|
MUSCLE-SKIN GRAFT - ARM(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 15736
|
| Hospital Charge Code |
761P0206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.03 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,708.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$670.03
|
| Rate for Payer: Anthem Medicaid |
$955.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,642.37
|
| Rate for Payer: Healthspan PPO |
$1,558.68
|
| Rate for Payer: Humana Medicaid |
$955.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,460.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$975.07
|
| Rate for Payer: Molina Healthcare Passport |
$955.95
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$703.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.51
|
|
|
MUSCLE-SKIN GRAFT - ARM(T
|
Facility
|
IP
|
$4,504.88
|
|
|
Service Code
|
HCPCS 15736
|
| Hospital Charge Code |
761T0206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.63 |
| Max. Negotiated Rate |
$4,324.68 |
| Rate for Payer: Aetna Commercial |
$3,468.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,513.81
|
| Rate for Payer: Cash Price |
$2,252.44
|
| Rate for Payer: Cigna Commercial |
$3,739.05
|
| Rate for Payer: First Health Commercial |
$4,279.64
|
| Rate for Payer: Humana Commercial |
$3,829.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,694.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,324.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,351.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,964.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,378.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.51
|
| Rate for Payer: PHCS Commercial |
$4,324.68
|
| Rate for Payer: United Healthcare All Payer |
$3,964.29
|
|
|
MUSCLE-SKIN GRAFT - ARM(T
|
Facility
|
OP
|
$4,504.88
|
|
|
Service Code
|
HCPCS 15736
|
| Hospital Charge Code |
761T0206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.63 |
| Max. Negotiated Rate |
$4,324.68 |
| Rate for Payer: Aetna Commercial |
$3,468.76
|
| Rate for Payer: Anthem Medicaid |
$1,549.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,513.81
|
| 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 |
$2,252.44
|
| Rate for Payer: Cash Price |
$2,252.44
|
| Rate for Payer: Cigna Commercial |
$3,739.05
|
| Rate for Payer: First Health Commercial |
$4,279.64
|
| Rate for Payer: Humana Commercial |
$3,829.15
|
| Rate for Payer: Humana KY Medicaid |
$1,549.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,565.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,694.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,324.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,580.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,964.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,378.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.51
|
| Rate for Payer: PHCS Commercial |
$4,324.68
|
| Rate for Payer: United Healthcare All Payer |
$3,964.29
|
|
|
MUSCLE-SKIN GRAFT LEG
|
Facility
|
IP
|
$8,250.75
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
76100207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$7,920.72 |
| Rate for Payer: Aetna Commercial |
$6,353.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.58
|
| Rate for Payer: Cash Price |
$4,125.38
|
| Rate for Payer: Cigna Commercial |
$6,848.12
|
| Rate for Payer: First Health Commercial |
$7,838.21
|
| Rate for Payer: Humana Commercial |
$7,013.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,089.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,188.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,650.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,072.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,557.73
|
| Rate for Payer: PHCS Commercial |
$7,920.72
|
| Rate for Payer: United Healthcare All Payer |
$7,260.66
|
|
|
MUSCLE-SKIN GRAFT LEG
|
Facility
|
OP
|
$8,250.75
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
76100207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$7,920.72 |
| Rate for Payer: Aetna Commercial |
$6,353.08
|
| Rate for Payer: Anthem Medicaid |
$2,837.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$4,125.38
|
| Rate for Payer: Cash Price |
$4,125.38
|
| Rate for Payer: Cigna Commercial |
$6,848.12
|
| Rate for Payer: First Health Commercial |
$7,838.21
|
| Rate for Payer: Humana Commercial |
$7,013.14
|
| Rate for Payer: Humana KY Medicaid |
$2,837.43
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,089.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,188.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,650.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,072.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,557.73
|
| Rate for Payer: PHCS Commercial |
$7,920.72
|
| Rate for Payer: United Healthcare All Payer |
$7,260.66
|
|
|
MUSCLE-SKIN GRAFT LEG
|
Professional
|
Both
|
$8,250.75
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
76100207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$8,250.75 |
| Rate for Payer: Aetna Commercial |
$1,862.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$652.16
|
| Rate for Payer: Anthem Medicaid |
$721.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,250.75
|
| Rate for Payer: Cash Price |
$4,125.38
|
| Rate for Payer: Cash Price |
$4,125.38
|
| Rate for Payer: Cigna Commercial |
$1,786.99
|
| Rate for Payer: Healthspan PPO |
$1,666.66
|
| Rate for Payer: Humana Medicaid |
$721.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,586.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$735.59
|
| Rate for Payer: Molina Healthcare Passport |
$721.17
|
| Rate for Payer: Multiplan PHCS |
$4,950.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,775.52
|
| Rate for Payer: UHCCP Medicaid |
$684.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$728.38
|
|
|
MUSCLE-SKIN GRAFT LEG(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
761P0207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$1,862.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$652.16
|
| Rate for Payer: Anthem Medicaid |
$721.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,786.99
|
| Rate for Payer: Healthspan PPO |
$1,666.66
|
| Rate for Payer: Humana Medicaid |
$721.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,586.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$735.59
|
| Rate for Payer: Molina Healthcare Passport |
$721.17
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$684.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$728.38
|
|
|
MUSCLE-SKIN GRAFT LEG(T
|
Facility
|
IP
|
$5,775.75
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
761T0207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.85 |
| Max. Negotiated Rate |
$5,544.72 |
| Rate for Payer: Aetna Commercial |
$4,447.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,505.08
|
| Rate for Payer: Cash Price |
$2,887.88
|
| Rate for Payer: Cigna Commercial |
$4,793.87
|
| Rate for Payer: First Health Commercial |
$5,486.96
|
| Rate for Payer: Humana Commercial |
$4,909.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,736.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,262.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,732.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,082.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,331.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,155.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$750.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,790.48
|
| Rate for Payer: PHCS Commercial |
$5,544.72
|
| Rate for Payer: United Healthcare All Payer |
$5,082.66
|
|
|
MUSCLE-SKIN GRAFT LEG(T
|
Facility
|
OP
|
$5,775.75
|
|
|
Service Code
|
HCPCS 15738
|
| Hospital Charge Code |
761T0207
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.85 |
| Max. Negotiated Rate |
$5,544.72 |
| Rate for Payer: Aetna Commercial |
$4,447.33
|
| Rate for Payer: Anthem Medicaid |
$1,986.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,505.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$2,887.88
|
| Rate for Payer: Cash Price |
$2,887.88
|
| Rate for Payer: Cigna Commercial |
$4,793.87
|
| Rate for Payer: First Health Commercial |
$5,486.96
|
| Rate for Payer: Humana Commercial |
$4,909.39
|
| Rate for Payer: Humana KY Medicaid |
$1,986.28
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,006.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,736.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,262.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,026.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,082.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,331.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,155.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$750.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,790.48
|
| Rate for Payer: PHCS Commercial |
$5,544.72
|
| Rate for Payer: United Healthcare All Payer |
$5,082.66
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Facility
|
OP
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.81 |
| Max. Negotiated Rate |
$6,275.52 |
| Rate for Payer: Aetna Commercial |
$5,033.49
|
| Rate for Payer: Anthem Medicaid |
$2,248.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,098.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$5,425.71
|
| Rate for Payer: First Health Commercial |
$6,210.15
|
| Rate for Payer: Humana Commercial |
$5,556.45
|
| Rate for Payer: Humana KY Medicaid |
$2,248.07
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,360.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,824.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,293.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.47
|
| Rate for Payer: PHCS Commercial |
$6,275.52
|
| Rate for Payer: United Healthcare All Payer |
$5,752.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Facility
|
IP
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.81 |
| Max. Negotiated Rate |
$6,275.52 |
| Rate for Payer: Aetna Commercial |
$5,033.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,098.86
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$5,425.71
|
| Rate for Payer: First Health Commercial |
$6,210.15
|
| Rate for Payer: Humana Commercial |
$5,556.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,360.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,824.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,961.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.47
|
| Rate for Payer: PHCS Commercial |
$6,275.52
|
| Rate for Payer: United Healthcare All Payer |
$5,752.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Professional
|
Both
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.58 |
| Max. Negotiated Rate |
$6,537.00 |
| Rate for Payer: Anthem Medicaid |
$827.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,537.00
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$1,723.35
|
| Rate for Payer: Humana Medicaid |
$827.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,354.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.13
|
| Rate for Payer: Molina Healthcare Passport |
$827.58
|
| Rate for Payer: Multiplan PHCS |
$3,922.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,575.90
|
| Rate for Payer: UHCCP Medicaid |
$2,287.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$835.86
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761P0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,723.35 |
| Rate for Payer: Anthem Medicaid |
$827.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,723.35
|
| Rate for Payer: Humana Medicaid |
$827.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,354.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.13
|
| Rate for Payer: Molina Healthcare Passport |
$827.58
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$835.86
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(T
|
Facility
|
IP
|
$5,287.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761T0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.31 |
| Max. Negotiated Rate |
$5,075.52 |
| Rate for Payer: Aetna Commercial |
$4,070.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.86
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cigna Commercial |
$4,388.21
|
| Rate for Payer: First Health Commercial |
$5,022.65
|
| Rate for Payer: Humana Commercial |
$4,493.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,335.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,586.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,652.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.97
|
| Rate for Payer: PHCS Commercial |
$5,075.52
|
| Rate for Payer: United Healthcare All Payer |
$4,652.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(T
|
Facility
|
OP
|
$5,287.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761T0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.31 |
| Max. Negotiated Rate |
$5,075.52 |
| Rate for Payer: Aetna Commercial |
$4,070.99
|
| Rate for Payer: Anthem Medicaid |
$1,818.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cigna Commercial |
$4,388.21
|
| Rate for Payer: First Health Commercial |
$5,022.65
|
| Rate for Payer: Humana Commercial |
$4,493.95
|
| Rate for Payer: Humana KY Medicaid |
$1,818.20
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,335.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,854.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,652.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.97
|
| Rate for Payer: PHCS Commercial |
$5,075.52
|
| Rate for Payer: United Healthcare All Payer |
$4,652.56
|
|
|
MUSC TST DONE W/N TST NONEX(P
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510P0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$132.44 |
| Rate for Payer: Anthem Medicaid |
$61.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$132.44
|
| Rate for Payer: Healthspan PPO |
$75.97
|
| Rate for Payer: Humana Medicaid |
$61.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.46
|
| Rate for Payer: Molina Healthcare Passport |
$61.24
|
| Rate for Payer: Multiplan PHCS |
$66.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.00
|
| Rate for Payer: UHCCP Medicaid |
$38.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.85
|
|
|
MUSC TST DONE W/N TST NONEX(T
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510T0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
MUSC TST DONE W/N TST NONEX(T
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510T0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Anthem Medicaid |
$61.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$355.00
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$132.44
|
| Rate for Payer: Healthspan PPO |
$75.97
|
| Rate for Payer: Humana Medicaid |
$61.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.46
|
| Rate for Payer: Molina Healthcare Passport |
$61.24
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.50
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.85
|
|
|
MUSTANG 10*20*135
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 10*20*135
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 10*20*40
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 10*20*40
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
