|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
|
Facility
|
OP
|
$6,327.54
|
|
|
Service Code
|
CPT 66991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,519.67 |
| Max. Negotiated Rate |
$6,327.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,519.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,327.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,101.55
|
| Rate for Payer: Humana Medicare Advantage |
$4,519.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,423.60
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$2,821.27
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,015.19 |
| Max. Negotiated Rate |
$2,821.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,015.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,821.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,720.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,015.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,418.23
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$18,715.96
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$12,700.11 |
| Max. Negotiated Rate |
$18,715.96 |
| Rate for Payer: Anthem Medicaid |
$12,700.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,368.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,715.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,047.53
|
| Rate for Payer: Humana KY Medicaid |
$12,700.11
|
| Rate for Payer: Humana Medicare Advantage |
$13,368.54
|
| Rate for Payer: Kentucky WC Medicaid |
$12,827.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,042.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,954.12
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,488.46
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$26,795.74 |
| Max. Negotiated Rate |
$39,488.46 |
| Rate for Payer: Anthem Medicaid |
$26,795.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,206.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,488.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,078.15
|
| Rate for Payer: Humana KY Medicaid |
$26,795.74
|
| Rate for Payer: Humana Medicare Advantage |
$28,206.04
|
| Rate for Payer: Kentucky WC Medicaid |
$27,063.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,847.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,331.65
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,347.63
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$9,057.32 |
| Max. Negotiated Rate |
$13,347.63 |
| Rate for Payer: Anthem Medicaid |
$9,057.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,534.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,347.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,870.93
|
| Rate for Payer: Humana KY Medicaid |
$9,057.32
|
| Rate for Payer: Humana Medicare Advantage |
$9,534.02
|
| Rate for Payer: Kentucky WC Medicaid |
$9,147.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,440.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,238.47
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$18,300.66
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$12,418.30 |
| Max. Negotiated Rate |
$18,300.66 |
| Rate for Payer: Anthem Medicaid |
$12,418.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,071.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,300.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,647.06
|
| Rate for Payer: Humana KY Medicaid |
$12,418.30
|
| Rate for Payer: Humana Medicare Advantage |
$13,071.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,542.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,686.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,666.67
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
761P1650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$589.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.30
|
| Rate for Payer: Anthem Medicaid |
$254.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$672.49
|
| Rate for Payer: Healthspan PPO |
$589.86
|
| Rate for Payer: Humana Medicaid |
$254.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.11
|
| Rate for Payer: Molina Healthcare Passport |
$254.03
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$265.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.57
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
761P1648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$498.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.71
|
| Rate for Payer: Anthem Medicaid |
$217.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$508.14
|
| Rate for Payer: Humana Medicaid |
$217.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.71
|
| Rate for Payer: Molina Healthcare Passport |
$217.36
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$240.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.53
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
761P1649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.11 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Aetna Commercial |
$500.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.26
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$583.70
|
| Rate for Payer: Healthspan PPO |
$511.74
|
| Rate for Payer: Humana Medicaid |
$150.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.11
|
| Rate for Payer: Molina Healthcare Passport |
$150.11
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$205.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.61
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(P
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
761P1657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.36 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Molina Healthcare Passport |
$420.36
|
| Rate for Payer: Multiplan PHCS |
$999.00
|
| Rate for Payer: Aetna Commercial |
$919.45
|
| Rate for Payer: Anthem Medicaid |
$420.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,665.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$913.02
|
| Rate for Payer: Healthspan PPO |
$775.39
|
| Rate for Payer: Humana Medicaid |
$420.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$815.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$428.77
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,165.50
|
| Rate for Payer: UHCCP Medicaid |
$582.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$424.56
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
761T1650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
761T1649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.24 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem Medicaid |
$1,460.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Humana KY Medicaid |
$1,460.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.88
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
761T1657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
761T1657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
761T1648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$6,669.12 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
761T1650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
761T1648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem Medicaid |
$2,389.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Humana KY Medicaid |
$2,389.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
EXTRAORAL I/D ABSC CYST/HEMA(T
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
761T1649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.24 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.88
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.36 |
| Max. Negotiated Rate |
$9,940.00 |
| Rate for Payer: Aetna Commercial |
$919.45
|
| Rate for Payer: Anthem Medicaid |
$420.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,940.00
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$913.02
|
| Rate for Payer: Healthspan PPO |
$775.39
|
| Rate for Payer: Humana Medicaid |
$420.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$815.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$428.77
|
| Rate for Payer: Molina Healthcare Passport |
$420.36
|
| Rate for Payer: Multiplan PHCS |
$5,964.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,958.00
|
| Rate for Payer: UHCCP Medicaid |
$3,479.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$424.56
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$5,323.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
76101649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.99 |
| Max. Negotiated Rate |
$5,110.08 |
| Rate for Payer: Aetna Commercial |
$4,098.71
|
| Rate for Payer: Anthem Medicaid |
$1,830.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,151.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cigna Commercial |
$4,418.09
|
| Rate for Payer: First Health Commercial |
$5,056.85
|
| Rate for Payer: Humana Commercial |
$4,524.55
|
| Rate for Payer: Humana KY Medicaid |
$1,830.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,849.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,364.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,867.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,684.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,992.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.13
|
| Rate for Payer: PHCS Commercial |
$5,110.08
|
| Rate for Payer: United Healthcare All Payer |
$4,684.24
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$5,323.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
76101649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.11 |
| Max. Negotiated Rate |
$5,323.00 |
| Rate for Payer: Aetna Commercial |
$500.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.26
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,323.00
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cigna Commercial |
$583.70
|
| Rate for Payer: Healthspan PPO |
$511.74
|
| Rate for Payer: Humana Medicaid |
$150.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.11
|
| Rate for Payer: Molina Healthcare Passport |
$150.11
|
| Rate for Payer: Multiplan PHCS |
$3,193.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,726.10
|
| Rate for Payer: UHCCP Medicaid |
$205.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.61
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$5,323.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
76101649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.99 |
| Max. Negotiated Rate |
$5,110.08 |
| Rate for Payer: Aetna Commercial |
$4,098.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,151.94
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cigna Commercial |
$4,418.09
|
| Rate for Payer: First Health Commercial |
$5,056.85
|
| Rate for Payer: Humana Commercial |
$4,524.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,364.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,596.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,684.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,992.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.13
|
| Rate for Payer: PHCS Commercial |
$5,110.08
|
| Rate for Payer: United Healthcare All Payer |
$4,684.24
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$3,033.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
76101650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.29 |
| Max. Negotiated Rate |
$2,911.68 |
| Rate for Payer: Aetna Commercial |
$2,335.41
|
| Rate for Payer: Anthem Medicaid |
$1,043.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,365.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna Commercial |
$2,517.39
|
| Rate for Payer: First Health Commercial |
$2,881.35
|
| Rate for Payer: Humana Commercial |
$2,578.05
|
| Rate for Payer: Humana KY Medicaid |
$1,043.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,274.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.23
|
| Rate for Payer: PHCS Commercial |
$2,911.68
|
| Rate for Payer: United Healthcare All Payer |
$2,669.04
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$9,542.40 |
| Rate for Payer: Aetna Commercial |
$7,653.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,753.20
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$8,250.20
|
| Rate for Payer: First Health Commercial |
$9,443.00
|
| Rate for Payer: Humana Commercial |
$8,449.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,150.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,335.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,982.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.40
|
| Rate for Payer: PHCS Commercial |
$9,542.40
|
| Rate for Payer: United Healthcare All Payer |
$8,747.20
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$9,542.40 |
| Rate for Payer: Aetna Commercial |
$7,653.80
|
| Rate for Payer: Anthem Medicaid |
$3,418.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,753.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$8,250.20
|
| Rate for Payer: First Health Commercial |
$9,443.00
|
| Rate for Payer: Humana Commercial |
$8,449.00
|
| Rate for Payer: Humana KY Medicaid |
$3,418.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,453.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,150.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,335.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,486.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.40
|
| Rate for Payer: PHCS Commercial |
$9,542.40
|
| Rate for Payer: United Healthcare All Payer |
$8,747.20
|
|
