|
REMOVE RENAL TUBE W/FLUORO (P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761P2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.46
|
| Rate for Payer: Anthem Medicaid |
$43.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$82.26
|
| Rate for Payer: Healthspan PPO |
$405.68
|
| Rate for Payer: Humana Medicaid |
$43.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.77
|
| Rate for Payer: Molina Healthcare Passport |
$43.89
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$42.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.33
|
|
|
REMOVE RENAL TUBE W/FLUORO (T
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761T2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.25 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem Medicaid |
$730.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Humana KY Medicaid |
$730.79
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$738.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.75
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
REMOVE RENAL TUBE W/FLUORO (T
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761T2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.25 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.75
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$24,421.07 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,443.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,421.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,548.89
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$17,443.62
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,932.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.75 |
| Max. Negotiated Rate |
$1,410.99 |
| Rate for Payer: Aetna Commercial |
$1,410.99
|
| Rate for Payer: Anthem Medicaid |
$656.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$1,342.62
|
| Rate for Payer: Healthspan PPO |
$1,366.20
|
| Rate for Payer: Humana Medicaid |
$656.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,174.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.18
|
| Rate for Payer: Molina Healthcare Passport |
$656.06
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.62
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Anthem Medicaid |
$271.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$629.48
|
| Rate for Payer: Healthspan PPO |
$422.88
|
| Rate for Payer: Humana Medicaid |
$271.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.87
|
| Rate for Payer: Molina Healthcare Passport |
$271.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.15
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE&REPLACE PM GEN SINGL(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
761P1258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Anthem Medicaid |
$271.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$629.48
|
| Rate for Payer: Healthspan PPO |
$422.88
|
| Rate for Payer: Humana Medicaid |
$271.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.87
|
| Rate for Payer: Molina Healthcare Passport |
$271.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.15
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
76100233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.32 |
| Max. Negotiated Rate |
$5,917.44 |
| Rate for Payer: Aetna Commercial |
$4,746.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,807.92
|
| Rate for Payer: Cash Price |
$3,082.00
|
| Rate for Payer: Cigna Commercial |
$5,116.12
|
| Rate for Payer: First Health Commercial |
$5,855.80
|
| Rate for Payer: Humana Commercial |
$5,239.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,054.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,549.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,849.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,424.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,623.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,232.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.84
|
| Rate for Payer: PHCS Commercial |
$5,917.44
|
| Rate for Payer: United Healthcare All Payer |
$5,424.32
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$8,320.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$7,987.20 |
| Rate for Payer: Aetna Commercial |
$6,406.40
|
| Rate for Payer: Anthem Medicaid |
$2,861.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,489.60
|
| 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 |
$4,160.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cigna Commercial |
$6,905.60
|
| Rate for Payer: First Health Commercial |
$7,904.00
|
| Rate for Payer: Humana Commercial |
$7,072.00
|
| Rate for Payer: Humana KY Medicaid |
$2,861.25
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,822.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,140.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,918.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,321.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.20
|
| Rate for Payer: PHCS Commercial |
$7,987.20
|
| Rate for Payer: United Healthcare All Payer |
$7,321.60
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Professional
|
Both
|
$8,320.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.06 |
| Max. Negotiated Rate |
$8,320.00 |
| Rate for Payer: Aetna Commercial |
$1,328.68
|
| Rate for Payer: Anthem Medicaid |
$571.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,320.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cigna Commercial |
$1,259.47
|
| Rate for Payer: Healthspan PPO |
$1,062.40
|
| Rate for Payer: Humana Medicaid |
$571.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,155.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.48
|
| Rate for Payer: Molina Healthcare Passport |
$571.06
|
| Rate for Payer: Multiplan PHCS |
$4,992.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,824.00
|
| Rate for Payer: UHCCP Medicaid |
$2,912.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.77
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Professional
|
Both
|
$6,164.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
76100233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.57 |
| Max. Negotiated Rate |
$6,164.00 |
| Rate for Payer: Aetna Commercial |
$1,578.76
|
| Rate for Payer: Anthem Medicaid |
$739.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,164.00
|
| Rate for Payer: Cash Price |
$3,082.00
|
| Rate for Payer: Cash Price |
$3,082.00
|
| Rate for Payer: Cigna Commercial |
$1,515.79
|
| Rate for Payer: Healthspan PPO |
$1,262.36
|
| Rate for Payer: Humana Medicaid |
$739.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,366.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$754.36
|
| Rate for Payer: Molina Healthcare Passport |
$739.57
|
| Rate for Payer: Multiplan PHCS |
$3,698.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,314.80
|
| Rate for Payer: UHCCP Medicaid |
$2,157.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.97
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$6,851.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$890.74 |
| Max. Negotiated Rate |
$6,577.80 |
| Rate for Payer: Aetna Commercial |
$5,275.94
|
| Rate for Payer: Anthem Medicaid |
$2,356.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,425.94
|
| Rate for Payer: Cash Price |
$3,425.94
|
| Rate for Payer: Cigna Commercial |
$5,687.05
|
| Rate for Payer: First Health Commercial |
$6,509.28
|
| Rate for Payer: Humana Commercial |
$5,824.09
|
| Rate for Payer: Humana KY Medicaid |
$2,356.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,380.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,403.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,138.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.08
|
| Rate for Payer: PHCS Commercial |
$6,577.80
|
| Rate for Payer: United Healthcare All Payer |
$6,029.65
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$6,851.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$890.74 |
| Max. Negotiated Rate |
$6,577.80 |
| Rate for Payer: Aetna Commercial |
$5,275.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.46
|
| Rate for Payer: Cash Price |
$3,425.94
|
| Rate for Payer: Cigna Commercial |
$5,687.05
|
| Rate for Payer: First Health Commercial |
$6,509.28
|
| Rate for Payer: Humana Commercial |
$5,824.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,138.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.08
|
| Rate for Payer: PHCS Commercial |
$6,577.80
|
| Rate for Payer: United Healthcare All Payer |
$6,029.65
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$8,320.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$7,987.20 |
| Rate for Payer: Aetna Commercial |
$6,406.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,489.60
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cigna Commercial |
$6,905.60
|
| Rate for Payer: First Health Commercial |
$7,904.00
|
| Rate for Payer: Humana Commercial |
$7,072.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,822.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,140.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,321.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,579.20
|
| Rate for Payer: PHCS Commercial |
$7,987.20
|
| Rate for Payer: United Healthcare All Payer |
$7,321.60
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Professional
|
Both
|
$6,851.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.52 |
| Max. Negotiated Rate |
$6,851.87 |
| Rate for Payer: Aetna Commercial |
$966.37
|
| Rate for Payer: Anthem Medicaid |
$330.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,851.87
|
| Rate for Payer: Cash Price |
$3,425.94
|
| Rate for Payer: Cash Price |
$3,425.94
|
| Rate for Payer: Cigna Commercial |
$911.40
|
| Rate for Payer: Healthspan PPO |
$772.70
|
| Rate for Payer: Humana Medicaid |
$330.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$840.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$337.13
|
| Rate for Payer: Molina Healthcare Passport |
$330.52
|
| Rate for Payer: Multiplan PHCS |
$4,111.12
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,796.31
|
| Rate for Payer: UHCCP Medicaid |
$2,398.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.83
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
76100233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.32 |
| Max. Negotiated Rate |
$5,917.44 |
| Rate for Payer: Aetna Commercial |
$4,746.28
|
| Rate for Payer: Anthem Medicaid |
$2,119.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,807.92
|
| 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 |
$3,082.00
|
| Rate for Payer: Cash Price |
$3,082.00
|
| Rate for Payer: Cigna Commercial |
$5,116.12
|
| Rate for Payer: First Health Commercial |
$5,855.80
|
| Rate for Payer: Humana Commercial |
$5,239.40
|
| Rate for Payer: Humana KY Medicaid |
$2,119.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,141.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,054.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,549.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,162.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,424.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,623.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,232.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.84
|
| Rate for Payer: PHCS Commercial |
$5,917.44
|
| Rate for Payer: United Healthcare All Payer |
$5,424.32
|
|
|
REMOVE SACRUM PRESSURE SORE(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
761P0233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$1,578.76
|
| Rate for Payer: Anthem Medicaid |
$739.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,515.79
|
| Rate for Payer: Healthspan PPO |
$1,262.36
|
| Rate for Payer: Humana Medicaid |
$739.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,366.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$754.36
|
| Rate for Payer: Molina Healthcare Passport |
$739.57
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.97
|
|
|
REMOVE SACRUM PRESSURE SORE(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
761P0231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.52 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$966.37
|
| Rate for Payer: Anthem Medicaid |
$330.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$911.40
|
| Rate for Payer: Healthspan PPO |
$772.70
|
| Rate for Payer: Humana Medicaid |
$330.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$840.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$337.13
|
| Rate for Payer: Molina Healthcare Passport |
$330.52
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.83
|
|
|
REMOVE SACRUM PRESSURE SORE(P
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
761P0232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,328.68 |
| Rate for Payer: Aetna Commercial |
$1,328.68
|
| Rate for Payer: Anthem Medicaid |
$571.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$1,259.47
|
| Rate for Payer: Healthspan PPO |
$1,062.40
|
| Rate for Payer: Humana Medicaid |
$571.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,155.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.48
|
| Rate for Payer: Molina Healthcare Passport |
$571.06
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.77
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
OP
|
$7,190.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
761T0232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.70 |
| Max. Negotiated Rate |
$6,902.40 |
| Rate for Payer: Aetna Commercial |
$5,536.30
|
| Rate for Payer: Anthem Medicaid |
$2,472.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,608.20
|
| 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 |
$3,595.00
|
| Rate for Payer: Cash Price |
$3,595.00
|
| Rate for Payer: Cigna Commercial |
$5,967.70
|
| Rate for Payer: First Health Commercial |
$6,830.50
|
| Rate for Payer: Humana Commercial |
$6,111.50
|
| Rate for Payer: Humana KY Medicaid |
$2,472.64
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,306.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,522.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,327.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.90
|
| Rate for Payer: PHCS Commercial |
$6,902.40
|
| Rate for Payer: United Healthcare All Payer |
$6,327.20
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
OP
|
$5,251.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
761T0231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.74 |
| Max. Negotiated Rate |
$5,041.80 |
| Rate for Payer: Aetna Commercial |
$4,043.94
|
| Rate for Payer: Anthem Medicaid |
$1,806.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,625.94
|
| Rate for Payer: Cash Price |
$2,625.94
|
| Rate for Payer: Cigna Commercial |
$4,359.05
|
| Rate for Payer: First Health Commercial |
$4,989.28
|
| Rate for Payer: Humana Commercial |
$4,464.09
|
| Rate for Payer: Humana KY Medicaid |
$1,806.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,842.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,938.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.08
|
| Rate for Payer: PHCS Commercial |
$5,041.80
|
| Rate for Payer: United Healthcare All Payer |
$4,621.65
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
761T0233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.32 |
| Max. Negotiated Rate |
$4,343.37 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem Medicaid |
$1,466.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| 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 |
$2,132.00
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cigna Commercial |
$3,539.12
|
| Rate for Payer: First Health Commercial |
$4,050.80
|
| Rate for Payer: Humana Commercial |
$3,624.40
|
| Rate for Payer: Humana KY Medicaid |
$1,466.39
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,495.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.84
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
