|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
IP
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,987.65 |
| Max. Negotiated Rate |
$6,360.48 |
| Rate for Payer: Aetna Commercial |
$5,101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.89
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cigna Commercial |
$5,499.16
|
| Rate for Payer: First Health Commercial |
$6,294.23
|
| Rate for Payer: Humana Commercial |
$5,631.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,969.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,764.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,571.60
|
| Rate for Payer: PHCS Commercial |
$6,360.48
|
| Rate for Payer: United Healthcare All Payer |
$5,830.44
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Facility
|
OP
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,987.65 |
| Max. Negotiated Rate |
$6,360.48 |
| Rate for Payer: Aetna Commercial |
$5,101.64
|
| Rate for Payer: Anthem Medicaid |
$2,278.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.89
|
| Rate for Payer: Cash Price |
$3,312.75
|
| Rate for Payer: Cigna Commercial |
$5,499.16
|
| Rate for Payer: First Health Commercial |
$6,294.23
|
| Rate for Payer: Humana Commercial |
$5,631.68
|
| Rate for Payer: Humana KY Medicaid |
$2,278.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,301.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,324.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,969.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,764.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,571.60
|
| Rate for Payer: PHCS Commercial |
$6,360.48
|
| Rate for Payer: United Healthcare All Payer |
$5,830.44
|
|
|
DRAINAGE OF PERITONEAL ABSCESS
|
Professional
|
Both
|
$6,625.50
|
|
|
Service Code
|
HCPCS 49020
|
| Hospital Charge Code |
76101977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.25 |
| Max. Negotiated Rate |
$3,975.30 |
| 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 |
$3,312.75
|
| Rate for Payer: Cash Price |
$3,312.75
|
| 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 |
$3,975.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,970.79
|
| Rate for Payer: UHCCP Medicaid |
$2,318.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,515.99
|
|
|
DRAINAGE OF PROSTATE ABSCESS
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 52700
|
| Hospital Charge Code |
76103028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.93 |
| Max. Negotiated Rate |
$702.20 |
| Rate for Payer: Aetna Commercial |
$702.20
|
| Rate for Payer: Ambetter Exchange |
$419.35
|
| Rate for Payer: Anthem Medicaid |
$281.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$419.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$419.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$503.22
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$621.09
|
| Rate for Payer: Healthspan PPO |
$561.47
|
| Rate for Payer: Humana Medicaid |
$281.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$594.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$419.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.57
|
| Rate for Payer: Molina Healthcare Passport |
$281.93
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$545.15
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$419.35
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$178.08
|
| Rate for Payer: Ambetter Exchange |
$126.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.85
|
| Rate for Payer: Anthem Medicaid |
$74.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$151.66
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Healthspan PPO |
$188.08
|
| Rate for Payer: Humana Medicaid |
$74.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.35
|
| Rate for Payer: Molina Healthcare Passport |
$74.85
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.29
|
| Rate for Payer: UHCCP Medicaid |
$111.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.38
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
76102666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
DRAINAGE OF SALIVARY GLAND (P
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761P2666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna Commercial |
$178.08
|
| Rate for Payer: Ambetter Exchange |
$126.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.85
|
| Rate for Payer: Anthem Medicaid |
$74.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$151.66
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Healthspan PPO |
$188.08
|
| Rate for Payer: Humana Medicaid |
$74.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.35
|
| Rate for Payer: Molina Healthcare Passport |
$74.85
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.29
|
| Rate for Payer: UHCCP Medicaid |
$111.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.38
|
|
|
DRAINAGE OF SALIVARY GLAND (T
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761T2666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
DRAINAGE OF SALIVARY GLAND (T
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 42310
|
| Hospital Charge Code |
761T2666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
OP
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,091.09 |
| Max. Negotiated Rate |
$3,045.80 |
| Rate for Payer: Aetna Commercial |
$2,442.99
|
| Rate for Payer: Anthem Medicaid |
$1,091.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,474.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$2,633.35
|
| Rate for Payer: First Health Commercial |
$3,014.07
|
| Rate for Payer: Humana Commercial |
$2,696.80
|
| Rate for Payer: Humana KY Medicaid |
$1,091.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,601.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,341.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,791.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,379.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,538.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,760.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.17
|
| Rate for Payer: PHCS Commercial |
$3,045.80
|
| Rate for Payer: United Healthcare All Payer |
$2,791.98
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
IP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
45000287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$707.31 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,051.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,626.82
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Professional
|
Both
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$1,903.63 |
| Rate for Payer: Aetna Commercial |
$257.17
|
| Rate for Payer: Ambetter Exchange |
$159.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.68
|
| Rate for Payer: Anthem Medicaid |
$78.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.86
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$230.90
|
| Rate for Payer: Healthspan PPO |
$329.33
|
| Rate for Payer: Humana Medicaid |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.73
|
| Rate for Payer: Molina Healthcare Passport |
$78.17
|
| Rate for Payer: Multiplan PHCS |
$1,903.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.76
|
| Rate for Payer: UHCCP Medicaid |
$106.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.05
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
OP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
45000287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$810.82 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem Medicaid |
$810.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Humana KY Medicaid |
$810.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$819.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$827.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,051.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,626.82
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF SCROTAL ABSCESS
|
Facility
|
IP
|
$3,172.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
76102145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$951.81 |
| Max. Negotiated Rate |
$3,045.80 |
| Rate for Payer: Aetna Commercial |
$2,442.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,474.71
|
| Rate for Payer: Cash Price |
$1,586.36
|
| Rate for Payer: Cigna Commercial |
$2,633.35
|
| Rate for Payer: First Health Commercial |
$3,014.07
|
| Rate for Payer: Humana Commercial |
$2,696.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,601.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,341.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,791.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,379.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,538.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,760.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,189.17
|
| Rate for Payer: PHCS Commercial |
$3,045.80
|
| Rate for Payer: United Healthcare All Payer |
$2,791.98
|
|
|
DRAINAGE OF SCROTAL ABSCESS(P
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761P2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna Commercial |
$257.17
|
| Rate for Payer: Ambetter Exchange |
$159.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.68
|
| Rate for Payer: Anthem Medicaid |
$78.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.86
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$230.90
|
| Rate for Payer: Healthspan PPO |
$329.33
|
| Rate for Payer: Humana Medicaid |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.73
|
| Rate for Payer: Molina Healthcare Passport |
$78.17
|
| Rate for Payer: Multiplan PHCS |
$489.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.76
|
| Rate for Payer: UHCCP Medicaid |
$106.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.05
|
|
|
DRAINAGE OF SCROTAL ABSCESS(T
|
Facility
|
IP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761T2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$707.31 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,051.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,626.82
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF SCROTAL ABSCESS(T
|
Facility
|
OP
|
$2,357.71
|
|
|
Service Code
|
HCPCS 55100
|
| Hospital Charge Code |
761T2145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.82 |
| Max. Negotiated Rate |
$2,263.40 |
| Rate for Payer: Aetna Commercial |
$1,815.44
|
| Rate for Payer: Anthem Medicaid |
$810.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cash Price |
$1,178.86
|
| Rate for Payer: Cigna Commercial |
$1,956.90
|
| Rate for Payer: First Health Commercial |
$2,239.82
|
| Rate for Payer: Humana Commercial |
$2,004.05
|
| Rate for Payer: Humana KY Medicaid |
$810.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$819.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,739.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$827.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,074.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,051.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,626.82
|
| Rate for Payer: PHCS Commercial |
$2,263.40
|
| Rate for Payer: United Healthcare All Payer |
$2,074.78
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
DRAINAGE OF THROAT ABSCESS
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
76101698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,184.24 |
| Rate for Payer: Aetna Commercial |
$1,184.24
|
| Rate for Payer: Ambetter Exchange |
$756.38
|
| Rate for Payer: Anthem Medicaid |
$355.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$756.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$756.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.66
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,165.31
|
| Rate for Payer: Healthspan PPO |
$998.69
|
| Rate for Payer: Humana Medicaid |
$355.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$756.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.36
|
| Rate for Payer: Molina Healthcare Passport |
$355.25
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$983.29
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$756.38
|
|
|
DRAINAGE OF THROAT ABSCESS(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 42725
|
| Hospital Charge Code |
761P1698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,184.24 |
| Rate for Payer: Aetna Commercial |
$1,184.24
|
| Rate for Payer: Ambetter Exchange |
$756.38
|
| Rate for Payer: Anthem Medicaid |
$355.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$756.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$756.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.66
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,165.31
|
| Rate for Payer: Healthspan PPO |
$998.69
|
| Rate for Payer: Humana Medicaid |
$355.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$756.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.36
|
| Rate for Payer: Molina Healthcare Passport |
$355.25
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$983.29
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$756.38
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$683.10 |
| Max. Negotiated Rate |
$2,185.92 |
| Rate for Payer: Aetna Commercial |
$1,753.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,776.06
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$1,889.91
|
| Rate for Payer: First Health Commercial |
$2,163.15
|
| Rate for Payer: Humana Commercial |
$1,935.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,867.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,680.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$683.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,003.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,707.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,980.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,571.13
|
| Rate for Payer: PHCS Commercial |
$2,185.92
|
| Rate for Payer: United Healthcare All Payer |
$2,003.76
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
OP
|
$2,577.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.23 |
| Max. Negotiated Rate |
$2,473.92 |
| Rate for Payer: Aetna Commercial |
$1,984.29
|
| Rate for Payer: Anthem Medicaid |
$886.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,010.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,288.50
|
| Rate for Payer: Cash Price |
$1,288.50
|
| Rate for Payer: Cigna Commercial |
$2,138.91
|
| Rate for Payer: First Health Commercial |
$2,448.15
|
| Rate for Payer: Humana Commercial |
$2,190.45
|
| Rate for Payer: Humana KY Medicaid |
$886.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$895.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,113.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,901.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$904.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,267.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,932.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,061.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,241.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,778.13
|
| Rate for Payer: PHCS Commercial |
$2,473.92
|
| Rate for Payer: United Healthcare All Payer |
$2,267.76
|
|
|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.10 |
| Max. Negotiated Rate |
$2,473.92 |
| Rate for Payer: Aetna Commercial |
$1,984.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,010.06
|
| Rate for Payer: Cash Price |
$1,288.50
|
| Rate for Payer: Cigna Commercial |
$2,138.91
|
| Rate for Payer: First Health Commercial |
$2,448.15
|
| Rate for Payer: Humana Commercial |
$2,190.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,113.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,901.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$773.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,267.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,932.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,061.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,241.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,778.13
|
| Rate for Payer: PHCS Commercial |
$2,473.92
|
| Rate for Payer: United Healthcare All Payer |
$2,267.76
|
|
