|
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 |
$4,111.12 |
| Rate for Payer: Aetna Commercial |
$966.37
|
| Rate for Payer: Ambetter Exchange |
$669.58
|
| Rate for Payer: Anthem Medicaid |
$330.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$669.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$669.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$803.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$669.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.58
|
| 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 |
$870.45
|
| Rate for Payer: UHCCP Medicaid |
$2,398.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$669.58
|
|
|
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 |
$4,992.00 |
| Rate for Payer: Aetna Commercial |
$1,328.68
|
| Rate for Payer: Ambetter Exchange |
$929.11
|
| Rate for Payer: Anthem Medicaid |
$571.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,114.93
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$929.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.11
|
| 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 |
$1,207.84
|
| Rate for Payer: UHCCP Medicaid |
$2,912.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.11
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$8,320.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,496.00 |
| 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 |
$6,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,238.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,740.80
|
| Rate for Payer: PHCS Commercial |
$7,987.20
|
| Rate for Payer: United Healthcare All Payer |
$7,321.60
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$6,851.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,356.36 |
| 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 |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$5,481.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,961.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.79
|
| 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 |
$2,055.56 |
| 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 |
$5,481.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,961.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.79
|
| Rate for Payer: PHCS Commercial |
$6,577.80
|
| Rate for Payer: United Healthcare All Payer |
$6,029.65
|
|
|
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 |
$3,698.40 |
| Rate for Payer: Aetna Commercial |
$1,578.76
|
| Rate for Payer: Ambetter Exchange |
$1,089.38
|
| Rate for Payer: Anthem Medicaid |
$739.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,089.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,089.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,307.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,089.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.38
|
| 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 |
$1,416.19
|
| Rate for Payer: UHCCP Medicaid |
$2,157.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,089.38
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$8,320.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
76100232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,861.25 |
| 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 |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,489.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| 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 |
$3,382.66
|
| 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 |
$4,059.19
|
| 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 |
$6,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,238.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,740.80
|
| Rate for Payer: PHCS Commercial |
$7,987.20
|
| Rate for Payer: United Healthcare All Payer |
$7,321.60
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
OP
|
$6,164.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
76100233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,119.80 |
| 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 |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,807.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| 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 |
$3,382.66
|
| 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 |
$4,059.19
|
| 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 |
$4,931.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,362.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,253.16
|
| Rate for Payer: PHCS Commercial |
$5,917.44
|
| Rate for Payer: United Healthcare All Payer |
$5,424.32
|
|
|
REMOVE SACRUM PRESSURE SORE
|
Facility
|
IP
|
$6,164.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
76100233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,849.20 |
| 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 |
$4,931.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,362.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,253.16
|
| 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
|
$1,600.00
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
761P0231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.52 |
| Max. Negotiated Rate |
$966.37 |
| Rate for Payer: Aetna Commercial |
$966.37
|
| Rate for Payer: Ambetter Exchange |
$669.58
|
| Rate for Payer: Anthem Medicaid |
$330.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$669.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$669.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$803.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$669.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.58
|
| 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 |
$870.45
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$669.58
|
|
|
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: Ambetter Exchange |
$929.11
|
| Rate for Payer: Anthem Medicaid |
$571.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,114.93
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$929.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.11
|
| 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 |
$1,207.84
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.11
|
|
|
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 |
$1,578.76 |
| Rate for Payer: Aetna Commercial |
$1,578.76
|
| Rate for Payer: Ambetter Exchange |
$1,089.38
|
| Rate for Payer: Anthem Medicaid |
$739.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,089.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,089.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,307.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,089.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.38
|
| 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 |
$1,416.19
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,089.38
|
|
|
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 |
$2,472.64 |
| 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 |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,608.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| 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 |
$3,382.66
|
| 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 |
$4,059.19
|
| 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 |
$5,752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,255.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,961.10
|
| 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 |
$1,806.12 |
| 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 |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$4,201.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,569.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,623.79
|
| Rate for Payer: PHCS Commercial |
$5,041.80
|
| Rate for Payer: United Healthcare All Payer |
$4,621.65
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$5,251.87
|
|
|
Service Code
|
HCPCS 15931
|
| Hospital Charge Code |
761T0231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,575.56 |
| Max. Negotiated Rate |
$5,041.80 |
| Rate for Payer: Aetna Commercial |
$4,043.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.46
|
| 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: 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 |
$1,575.56
|
| 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 |
$4,201.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,569.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,623.79
|
| Rate for Payer: PHCS Commercial |
$5,041.80
|
| Rate for Payer: United Healthcare All Payer |
$4,621.65
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$7,190.00
|
|
|
Service Code
|
HCPCS 15934
|
| Hospital Charge Code |
761T0232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,157.00 |
| Max. Negotiated Rate |
$6,902.40 |
| Rate for Payer: Aetna Commercial |
$5,536.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,608.20
|
| 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: 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 |
$2,157.00
|
| 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 |
$5,752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,255.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,961.10
|
| 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
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
761T0233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,466.39 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem Medicaid |
$1,466.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| 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 |
$3,382.66
|
| 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 |
$4,059.19
|
| 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 |
$3,411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,709.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.16
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15935
|
| Hospital Charge Code |
761T0233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,279.20 |
| Max. Negotiated Rate |
$4,093.44 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| 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: 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 |
$1,279.20
|
| 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 |
$3,411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,709.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.16
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 54415
|
| Hospital Charge Code |
76102824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
REMOVE SELF-CONTD PENIS PROS
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 54415
|
| Hospital Charge Code |
76102824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.50 |
| Max. Negotiated Rate |
$853.65 |
| Rate for Payer: Aetna Commercial |
$853.65
|
| Rate for Payer: Ambetter Exchange |
$503.63
|
| Rate for Payer: Anthem Medicaid |
$387.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$604.36
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$755.03
|
| Rate for Payer: Healthspan PPO |
$826.55
|
| Rate for Payer: Humana Medicaid |
$387.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$395.59
|
| Rate for Payer: Molina Healthcare Passport |
$387.83
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.72
|
| Rate for Payer: UHCCP Medicaid |
$185.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$391.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.63
|
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 54415
|
| Hospital Charge Code |
76102824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
REMOVE SHOULDER BONE PART
|
Professional
|
Both
|
$1,159.00
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna Commercial |
$878.21
|
| Rate for Payer: Ambetter Exchange |
$590.22
|
| Rate for Payer: Anthem Medicaid |
$425.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$590.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$708.26
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cigna Commercial |
$970.00
|
| Rate for Payer: Healthspan PPO |
$795.47
|
| Rate for Payer: Humana Medicaid |
$425.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$747.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$590.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$433.63
|
| Rate for Payer: Molina Healthcare Passport |
$425.13
|
| Rate for Payer: Multiplan PHCS |
$695.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$767.29
|
| Rate for Payer: UHCCP Medicaid |
$405.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$429.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$590.22
|
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
IP
|
$1,159.00
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.70 |
| Max. Negotiated Rate |
$1,112.64 |
| Rate for Payer: Aetna Commercial |
$892.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.02
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cigna Commercial |
$961.97
|
| Rate for Payer: First Health Commercial |
$1,101.05
|
| Rate for Payer: Humana Commercial |
$985.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.92
|
| Rate for Payer: Ohio Health Group HMO |
$869.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.71
|
| Rate for Payer: PHCS Commercial |
$1,112.64
|
| Rate for Payer: United Healthcare All Payer |
$1,019.92
|
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
OP
|
$1,159.00
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
76100447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.58 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$892.43
|
| Rate for Payer: Anthem Medicaid |
$398.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cigna Commercial |
$961.97
|
| Rate for Payer: First Health Commercial |
$1,101.05
|
| Rate for Payer: Humana Commercial |
$985.15
|
| Rate for Payer: Humana KY Medicaid |
$398.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$402.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.92
|
| Rate for Payer: Ohio Health Group HMO |
$869.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.71
|
| Rate for Payer: PHCS Commercial |
$1,112.64
|
| Rate for Payer: United Healthcare All Payer |
$1,019.92
|
|
|
REMOVE SHOULDER BONE PART(P
|
Professional
|
Both
|
$1,159.00
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
761P0447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.65 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna Commercial |
$878.21
|
| Rate for Payer: Ambetter Exchange |
$590.22
|
| Rate for Payer: Anthem Medicaid |
$425.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$590.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$708.26
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cash Price |
$579.50
|
| Rate for Payer: Cigna Commercial |
$970.00
|
| Rate for Payer: Healthspan PPO |
$795.47
|
| Rate for Payer: Humana Medicaid |
$425.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$747.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$590.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$433.63
|
| Rate for Payer: Molina Healthcare Passport |
$425.13
|
| Rate for Payer: Multiplan PHCS |
$695.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$767.29
|
| Rate for Payer: UHCCP Medicaid |
$405.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$429.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$590.22
|
|
