|
NEGATIVE PRESS GREATER 50 SQCM
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42000075
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.77 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
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 |
$99.73 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
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 |
$87.00 |
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
76102504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.77 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| 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 |
42000076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| 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 |
$19.94 |
| Max. Negotiated Rate |
$252.62 |
| Rate for Payer: Ambetter Exchange |
$19.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$247.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$19.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$19.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Humana Medicaid |
$247.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$19.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.62
|
| Rate for Payer: Molina Healthcare Passport |
$247.67
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$25.92
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.94
|
|
|
NEG PRESS LESS 50CM DISP
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
76102504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| 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 |
42000076
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.77 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
761T2503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.15 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem Medicaid |
$200.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Humana KY Medicaid |
$200.15
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$202.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$502.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$508.56
|
| Rate for Payer: Cash Price |
$326.00
|
| Rate for Payer: Cigna Commercial |
$541.16
|
| Rate for Payer: First Health Commercial |
$619.40
|
| Rate for Payer: Humana Commercial |
$554.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$534.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$481.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$573.76
|
| Rate for Payer: Ohio Health Group HMO |
$489.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$521.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.88
|
| Rate for Payer: PHCS Commercial |
$625.92
|
| Rate for Payer: United Healthcare All Payer |
$573.76
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
761T2503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.60 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$502.04
|
| Rate for Payer: Anthem Medicaid |
$224.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$508.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$326.00
|
| Rate for Payer: Cash Price |
$326.00
|
| Rate for Payer: Cigna Commercial |
$541.16
|
| Rate for Payer: First Health Commercial |
$619.40
|
| Rate for Payer: Humana Commercial |
$554.20
|
| Rate for Payer: Humana KY Medicaid |
$224.22
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$226.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$534.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$481.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$573.76
|
| Rate for Payer: Ohio Health Group HMO |
$489.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$521.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.88
|
| Rate for Payer: PHCS Commercial |
$625.92
|
| Rate for Payer: United Healthcare All Payer |
$573.76
|
|
|
NEG PRESSURE WND THERAP >50 CM
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
76102503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$391.20 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Ambetter Exchange |
$25.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$29.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.06
|
| Rate for Payer: Cash Price |
$326.00
|
| Rate for Payer: Cash Price |
$326.00
|
| Rate for Payer: Cigna Commercial |
$41.23
|
| Rate for Payer: Humana Medicaid |
$29.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.65
|
| Rate for Payer: Molina Healthcare Passport |
$29.07
|
| Rate for Payer: Multiplan PHCS |
$391.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.56
|
| Rate for Payer: UHCCP Medicaid |
$27.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.05
|
|
|
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 |
$25.05 |
| Max. Negotiated Rate |
$45.34 |
| Rate for Payer: Aetna Commercial |
$45.34
|
| Rate for Payer: Ambetter Exchange |
$25.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$29.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.06
|
| 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 |
$29.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.65
|
| Rate for Payer: Molina Healthcare Passport |
$29.07
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.56
|
| Rate for Payer: UHCCP Medicaid |
$27.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.05
|
|
|
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 |
$23.13 |
| Max. Negotiated Rate |
$41.21 |
| Rate for Payer: Aetna Commercial |
$41.21
|
| Rate for Payer: Ambetter Exchange |
$23.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$32.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.76
|
| 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 |
$32.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.01
|
| Rate for Payer: Molina Healthcare Passport |
$32.36
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.07
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.13
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761T2502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761T2502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem Medicaid |
$123.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Humana KY Medicaid |
$123.46
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
NEG PRESSURE WND THERAP 50 CM<
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
76102502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$215.40 |
| Rate for Payer: Aetna Commercial |
$41.21
|
| Rate for Payer: Ambetter Exchange |
$23.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.75
|
| Rate for Payer: Anthem Medicaid |
$32.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.76
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$37.52
|
| Rate for Payer: Humana Medicaid |
$32.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.01
|
| Rate for Payer: Molina Healthcare Passport |
$32.36
|
| Rate for Payer: Multiplan PHCS |
$215.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.07
|
| Rate for Payer: UHCCP Medicaid |
$24.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.13
|
|
|
NEG PRESS WND THER >50CM DISP
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
42000077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS WND THER >50CM DISP
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
42000077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.77 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
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 |
$163.80 |
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS WND THER >50CM DISP
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
76102505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.77 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.74
|
| Rate for Payer: PHCS Commercial |
$524.16
|
| Rate for Payer: United Healthcare All Payer |
$480.48
|
|
|
NEG PRESS WND THER >50CM DISP
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
76102505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Ambetter Exchange |
$23.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$248.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.78
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Humana Medicaid |
$248.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.57
|
| Rate for Payer: Molina Healthcare Passport |
$248.60
|
| Rate for Payer: Multiplan PHCS |
$327.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.09
|
| Rate for Payer: UHCCP Medicaid |
$27.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$251.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.15
|
|
