |
$592.11
|
| Rate for Payer: Ambetter Exchange |
$399.51
|
| Rate for Payer: Anthem Medicaid |
$266.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.41
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$657.54
|
| Rate for Payer: Healthspan PPO |
$536.33
|
| Rate for Payer: Humana Medicaid |
$266.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$399.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.52
|
| Rate for Payer: Molina Healthcare Passport |
$266.20
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$519.36
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.51
|
|
|
DRAINAGE OF PALM BURSA
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
76100654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
DRAINAGE OF PALM BURSA(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26025
|
| Hospital Charge Code |
761P0654
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$657.54 |
| Rate for Payer: Aetna Commercial |
$592.11
|
| Rate for Payer: Ambetter Exchange |
$399.51
|
| Rate for Payer: Anthem Medicaid |
$266.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.41
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$657.54
|
| Rate for Payer: Healthspan PPO |
$536.33
|
| Rate for Payer: Humana Medicaid |
$266.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$399.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.52
|
| Rate for Payer: Molina Healthcare Passport |
$266.20
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$519.36
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.51
|
|
|
DRAINAGE OF PALM BURSAS
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.78 |
| Max. Negotiated Rate |
$774.64 |
| Rate for Payer: Aetna Commercial |
$701.54
|
| Rate for Payer: Ambetter Exchange |
$470.56
|
| Rate for Payer: Anthem Medicaid |
$334.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$470.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$564.67
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Healthspan PPO |
$635.45
|
| Rate for Payer: Humana Medicaid |
$334.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$470.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.48
|
| Rate for Payer: Molina Healthcare Passport |
$334.78
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$611.73
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$470.56
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DRAINAGE OF PALM BURSAS
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
76100655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DRAINAGE OF PALM BURSAS(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 26030
|
| Hospital Charge Code |
761P0655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.78 |
| Max. Negotiated Rate |
$774.64 |
| Rate for Payer: Aetna Commercial |
$701.54
|
| Rate for Payer: Ambetter Exchange |
$470.56
|
| Rate for Payer: Anthem Medicaid |
$334.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$470.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$564.67
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Healthspan PPO |
$635.45
|
| Rate for Payer: Humana Medicaid |
$334.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$470.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.48
|
| Rate for Payer: Molina Healthcare Passport |
$334.78
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$611.73
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$470.56
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761T1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,346.25 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$3,455.38
|
| Rate for Payer: Anthem Medicaid |
$1,543.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.25
|
| Rate for Payer: Cash Price |
$2,243.75
|
| Rate for Payer: Cigna Commercial |
$3,724.62
|
| Rate for Payer: First Health Commercial |
$4,263.12
|
| Rate for Payer: Humana Commercial |
$3,814.38
|
| Rate for Payer: Humana KY Medicaid |
$1,543.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,558.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,679.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,574.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.38
|
| Rate for Payer: PHCS Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Payer |
$3,949.00
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761T1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,346.25 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$3,455.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.25
|
| Rate for Payer: Cash Price |
$2,243.75
|
| Rate for Payer: Cigna Commercial |
$3,724.62
|
| Rate for Payer: First Health Commercial |
$4,263.12
|
| Rate for Payer: Humana Commercial |
$3,814.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,679.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,365.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.38
|
| Rate for Payer: PHCS Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Payer |
$3,949.00
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
761P1977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.25 |
| Max. Negotiated Rate |
$2,281.70 |
| Rate for Payer: Aetna Commercial |
$2,281.70
|
| Rate for Payer: Ambetter Exchange |
$1,515.99
|
| Rate for Payer: Anthem Medicaid |
$417.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,515.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,515.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,819.19
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cash Price |
$1,069.00
|
| Rate for Payer: Cigna Commercial |
$2,123.60
|
| Rate for Payer: Healthspan PPO |
$1,924.20
|
| Rate for Payer: Humana Medicaid |
$417.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,029.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,515.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.60
|
| Rate for Payer: Molina Healthcare Passport |
$417.25
|
| Rate for Payer: Multiplan PHCS |
$1,282.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,970.79
|
| Rate for Payer: UHCCP Medicaid |
$748.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,515.99
|
|
