|
DRAIN OPEN LUNG LESION(P
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
HCPCS 32200
|
| Hospital Charge Code |
761P1181
|
|
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 PELVIC ABSCES BY CATH
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,529.60 |
| Rate for Payer: Aetna Commercial |
$4,435.20
|
| Rate for Payer: Anthem Medicaid |
$1,980.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,492.80
|
| 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 |
$2,880.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cigna Commercial |
$4,780.80
|
| Rate for Payer: First Health Commercial |
$5,472.00
|
| Rate for Payer: Humana Commercial |
$4,896.00
|
| Rate for Payer: Humana KY Medicaid |
$1,980.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,001.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,723.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,250.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,020.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,068.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,011.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,974.40
|
| Rate for Payer: PHCS Commercial |
$5,529.60
|
| Rate for Payer: United Healthcare All Payer |
$5,068.80
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Professional
|
Both
|
$5,760.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Ambetter Exchange |
$181.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.51
|
| Rate for Payer: Anthem Medicaid |
$654.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.62
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cigna Commercial |
$355.84
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$654.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$667.99
|
| Rate for Payer: Molina Healthcare Passport |
$654.89
|
| Rate for Payer: Multiplan PHCS |
$3,456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.75
|
| Rate for Payer: UHCCP Medicaid |
$173.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$661.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.35
|
|
|
DRAIN PELVIC ABSCES BY CATH
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
76101998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$5,529.60 |
| Rate for Payer: Aetna Commercial |
$4,435.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,492.80
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cigna Commercial |
$4,780.80
|
| Rate for Payer: First Health Commercial |
$5,472.00
|
| Rate for Payer: Humana Commercial |
$4,896.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,723.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,250.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,728.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,068.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,011.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,974.40
|
| Rate for Payer: PHCS Commercial |
$5,529.60
|
| Rate for Payer: United Healthcare All Payer |
$5,068.80
|
|
|
DRAIN PELVIC ABSCES BY CATH(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761P1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Ambetter Exchange |
$181.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.51
|
| Rate for Payer: Anthem Medicaid |
$654.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.62
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$355.84
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$654.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$667.99
|
| Rate for Payer: Molina Healthcare Passport |
$654.89
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.75
|
| Rate for Payer: UHCCP Medicaid |
$173.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$661.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.35
|
|
|
DRAIN PELVIC ABSCES BY CATH(T
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,218.00 |
| Max. Negotiated Rate |
$3,897.60 |
| Rate for Payer: Aetna Commercial |
$3,126.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,166.80
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cigna Commercial |
$3,369.80
|
| Rate for Payer: First Health Commercial |
$3,857.00
|
| Rate for Payer: Humana Commercial |
$3,451.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,329.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,996.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,572.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,532.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.40
|
| Rate for Payer: PHCS Commercial |
$3,897.60
|
| Rate for Payer: United Healthcare All Payer |
$3,572.80
|
|
|
DRAIN PELVIC ABSCES BY CATH(T
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
761T1998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,396.23 |
| Max. Negotiated Rate |
$3,897.60 |
| Rate for Payer: Aetna Commercial |
$3,126.20
|
| Rate for Payer: Anthem Medicaid |
$1,396.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,166.80
|
| 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 |
$2,030.00
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cigna Commercial |
$3,369.80
|
| Rate for Payer: First Health Commercial |
$3,857.00
|
| Rate for Payer: Humana Commercial |
$3,451.00
|
| Rate for Payer: Humana KY Medicaid |
$1,396.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,410.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,329.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,996.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,424.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,572.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,532.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,801.40
|
| Rate for Payer: PHCS Commercial |
$3,897.60
|
| Rate for Payer: United Healthcare All Payer |
$3,572.80
|
|
|
DRAIN RETROPERITONEAL ABSCES(P
|
Professional
|
Both
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
761P1978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.71 |
| Max. Negotiated Rate |
$1,591.53 |
| Rate for Payer: Aetna Commercial |
$1,591.53
|
| Rate for Payer: Ambetter Exchange |
$1,051.11
|
| Rate for Payer: Anthem Medicaid |
$482.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,051.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,051.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,261.33
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,483.31
|
| Rate for Payer: Healthspan PPO |
$1,342.17
|
| Rate for Payer: Humana Medicaid |
$482.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,051.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.36
|
| Rate for Payer: Molina Healthcare Passport |
$482.71
|
| Rate for Payer: Multiplan PHCS |
$894.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,366.44
|
| Rate for Payer: UHCCP Medicaid |
$521.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,051.11
|
|
|
DRAIN RETROPERITONEAL ABSCESS
|
Professional
|
Both
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
76101978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.71 |
| Max. Negotiated Rate |
$1,591.53 |
| Rate for Payer: Aetna Commercial |
$1,591.53
|
| Rate for Payer: Ambetter Exchange |
$1,051.11
|
| Rate for Payer: Anthem Medicaid |
$482.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,051.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,051.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,261.33
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,483.31
|
| Rate for Payer: Healthspan PPO |
$1,342.17
|
| Rate for Payer: Humana Medicaid |
$482.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,051.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.36
|
| Rate for Payer: Molina Healthcare Passport |
$482.71
|
| Rate for Payer: Multiplan PHCS |
$894.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,366.44
|
| Rate for Payer: UHCCP Medicaid |
$521.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,051.11
|
|
|
DRAIN RETROPERITONEAL ABSCESS
|
Facility
|
IP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
76101978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$1,431.36 |
| Rate for Payer: Aetna Commercial |
$1,148.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.98
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,237.53
|
| Rate for Payer: First Health Commercial |
$1,416.45
|
| Rate for Payer: Humana Commercial |
$1,267.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,312.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.79
|
| Rate for Payer: PHCS Commercial |
$1,431.36
|
| Rate for Payer: United Healthcare All Payer |
$1,312.08
|
|
|
DRAIN RETROPERITONEAL ABSCESS
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
76101978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$1,431.36 |
| Rate for Payer: Aetna Commercial |
$1,148.07
|
| Rate for Payer: Anthem Medicaid |
$512.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.98
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,237.53
|
| Rate for Payer: First Health Commercial |
$1,416.45
|
| Rate for Payer: Humana Commercial |
$1,267.35
|
| Rate for Payer: Humana KY Medicaid |
$512.75
|
| Rate for Payer: Kentucky WC Medicaid |
$517.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$523.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,312.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.79
|
| Rate for Payer: PHCS Commercial |
$1,431.36
|
| Rate for Payer: United Healthcare All Payer |
$1,312.08
|
|
|
DRAIN SHOULDER BONE LESION
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 23035
|
| Hospital Charge Code |
76102689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$309.75 |
| Max. Negotiated Rate |
$1,132.95 |
| Rate for Payer: Aetna Commercial |
$1,001.68
|
| Rate for Payer: Ambetter Exchange |
$649.11
|
| Rate for Payer: Anthem Medicaid |
$420.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$649.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$778.93
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$1,132.95
|
| Rate for Payer: Healthspan PPO |
$907.31
|
| Rate for Payer: Humana Medicaid |
$420.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$649.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.40
|
| Rate for Payer: Molina Healthcare Passport |
$420.98
|
| Rate for Payer: Multiplan PHCS |
$531.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$843.84
|
| Rate for Payer: UHCCP Medicaid |
$309.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.11
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,454.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.99
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
|
DRAIN SHOULDER BURSA
|
Professional
|
Both
|
$3,971.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.56 |
| Max. Negotiated Rate |
$2,382.60 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Ambetter Exchange |
$212.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.65
|
| Rate for Payer: Anthem Medicaid |
$93.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$212.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.60
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$357.06
|
| Rate for Payer: Healthspan PPO |
$482.79
|
| Rate for Payer: Humana Medicaid |
$93.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$212.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.43
|
| Rate for Payer: Molina Healthcare Passport |
$93.56
|
| Rate for Payer: Multiplan PHCS |
$2,382.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$275.82
|
| Rate for Payer: UHCCP Medicaid |
$118.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.17
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,365.63 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem Medicaid |
$1,365.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Humana KY Medicaid |
$1,365.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,454.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.99
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
|
DRAIN SHOULDER BURSA(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
761P0433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.56 |
| Max. Negotiated Rate |
$482.79 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Ambetter Exchange |
$212.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.65
|
| Rate for Payer: Anthem Medicaid |
$93.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$212.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.60
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$357.06
|
| Rate for Payer: Healthspan PPO |
$482.79
|
| Rate for Payer: Humana Medicaid |
$93.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$212.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.43
|
| Rate for Payer: Molina Healthcare Passport |
$93.56
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$275.82
|
| Rate for Payer: UHCCP Medicaid |
$118.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.17
|
|
|
DRAIN SHOULDER BURSA(T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
761T0433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.30 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAIN SHOULDER BURSA(T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
761T0433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,889.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.49
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DRAMAMINE 50MG TABLET
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 10135017736
|
| Hospital Charge Code |
25000581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
DRAMAMINE 50MG TABLET
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 31248000197
|
| Hospital Charge Code |
25000581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Anthem Medicaid |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.27
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna Commercial |
$0.29
|
| Rate for Payer: First Health Commercial |
$0.33
|
| Rate for Payer: Humana Commercial |
$0.30
|
| Rate for Payer: Humana KY Medicaid |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$0.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.31
|
| Rate for Payer: Ohio Health Group HMO |
$0.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.24
|
| Rate for Payer: PHCS Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Payer |
$0.31
|
|
|
DRAMAMINE 50MG TABLET
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 10135017736
|
| Hospital Charge Code |
25000581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
DRAMAMINE 50MG TABLET
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 31248000197
|
| Hospital Charge Code |
25000581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.27
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna Commercial |
$0.29
|
| Rate for Payer: First Health Commercial |
$0.33
|
| Rate for Payer: Humana Commercial |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.31
|
| Rate for Payer: Ohio Health Group HMO |
$0.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.24
|
| Rate for Payer: PHCS Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Payer |
$0.31
|
|
|
DREAMWIRE ST .035*260
|
Facility
|
IP
|
$1,978.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.62 |
| Max. Negotiated Rate |
$1,899.57 |
| Rate for Payer: Aetna Commercial |
$1,523.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,543.40
|
| Rate for Payer: Cash Price |
$989.36
|
| Rate for Payer: Cigna Commercial |
$1,642.34
|
| Rate for Payer: First Health Commercial |
$1,879.78
|
| Rate for Payer: Humana Commercial |
$1,681.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,622.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,741.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,484.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.32
|
| Rate for Payer: PHCS Commercial |
$1,899.57
|
| Rate for Payer: United Healthcare All Payer |
$1,741.27
|
|
|
DREAMWIRE ST .035*260
|
Facility
|
OP
|
$1,978.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.62 |
| Max. Negotiated Rate |
$1,899.57 |
| Rate for Payer: Aetna Commercial |
$1,523.61
|
| Rate for Payer: Anthem Medicaid |
$680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,543.40
|
| Rate for Payer: Cash Price |
$989.36
|
| Rate for Payer: Cigna Commercial |
$1,642.34
|
| Rate for Payer: First Health Commercial |
$1,879.78
|
| Rate for Payer: Humana Commercial |
$1,681.91
|
| Rate for Payer: Humana KY Medicaid |
$680.48
|
| Rate for Payer: Kentucky WC Medicaid |
$687.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,622.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,741.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,484.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.32
|
| Rate for Payer: PHCS Commercial |
$1,899.57
|
| Rate for Payer: United Healthcare All Payer |
$1,741.27
|
|
|
DREAMWIRE ST SS .035*450
|
Facility
|
IP
|
$1,978.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.62 |
| Max. Negotiated Rate |
$1,899.57 |
| Rate for Payer: Aetna Commercial |
$1,523.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,543.40
|
| Rate for Payer: Cash Price |
$989.36
|
| Rate for Payer: Cigna Commercial |
$1,642.34
|
| Rate for Payer: First Health Commercial |
$1,879.78
|
| Rate for Payer: Humana Commercial |
$1,681.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,622.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,741.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,484.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.32
|
| Rate for Payer: PHCS Commercial |
$1,899.57
|
| Rate for Payer: United Healthcare All Payer |
$1,741.27
|
|
