|
DRAIN EXTERN AUDITORYCANALABSC
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761P2403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$312.82 |
| 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 |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| 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 |
$210.00
|
| 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
|
|
|
DRAIN EXTERN AUDITORYCANALABSC
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761T2403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$437.00
|
| 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: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| 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 |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| 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
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
45000306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$437.00
|
| 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: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| 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 |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| 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
|
$874.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
761T2403
|
|
Hospital Revenue Code
|
761
|
| 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 FNGR ABSCESS CMPLXFELON
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| 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 |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
45000134
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
45000134
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
DRAIN FNGR ABSCESS CMPLXFELON
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
76100652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.34 |
| Max. Negotiated Rate |
$469.86 |
| Rate for Payer: Aetna Commercial |
$262.39
|
| Rate for Payer: Ambetter Exchange |
$175.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.34
|
| Rate for Payer: Anthem Medicaid |
$109.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.58
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$469.86
|
| Rate for Payer: Healthspan PPO |
$468.92
|
| Rate for Payer: Humana Medicaid |
$109.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.13
|
| Rate for Payer: Molina Healthcare Passport |
$109.93
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.12
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.48
|
|
|
DRAIN FNGR ABSCESS CMPLXFELO(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
761P0652
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.34 |
| Max. Negotiated Rate |
$469.86 |
| Rate for Payer: Aetna Commercial |
$262.39
|
| Rate for Payer: Ambetter Exchange |
$175.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.34
|
| Rate for Payer: Anthem Medicaid |
$109.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.58
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$469.86
|
| Rate for Payer: Healthspan PPO |
$468.92
|
| Rate for Payer: Humana Medicaid |
$109.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.13
|
| Rate for Payer: Molina Healthcare Passport |
$109.93
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.12
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.48
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.60
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DRAIN HAND TENDON SHEATH
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$690.78 |
| Rate for Payer: Aetna Commercial |
$603.80
|
| Rate for Payer: Ambetter Exchange |
$531.37
|
| Rate for Payer: Anthem Medicaid |
$232.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$531.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$531.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$637.64
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$669.87
|
| Rate for Payer: Healthspan PPO |
$546.91
|
| Rate for Payer: Humana Medicaid |
$232.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$531.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.41
|
| Rate for Payer: Molina Healthcare Passport |
$232.75
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$690.78
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$531.37
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
76100653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.27 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem Medicaid |
$323.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| 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 |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Humana KY Medicaid |
$323.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$326.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$329.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.60
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DRAIN HAND TENDON SHEATH(P
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
761P0653
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$690.78 |
| Rate for Payer: Aetna Commercial |
$603.80
|
| Rate for Payer: Ambetter Exchange |
$531.37
|
| Rate for Payer: Anthem Medicaid |
$232.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$531.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$531.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$637.64
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$669.87
|
| Rate for Payer: Healthspan PPO |
$546.91
|
| Rate for Payer: Humana Medicaid |
$232.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$531.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.41
|
| Rate for Payer: Molina Healthcare Passport |
$232.75
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$690.78
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$531.37
|
|
|
DRAIN/INJ JOINT/BURSA W/O U(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761P0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$60.93
|
| Rate for Payer: Ambetter Exchange |
$33.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.63
|
| Rate for Payer: Anthem Medicaid |
$33.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$85.63
|
| Rate for Payer: Healthspan PPO |
$71.66
|
| Rate for Payer: Humana Medicaid |
$33.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.85
|
| Rate for Payer: Molina Healthcare Passport |
$33.19
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.88
|
| Rate for Payer: UHCCP Medicaid |
$26.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.75
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
45000089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$592.32 |
| Rate for Payer: Aetna Commercial |
$475.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.26
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cigna Commercial |
$512.11
|
| Rate for Payer: First Health Commercial |
$586.15
|
| Rate for Payer: Humana Commercial |
$524.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$455.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.96
|
| Rate for Payer: Ohio Health Group HMO |
$462.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$425.73
|
| Rate for Payer: PHCS Commercial |
$592.32
|
| Rate for Payer: United Healthcare All Payer |
$542.96
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
45000089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.19 |
| Max. Negotiated Rate |
$592.32 |
| Rate for Payer: Aetna Commercial |
$475.09
|
| Rate for Payer: Anthem Medicaid |
$212.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cigna Commercial |
$512.11
|
| Rate for Payer: First Health Commercial |
$586.15
|
| Rate for Payer: Humana Commercial |
$524.45
|
| Rate for Payer: Humana KY Medicaid |
$212.19
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$214.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$455.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.96
|
| Rate for Payer: Ohio Health Group HMO |
$462.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$425.73
|
| Rate for Payer: PHCS Commercial |
$592.32
|
| Rate for Payer: United Healthcare All Payer |
$542.96
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$370.20 |
| Rate for Payer: Aetna Commercial |
$60.93
|
| Rate for Payer: Ambetter Exchange |
$33.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.63
|
| Rate for Payer: Anthem Medicaid |
$33.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.50
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cigna Commercial |
$85.63
|
| Rate for Payer: Healthspan PPO |
$71.66
|
| Rate for Payer: Humana Medicaid |
$33.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.85
|
| Rate for Payer: Molina Healthcare Passport |
$33.19
|
| Rate for Payer: Multiplan PHCS |
$370.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.88
|
| Rate for Payer: UHCCP Medicaid |
$26.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.75
|
|
|
DRAIN/INJ JOINT/BURSA W/O U(T
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761T0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
DRAIN/INJ JOINT/BURSA W/O U(T
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
761T0341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
DRAIN OPEN LUNG LESION
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.80 |
| Max. Negotiated Rate |
$1,838.28 |
| Rate for Payer: Aetna Commercial |
$1,838.28
|
| Rate for Payer: Ambetter Exchange |
$1,075.44
|
| Rate for Payer: Anthem Medicaid |
$591.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,075.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,290.53
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,716.85
|
| Rate for Payer: Healthspan PPO |
$1,435.28
|
| Rate for Payer: Humana Medicaid |
$591.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,557.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,075.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.64
|
| Rate for Payer: Molina Healthcare Passport |
$591.80
|
| Rate for Payer: Multiplan PHCS |
$1,126.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,398.07
|
| Rate for Payer: UHCCP Medicaid |
$656.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,075.44
|
|
|
DRAIN OPEN LUNG LESION
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.10 |
| Max. Negotiated Rate |
$1,801.92 |
| Rate for Payer: Aetna Commercial |
$1,445.29
|
| Rate for Payer: Anthem Medicaid |
$645.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,557.91
|
| Rate for Payer: First Health Commercial |
$1,783.15
|
| Rate for Payer: Humana Commercial |
$1,595.45
|
| Rate for Payer: Humana KY Medicaid |
$645.50
|
| Rate for Payer: Kentucky WC Medicaid |
$652.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.13
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
|
DRAIN OPEN LUNG LESION
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
76101181
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.10 |
| Max. Negotiated Rate |
$1,801.92 |
| Rate for Payer: Aetna Commercial |
$1,445.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
| Rate for Payer: Cash Price |
$938.50
|
| Rate for Payer: Cigna Commercial |
$1,557.91
|
| Rate for Payer: First Health Commercial |
$1,783.15
|
| Rate for Payer: Humana Commercial |
$1,595.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.13
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
