|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
45000056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
761P0135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna Commercial |
$272.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.52
|
| Rate for Payer: Anthem Medicaid |
$87.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$389.00
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$379.66
|
| Rate for Payer: Healthspan PPO |
$331.61
|
| Rate for Payer: Humana Medicaid |
$87.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.27
|
| Rate for Payer: Molina Healthcare Passport |
$87.52
|
| Rate for Payer: Multiplan PHCS |
$233.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.30
|
| Rate for Payer: UHCCP Medicaid |
$100.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.40
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
76100135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.28
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
76100135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.28
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
761T0135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
76100135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$272.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.52
|
| Rate for Payer: Anthem Medicaid |
$87.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$888.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$379.66
|
| Rate for Payer: Healthspan PPO |
$331.61
|
| Rate for Payer: Humana Medicaid |
$87.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.27
|
| Rate for Payer: Molina Healthcare Passport |
$87.52
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$621.60
|
| Rate for Payer: UHCCP Medicaid |
$100.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.40
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
45000056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
761T0135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE OF WOUNDS OF SCA
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
LAYER CLOSURE OF WOUND(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
761T0145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE OF WOUND(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
761T0145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
IP
|
$1,875.80
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.85 |
| Max. Negotiated Rate |
$1,800.77 |
| Rate for Payer: Aetna Commercial |
$1,444.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.12
|
| Rate for Payer: Cash Price |
$937.90
|
| Rate for Payer: Cigna Commercial |
$1,556.91
|
| Rate for Payer: First Health Commercial |
$1,782.01
|
| Rate for Payer: Humana Commercial |
$1,594.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$1,800.77
|
| Rate for Payer: United Healthcare All Payer |
$1,650.70
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.99 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem Medicaid |
$833.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Humana KY Medicaid |
$833.27
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$841.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.13
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
45000058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
45000058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
OP
|
$1,875.80
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.85 |
| Max. Negotiated Rate |
$1,800.77 |
| Rate for Payer: Aetna Commercial |
$1,444.37
|
| Rate for Payer: Anthem Medicaid |
$645.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$937.90
|
| Rate for Payer: Cash Price |
$937.90
|
| Rate for Payer: Cigna Commercial |
$1,556.91
|
| Rate for Payer: First Health Commercial |
$1,782.01
|
| Rate for Payer: Humana Commercial |
$1,594.43
|
| Rate for Payer: Humana KY Medicaid |
$645.09
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$651.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$1,800.77
|
| Rate for Payer: United Healthcare All Payer |
$1,650.70
|
|
|
LAYER CLOSURE WOUND
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.99 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.13
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
LAYER CLOSURE WOUND
|
Professional
|
Both
|
$1,875.80
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$1,875.80 |
| Rate for Payer: Aetna Commercial |
$341.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.68
|
| Rate for Payer: Anthem Medicaid |
$156.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.80
|
| Rate for Payer: Cash Price |
$937.90
|
| Rate for Payer: Cash Price |
$937.90
|
| Rate for Payer: Cigna Commercial |
$322.55
|
| Rate for Payer: Healthspan PPO |
$405.24
|
| Rate for Payer: Humana Medicaid |
$156.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$294.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.40
|
| Rate for Payer: Molina Healthcare Passport |
$156.27
|
| Rate for Payer: Multiplan PHCS |
$1,125.48
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,313.06
|
| Rate for Payer: UHCCP Medicaid |
$128.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.83
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
761T0146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
761P0146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$327.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.92
|
| Rate for Payer: Anthem Medicaid |
$175.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$297.15
|
| Rate for Payer: Healthspan PPO |
$386.96
|
| Rate for Payer: Humana Medicaid |
$175.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$284.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.39
|
| Rate for Payer: Molina Healthcare Passport |
$175.87
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$116.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.63
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
76100146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$911.04 |
| Rate for Payer: Aetna Commercial |
$730.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$740.22
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$787.67
|
| Rate for Payer: First Health Commercial |
$901.55
|
| Rate for Payer: Humana Commercial |
$806.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$700.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$835.12
|
| Rate for Payer: Ohio Health Group HMO |
$711.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.19
|
| Rate for Payer: PHCS Commercial |
$911.04
|
| Rate for Payer: United Healthcare All Payer |
$835.12
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
45000068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
76100146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$911.04 |
| Rate for Payer: Aetna Commercial |
$730.73
|
| Rate for Payer: Anthem Medicaid |
$326.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$740.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$787.67
|
| Rate for Payer: First Health Commercial |
$901.55
|
| Rate for Payer: Humana Commercial |
$806.65
|
| Rate for Payer: Humana KY Medicaid |
$326.36
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$329.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$700.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$835.12
|
| Rate for Payer: Ohio Health Group HMO |
$711.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.19
|
| Rate for Payer: PHCS Commercial |
$911.04
|
| Rate for Payer: United Healthcare All Payer |
$835.12
|
|
|
LAYER CLOSURE WOUND 7.6-12.5CM
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
76100146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$327.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.92
|
| Rate for Payer: Anthem Medicaid |
$175.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$949.00
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$297.15
|
| Rate for Payer: Healthspan PPO |
$386.96
|
| Rate for Payer: Humana Medicaid |
$175.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$284.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.39
|
| Rate for Payer: Molina Healthcare Passport |
$175.87
|
| Rate for Payer: Multiplan PHCS |
$569.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.30
|
| Rate for Payer: UHCCP Medicaid |
$116.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.63
|
|
