|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
740T0013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$1,355.52 |
| Rate for Payer: Aetna Commercial |
$1,087.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,101.36
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,171.96
|
| Rate for Payer: First Health Commercial |
$1,341.40
|
| Rate for Payer: Humana Commercial |
$1,200.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,157.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,042.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,242.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,059.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.72
|
| Rate for Payer: PHCS Commercial |
$1,355.52
|
| Rate for Payer: United Healthcare All Payer |
$1,242.56
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Professional
|
Both
|
$1,912.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
74000013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,912.00
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Multiplan PHCS |
$1,147.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,338.40
|
| Rate for Payer: UHCCP Medicaid |
$669.20
|
|
|
NE EEG CONT RECORD 2-4 HRS W/V
|
Facility
|
IP
|
$1,912.00
|
|
|
Service Code
|
HCPCS 95711
|
| Hospital Charge Code |
74000013
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$1,835.52 |
| Rate for Payer: Aetna Commercial |
$1,472.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.36
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cigna Commercial |
$1,586.96
|
| Rate for Payer: First Health Commercial |
$1,816.40
|
| Rate for Payer: Humana Commercial |
$1,625.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,411.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,434.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.72
|
| Rate for Payer: PHCS Commercial |
$1,835.52
|
| Rate for Payer: United Healthcare All Payer |
$1,682.56
|
|
|
NEGATIVE PRESS GREATER 50 SQCM
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42000075
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEGATIVE PRESS GREATER 50 SQCM
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42000075
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$187.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$187.77
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$189.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEGATIVE PRESS LESS 50 SQ CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
42000074
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
NEGATIVE PRESS LESS 50 SQ CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
42000074
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
NEG PRESS LESS 50CM DISP
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
42000076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$187.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$187.77
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$189.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS LESS 50CM DISP
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
76102504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS LESS 50CM DISP
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
76102504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$18.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Humana Medicaid |
$18.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.44
|
| Rate for Payer: Molina Healthcare Passport |
$18.08
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.26
|
|
|
NEG PRESS LESS 50CM DISP
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
42000076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS LESS 50CM DISP
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
76102504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$187.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$187.77
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$189.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna Commercial |
$41.23
|
| Rate for Payer: Humana Medicaid |
$23.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.39
|
| Rate for Payer: Molina Healthcare Passport |
$23.91
|
| Rate for Payer: Multiplan PHCS |
$369.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$431.20
|
| Rate for Payer: UHCCP Medicaid |
$27.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.15
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
761T2503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem Medicaid |
$187.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Humana KY Medicaid |
$187.77
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$189.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
761T2503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$591.36 |
| Rate for Payer: Aetna Commercial |
$474.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$480.48
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna Commercial |
$511.28
|
| Rate for Payer: First Health Commercial |
$585.20
|
| Rate for Payer: Humana Commercial |
$523.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$454.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.08
|
| Rate for Payer: Ohio Health Group HMO |
$462.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.96
|
| Rate for Payer: PHCS Commercial |
$591.36
|
| Rate for Payer: United Healthcare All Payer |
$542.08
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$591.36 |
| Rate for Payer: Aetna Commercial |
$474.32
|
| Rate for Payer: Anthem Medicaid |
$211.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$480.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna Commercial |
$511.28
|
| Rate for Payer: First Health Commercial |
$585.20
|
| Rate for Payer: Humana Commercial |
$523.60
|
| Rate for Payer: Humana KY Medicaid |
$211.84
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$454.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.08
|
| Rate for Payer: Ohio Health Group HMO |
$462.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.96
|
| Rate for Payer: PHCS Commercial |
$591.36
|
| Rate for Payer: United Healthcare All Payer |
$542.08
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
761P2503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$41.23
|
| Rate for Payer: Humana Medicaid |
$23.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.39
|
| Rate for Payer: Molina Healthcare Passport |
$23.91
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$27.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.15
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761T2502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$41.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$21.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$37.52
|
| Rate for Payer: Humana Medicaid |
$21.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.21
|
| Rate for Payer: Molina Healthcare Passport |
$21.77
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.99
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761T2502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761P2502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$41.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$21.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$37.52
|
| Rate for Payer: Humana Medicaid |
$21.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.21
|
| Rate for Payer: Molina Healthcare Passport |
$21.77
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.99
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.40
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$116.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$116.93
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$118.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.40
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
NEG PRESS WND THER >50CM DISP
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
76102505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$420.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$453.18
|
| Rate for Payer: First Health Commercial |
$518.70
|
| Rate for Payer: Humana Commercial |
$464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$447.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.48
|
| Rate for Payer: Ohio Health Group HMO |
$409.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.26
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
