|
WOLVERINE CUT. BALLOON 4*15
|
Facility
|
OP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem Medicaid |
$1,532.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Humana KY Medicaid |
$1,532.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 4*15
|
Facility
|
IP
|
$4,456.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$4,278.66 |
| Rate for Payer: Aetna Commercial |
$3,431.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.41
|
| Rate for Payer: Cash Price |
$2,228.47
|
| Rate for Payer: Cigna Commercial |
$3,699.26
|
| Rate for Payer: First Health Commercial |
$4,234.09
|
| Rate for Payer: Humana Commercial |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$891.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.65
|
| Rate for Payer: PHCS Commercial |
$4,278.66
|
| Rate for Payer: United Healthcare All Payer |
$3,922.11
|
|
|
WOLVERINE CUT. BALLOON 4*6
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem Medicaid |
$1,582.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Humana KY Medicaid |
$1,582.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WOLVERINE CUT. BALLOON 4*6
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.13 |
| Max. Negotiated Rate |
$4,416.96 |
| Rate for Payer: Aetna Commercial |
$3,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.78
|
| Rate for Payer: Cash Price |
$2,300.50
|
| Rate for Payer: Cigna Commercial |
$3,818.83
|
| Rate for Payer: First Health Commercial |
$4,370.95
|
| Rate for Payer: Humana Commercial |
$3,910.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,395.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.31
|
| Rate for Payer: PHCS Commercial |
$4,416.96
|
| Rate for Payer: United Healthcare All Payer |
$4,048.88
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
WORK CONDITIONING PT EA ADD HR
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
WORK CONDITIONING PT EA ADD HR
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
WORK CONDITION OT EA ADDTL HR
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
43000028
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
WORK CONDITION OT EA ADDTL HR
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
43000028
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
WORK & OTHER PHYSICALS
|
Professional
|
Both
|
$25.00
|
|
| Hospital Charge Code |
45000320
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$25.00
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$148.10
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
76102534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$142.18 |
| Rate for Payer: Aetna Commercial |
$114.04
|
| Rate for Payer: Anthem Medicaid |
$50.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.52
|
| Rate for Payer: Cash Price |
$74.05
|
| Rate for Payer: Cigna Commercial |
$122.92
|
| Rate for Payer: First Health Commercial |
$140.70
|
| Rate for Payer: Humana Commercial |
$125.88
|
| Rate for Payer: Humana KY Medicaid |
$50.93
|
| Rate for Payer: Kentucky WC Medicaid |
$51.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.33
|
| Rate for Payer: Ohio Health Group HMO |
$111.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.91
|
| Rate for Payer: PHCS Commercial |
$142.18
|
| Rate for Payer: United Healthcare All Payer |
$130.33
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$148.10
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
76102534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$142.18 |
| Rate for Payer: Aetna Commercial |
$114.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.52
|
| Rate for Payer: Cash Price |
$74.05
|
| Rate for Payer: Cigna Commercial |
$122.92
|
| Rate for Payer: First Health Commercial |
$140.70
|
| Rate for Payer: Humana Commercial |
$125.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.33
|
| Rate for Payer: Ohio Health Group HMO |
$111.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.91
|
| Rate for Payer: PHCS Commercial |
$142.18
|
| Rate for Payer: United Healthcare All Payer |
$130.33
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$35,110.99
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$23,825.32 |
| Max. Negotiated Rate |
$35,110.99 |
| Rate for Payer: Anthem Medicaid |
$23,825.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,079.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,110.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,857.03
|
| Rate for Payer: Humana KY Medicaid |
$23,825.32
|
| Rate for Payer: Humana Medicare Advantage |
$25,079.28
|
| Rate for Payer: Kentucky WC Medicaid |
$24,063.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,095.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,301.82
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$66,255.13
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$44,958.84 |
| Max. Negotiated Rate |
$66,255.13 |
| Rate for Payer: Anthem Medicaid |
$44,958.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47,325.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66,255.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$63,888.87
|
| Rate for Payer: Humana KY Medicaid |
$44,958.84
|
| Rate for Payer: Humana Medicare Advantage |
$47,325.09
|
| Rate for Payer: Kentucky WC Medicaid |
$45,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56,790.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,858.01
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,885.00
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$14,850.53 |
| Max. Negotiated Rate |
$21,885.00 |
| Rate for Payer: Anthem Medicaid |
$14,850.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,632.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,885.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,103.39
|
| Rate for Payer: Humana KY Medicaid |
$14,850.53
|
| Rate for Payer: Humana Medicare Advantage |
$15,632.14
|
| Rate for Payer: Kentucky WC Medicaid |
$14,999.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,758.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,147.54
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$22,047.62
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$14,960.88 |
| Max. Negotiated Rate |
$22,047.62 |
| Rate for Payer: Anthem Medicaid |
$14,960.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,748.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,047.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,260.20
|
| Rate for Payer: Humana KY Medicaid |
$14,960.88
|
| Rate for Payer: Humana Medicare Advantage |
$15,748.30
|
| Rate for Payer: Kentucky WC Medicaid |
$15,110.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,897.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,260.10
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$50,627.49
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$34,354.37 |
| Max. Negotiated Rate |
$50,627.49 |
| Rate for Payer: Anthem Medicaid |
$34,354.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36,162.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50,627.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$48,819.36
|
| Rate for Payer: Humana KY Medicaid |
$34,354.37
|
| Rate for Payer: Humana Medicare Advantage |
$36,162.49
|
| Rate for Payer: Kentucky WC Medicaid |
$34,697.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43,394.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,041.45
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,523.32
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,855.11 |
| Max. Negotiated Rate |
$14,523.32 |
| Rate for Payer: Anthem Medicaid |
$9,855.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,373.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,523.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,004.63
|
| Rate for Payer: Humana KY Medicaid |
$9,855.11
|
| Rate for Payer: Humana Medicare Advantage |
$10,373.80
|
| Rate for Payer: Kentucky WC Medicaid |
$9,953.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,448.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,052.21
|
|
|
WOUND EXPLORATION ABDOMEN
|
Facility
|
IP
|
$6,860.25
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$891.83 |
| Max. Negotiated Rate |
$6,585.84 |
| Rate for Payer: Aetna Commercial |
$5,282.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.00
|
| Rate for Payer: Cash Price |
$3,430.12
|
| Rate for Payer: Cigna Commercial |
$5,694.01
|
| Rate for Payer: First Health Commercial |
$6,517.24
|
| Rate for Payer: Humana Commercial |
$5,831.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,625.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,058.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.68
|
| Rate for Payer: PHCS Commercial |
$6,585.84
|
| Rate for Payer: United Healthcare All Payer |
$6,037.02
|
|
|
WOUND EXPLORATION ABDOMEN
|
Facility
|
OP
|
$6,860.25
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$891.83 |
| Max. Negotiated Rate |
$6,585.84 |
| Rate for Payer: Aetna Commercial |
$5,282.39
|
| Rate for Payer: Anthem Medicaid |
$2,359.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,430.12
|
| Rate for Payer: Cash Price |
$3,430.12
|
| Rate for Payer: Cigna Commercial |
$5,694.01
|
| Rate for Payer: First Health Commercial |
$6,517.24
|
| Rate for Payer: Humana Commercial |
$5,831.21
|
| Rate for Payer: Humana KY Medicaid |
$2,359.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,383.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,625.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.68
|
| Rate for Payer: PHCS Commercial |
$6,585.84
|
| Rate for Payer: United Healthcare All Payer |
$6,037.02
|
|
|
WOUND EXPLORATION ABDOMEN
|
Professional
|
Both
|
$6,860.25
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.35 |
| Max. Negotiated Rate |
$6,860.25 |
| Rate for Payer: Aetna Commercial |
$365.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.35
|
| Rate for Payer: Anthem Medicaid |
$170.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,860.25
|
| Rate for Payer: Cash Price |
$3,430.12
|
| Rate for Payer: Cash Price |
$3,430.12
|
| Rate for Payer: Cigna Commercial |
$386.13
|
| Rate for Payer: Healthspan PPO |
$578.94
|
| Rate for Payer: Humana Medicaid |
$170.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.83
|
| Rate for Payer: Molina Healthcare Passport |
$170.42
|
| Rate for Payer: Multiplan PHCS |
$4,116.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,802.18
|
| Rate for Payer: UHCCP Medicaid |
$141.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.12
|
|
|
WOUND EXPLORATION ABDOMEN(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
761P0324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.35 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$365.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.35
|
| Rate for Payer: Anthem Medicaid |
$170.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$386.13
|
| Rate for Payer: Healthspan PPO |
$578.94
|
| Rate for Payer: Humana Medicaid |
$170.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.83
|
| Rate for Payer: Molina Healthcare Passport |
$170.42
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$141.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.12
|
|
