|
DRAINAGE TEMATOMA/FLUID
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$783.06 |
| Max. Negotiated Rate |
$2,185.92 |
| Rate for Payer: Aetna Commercial |
$1,753.29
|
| Rate for Payer: Anthem Medicaid |
$783.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,776.06
|
| 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 |
$1,138.50
|
| 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: Humana KY Medicaid |
$783.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$791.03
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$798.77
|
| 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
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
76100014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.52 |
| Max. Negotiated Rate |
$1,546.20 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Ambetter Exchange |
$111.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$57.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.75
|
| Rate for Payer: Cash Price |
$1,288.50
|
| Rate for Payer: Cash Price |
$1,288.50
|
| Rate for Payer: Cigna Commercial |
$197.05
|
| Rate for Payer: Healthspan PPO |
$172.24
|
| Rate for Payer: Humana Medicaid |
$57.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.67
|
| Rate for Payer: Molina Healthcare Passport |
$57.52
|
| Rate for Payer: Multiplan PHCS |
$1,546.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.90
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.46
|
|
|
DRAINAGE TEMATOMA/FLUID(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761P0014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.52 |
| Max. Negotiated Rate |
$197.05 |
| Rate for Payer: Aetna Commercial |
$171.51
|
| Rate for Payer: Ambetter Exchange |
$111.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$57.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.75
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$197.05
|
| Rate for Payer: Healthspan PPO |
$172.24
|
| Rate for Payer: Humana Medicaid |
$57.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.67
|
| Rate for Payer: Molina Healthcare Passport |
$57.52
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.90
|
| Rate for Payer: UHCCP Medicaid |
$63.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.46
|
|
|
DRAINAGE TEMATOMA/FLUID(T
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761T0014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.06 |
| Max. Negotiated Rate |
$2,185.92 |
| Rate for Payer: Aetna Commercial |
$1,753.29
|
| Rate for Payer: Anthem Medicaid |
$783.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,776.06
|
| 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 |
$1,138.50
|
| 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: Humana KY Medicaid |
$783.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$791.03
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$798.77
|
| 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(T
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
761T0014
|
|
Hospital Revenue Code
|
761
|
| 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 W CATHETER
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna Commercial |
$1,580.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.56
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$1,703.16
|
| Rate for Payer: First Health Commercial |
$1,949.40
|
| Rate for Payer: Humana Commercial |
$1,744.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,785.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.88
|
| Rate for Payer: PHCS Commercial |
$1,969.92
|
| Rate for Payer: United Healthcare All Payer |
$1,805.76
|
|
|
DRAINAGE W CATHETER
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.68 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Ambetter Exchange |
$101.57
|
| Rate for Payer: Anthem Medicaid |
$135.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.88
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$251.00
|
| Rate for Payer: Healthspan PPO |
$208.94
|
| Rate for Payer: Humana Medicaid |
$135.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.61
|
| Rate for Payer: Molina Healthcare Passport |
$135.89
|
| Rate for Payer: Multiplan PHCS |
$1,231.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.04
|
| Rate for Payer: UHCCP Medicaid |
$718.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.57
|
|
|
DRAINAGE W CATHETER
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna Commercial |
$1,580.04
|
| Rate for Payer: Anthem Medicaid |
$705.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.56
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$1,703.16
|
| Rate for Payer: First Health Commercial |
$1,949.40
|
| Rate for Payer: Humana Commercial |
$1,744.20
|
| Rate for Payer: Humana KY Medicaid |
$705.68
|
| Rate for Payer: Kentucky WC Medicaid |
$712.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,785.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.88
|
| Rate for Payer: PHCS Commercial |
$1,969.92
|
| Rate for Payer: United Healthcare All Payer |
$1,805.76
|
|
|
DRAINAGE W CATHETER(P
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402P0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.68 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna Commercial |
$222.98
|
| Rate for Payer: Ambetter Exchange |
$101.57
|
| Rate for Payer: Anthem Medicaid |
$135.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.88
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$251.00
|
| Rate for Payer: Healthspan PPO |
$208.94
|
| Rate for Payer: Humana Medicaid |
$135.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.61
|
| Rate for Payer: Molina Healthcare Passport |
$135.89
|
| Rate for Payer: Multiplan PHCS |
$228.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.04
|
| Rate for Payer: UHCCP Medicaid |
$133.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.57
|
|
|
DRAINAGE W CATHETER(T
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402T0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$1,605.12 |
| Rate for Payer: Aetna Commercial |
$1,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,304.16
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cigna Commercial |
$1,387.76
|
| Rate for Payer: First Health Commercial |
$1,588.40
|
| Rate for Payer: Humana Commercial |
$1,421.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,371.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,233.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,471.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,454.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.68
|
| Rate for Payer: PHCS Commercial |
$1,605.12
|
| Rate for Payer: United Healthcare All Payer |
$1,471.36
|
|
|
DRAINAGE W CATHETER(T
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
402T0003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$1,605.12 |
| Rate for Payer: Aetna Commercial |
$1,287.44
|
| Rate for Payer: Anthem Medicaid |
$575.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,304.16
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cigna Commercial |
$1,387.76
|
| Rate for Payer: First Health Commercial |
$1,588.40
|
| Rate for Payer: Humana Commercial |
$1,421.20
|
| Rate for Payer: Humana KY Medicaid |
$575.00
|
| Rate for Payer: Kentucky WC Medicaid |
$580.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,371.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,233.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$586.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,471.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,454.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.68
|
| Rate for Payer: PHCS Commercial |
$1,605.12
|
| Rate for Payer: United Healthcare All Payer |
$1,471.36
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.82 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$1,087.40
|
| Rate for Payer: Ambetter Exchange |
$748.38
|
| Rate for Payer: Anthem Medicaid |
$366.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$748.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$898.06
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.61
|
| Rate for Payer: Healthspan PPO |
$917.03
|
| Rate for Payer: Humana Medicaid |
$366.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$981.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$748.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.16
|
| Rate for Payer: Molina Healthcare Passport |
$366.82
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$972.89
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$748.38
|
|
|
DRAIN APPENDIX ABSCESS OPEN
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
76101868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
DRAIN APPENDIX ABSCESS OPEN(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 44900
|
| Hospital Charge Code |
761P1868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.82 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$1,087.40
|
| Rate for Payer: Ambetter Exchange |
$748.38
|
| Rate for Payer: Anthem Medicaid |
$366.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$748.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$898.06
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.61
|
| Rate for Payer: Healthspan PPO |
$917.03
|
| Rate for Payer: Humana Medicaid |
$366.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$981.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$748.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.16
|
| Rate for Payer: Molina Healthcare Passport |
$366.82
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$972.89
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$748.38
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761P2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$289.71 |
| Rate for Payer: Aetna Commercial |
$226.05
|
| Rate for Payer: Ambetter Exchange |
$151.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$94.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.29
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$289.71
|
| Rate for Payer: Healthspan PPO |
$261.76
|
| Rate for Payer: Humana Medicaid |
$94.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.61
|
| Rate for Payer: Molina Healthcare Passport |
$94.72
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.48
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.91
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(T
|
Facility
|
IP
|
$3,391.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761T2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,017.45 |
| Max. Negotiated Rate |
$3,255.84 |
| Rate for Payer: Aetna Commercial |
$2,611.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.37
|
| Rate for Payer: Cash Price |
$1,695.75
|
| Rate for Payer: Cigna Commercial |
$2,814.95
|
| Rate for Payer: First Health Commercial |
$3,221.93
|
| Rate for Payer: Humana Commercial |
$2,882.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,781.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.14
|
| Rate for Payer: PHCS Commercial |
$3,255.84
|
| Rate for Payer: United Healthcare All Payer |
$2,984.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMA(T
|
Facility
|
OP
|
$3,391.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
761T2402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,166.34 |
| Max. Negotiated Rate |
$3,255.84 |
| Rate for Payer: Aetna Commercial |
$2,611.45
|
| Rate for Payer: Anthem Medicaid |
$1,166.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.37
|
| 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 |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,695.75
|
| Rate for Payer: Cigna Commercial |
$2,814.95
|
| Rate for Payer: First Health Commercial |
$3,221.93
|
| Rate for Payer: Humana Commercial |
$2,882.78
|
| Rate for Payer: Humana KY Medicaid |
$1,166.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,178.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,781.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,340.14
|
| Rate for Payer: PHCS Commercial |
$3,255.84
|
| Rate for Payer: United Healthcare All Payer |
$2,984.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Facility
|
IP
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,152.45 |
| Max. Negotiated Rate |
$3,687.84 |
| Rate for Payer: Aetna Commercial |
$2,957.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,996.37
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$3,188.45
|
| Rate for Payer: First Health Commercial |
$3,649.43
|
| Rate for Payer: Humana Commercial |
$3,265.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,150.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,835.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,152.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,881.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,342.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.64
|
| Rate for Payer: PHCS Commercial |
$3,687.84
|
| Rate for Payer: United Healthcare All Payer |
$3,380.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Facility
|
OP
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,321.09 |
| Max. Negotiated Rate |
$3,687.84 |
| Rate for Payer: Aetna Commercial |
$2,957.95
|
| Rate for Payer: Anthem Medicaid |
$1,321.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,996.37
|
| 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 |
$1,920.75
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$3,188.45
|
| Rate for Payer: First Health Commercial |
$3,649.43
|
| Rate for Payer: Humana Commercial |
$3,265.28
|
| Rate for Payer: Humana KY Medicaid |
$1,321.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,334.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,150.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,835.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,347.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,881.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,342.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.64
|
| Rate for Payer: PHCS Commercial |
$3,687.84
|
| Rate for Payer: United Healthcare All Payer |
$3,380.52
|
|
|
DRAIN EXT EAR - ABSCESS HEMAT
|
Professional
|
Both
|
$3,841.50
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
76102402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$2,304.90 |
| Rate for Payer: Aetna Commercial |
$226.05
|
| Rate for Payer: Ambetter Exchange |
$151.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.02
|
| Rate for Payer: Anthem Medicaid |
$94.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.29
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cash Price |
$1,920.75
|
| Rate for Payer: Cigna Commercial |
$289.71
|
| Rate for Payer: Healthspan PPO |
$261.76
|
| Rate for Payer: Humana Medicaid |
$94.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.61
|
| Rate for Payer: Molina Healthcare Passport |
$94.72
|
| Rate for Payer: Multiplan PHCS |
$2,304.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.48
|
| Rate for Payer: UHCCP Medicaid |
$86.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.91
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.93 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem Medicaid |
$420.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Humana KY Medicaid |
$420.93
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$425.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$844.56
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
45000306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.06
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$844.56
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
76102403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$200.04
|
| Rate for Payer: Ambetter Exchange |
$133.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.89
|
| Rate for Payer: Anthem Medicaid |
$55.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.10
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$312.82
|
| Rate for Payer: Healthspan PPO |
$277.14
|
| Rate for Payer: Humana Medicaid |
$55.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.10
|
| Rate for Payer: Molina Healthcare Passport |
$55.00
|
| Rate for Payer: Multiplan PHCS |
$734.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.45
|
| Rate for Payer: UHCCP Medicaid |
$77.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.42
|
|
