|
DEBEXT GENIT PERIN ABDOM WALL
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 11006
|
| Hospital Charge Code |
76100021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.11 |
| Max. Negotiated Rate |
$1,005.12 |
| Rate for Payer: Aetna Commercial |
$806.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$816.66
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$869.01
|
| Rate for Payer: First Health Commercial |
$994.65
|
| Rate for Payer: Humana Commercial |
$889.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$858.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$772.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$921.36
|
| Rate for Payer: Ohio Health Group HMO |
$785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.57
|
| Rate for Payer: PHCS Commercial |
$1,005.12
|
| Rate for Payer: United Healthcare All Payer |
$921.36
|
|
|
DEBEXT GENIT PERIN ABDOM WALL
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 11006
|
| Hospital Charge Code |
76100021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.11 |
| Max. Negotiated Rate |
$1,005.12 |
| Rate for Payer: Aetna Commercial |
$806.19
|
| Rate for Payer: Anthem Medicaid |
$360.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$816.66
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$869.01
|
| Rate for Payer: First Health Commercial |
$994.65
|
| Rate for Payer: Humana Commercial |
$889.95
|
| Rate for Payer: Humana KY Medicaid |
$360.06
|
| Rate for Payer: Kentucky WC Medicaid |
$363.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$858.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$772.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$367.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$921.36
|
| Rate for Payer: Ohio Health Group HMO |
$785.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.57
|
| Rate for Payer: PHCS Commercial |
$1,005.12
|
| Rate for Payer: United Healthcare All Payer |
$921.36
|
|
|
DEBEXT GENIT PERIN ABDOM WALL
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 11006
|
| Hospital Charge Code |
76100021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.45 |
| Max. Negotiated Rate |
$1,079.67 |
| Rate for Payer: Aetna Commercial |
$1,079.67
|
| Rate for Payer: Anthem Medicaid |
$531.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,047.00
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,021.15
|
| Rate for Payer: Healthspan PPO |
$863.30
|
| Rate for Payer: Humana Medicaid |
$531.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.67
|
| Rate for Payer: Molina Healthcare Passport |
$531.05
|
| Rate for Payer: Multiplan PHCS |
$628.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$732.90
|
| Rate for Payer: UHCCP Medicaid |
$366.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.36
|
|
|
DEBEXT GENIT PERIN ABDOM WAL(P
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 11006
|
| Hospital Charge Code |
761P0021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.45 |
| Max. Negotiated Rate |
$1,079.67 |
| Rate for Payer: Aetna Commercial |
$1,079.67
|
| Rate for Payer: Anthem Medicaid |
$531.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,047.00
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,021.15
|
| Rate for Payer: Healthspan PPO |
$863.30
|
| Rate for Payer: Humana Medicaid |
$531.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.67
|
| Rate for Payer: Molina Healthcare Passport |
$531.05
|
| Rate for Payer: Multiplan PHCS |
$628.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$732.90
|
| Rate for Payer: UHCCP Medicaid |
$366.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.36
|
|
|
DEBR BONE 1ST 20 SQ CM OR <
|
Facility
|
IP
|
$3,818.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.34 |
| Max. Negotiated Rate |
$3,665.28 |
| Rate for Payer: Aetna Commercial |
$2,939.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,978.04
|
| Rate for Payer: Cash Price |
$1,909.00
|
| Rate for Payer: Cigna Commercial |
$3,168.94
|
| Rate for Payer: First Health Commercial |
$3,627.10
|
| Rate for Payer: Humana Commercial |
$3,245.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,130.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,817.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,145.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,359.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$763.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,183.58
|
| Rate for Payer: PHCS Commercial |
$3,665.28
|
| Rate for Payer: United Healthcare All Payer |
$3,359.84
|
|
|
DEBR BONE 1ST 20 SQ CM OR <
|
Facility
|
OP
|
$3,818.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.34 |
| Max. Negotiated Rate |
$3,665.28 |
| Rate for Payer: Aetna Commercial |
$2,939.86
|
| Rate for Payer: Anthem Medicaid |
$1,313.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,978.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,909.00
|
| Rate for Payer: Cash Price |
$1,909.00
|
| Rate for Payer: Cigna Commercial |
$3,168.94
|
| Rate for Payer: First Health Commercial |
$3,627.10
|
| Rate for Payer: Humana Commercial |
$3,245.30
|
| Rate for Payer: Humana KY Medicaid |
$1,313.01
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,326.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,130.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,817.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,339.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,359.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$763.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,183.58
|
| Rate for Payer: PHCS Commercial |
$3,665.28
|
| Rate for Payer: United Healthcare All Payer |
$3,359.84
|
|
|
DEBR BONE 1ST 20 SQ CM OR <
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna Commercial |
$463.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.20
|
| Rate for Payer: Anthem Medicaid |
$154.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,818.00
|
| Rate for Payer: Cash Price |
$1,909.00
|
| Rate for Payer: Cash Price |
$1,909.00
|
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Healthspan PPO |
$417.47
|
| Rate for Payer: Humana Medicaid |
$154.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.54
|
| Rate for Payer: Molina Healthcare Passport |
$154.45
|
| Rate for Payer: Multiplan PHCS |
$2,290.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,672.60
|
| Rate for Payer: UHCCP Medicaid |
$122.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$155.99
|
|
|
DEBR BONE 1ST 20 SQ CM OR <(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761P0028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$463.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.20
|
| Rate for Payer: Anthem Medicaid |
$154.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Healthspan PPO |
$417.47
|
| Rate for Payer: Humana Medicaid |
$154.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.54
|
| Rate for Payer: Molina Healthcare Passport |
$154.45
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$122.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$155.99
|
|
|
DEBR BONE 1ST 20 SQ CM OR <(T
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761T0028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.84 |
| Max. Negotiated Rate |
$3,041.28 |
| Rate for Payer: Aetna Commercial |
$2,439.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.04
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cigna Commercial |
$2,629.44
|
| Rate for Payer: First Health Commercial |
$3,009.60
|
| Rate for Payer: Humana Commercial |
$2,692.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,597.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,787.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.08
|
| Rate for Payer: PHCS Commercial |
$3,041.28
|
| Rate for Payer: United Healthcare All Payer |
$2,787.84
|
|
|
DEBR BONE 1ST 20 SQ CM OR <(T
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761T0028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.84 |
| Max. Negotiated Rate |
$3,041.28 |
| Rate for Payer: Aetna Commercial |
$2,439.36
|
| Rate for Payer: Anthem Medicaid |
$1,089.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Cigna Commercial |
$2,629.44
|
| Rate for Payer: First Health Commercial |
$3,009.60
|
| Rate for Payer: Humana Commercial |
$2,692.80
|
| Rate for Payer: Humana KY Medicaid |
$1,089.48
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,597.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,111.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,787.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.08
|
| Rate for Payer: PHCS Commercial |
$3,041.28
|
| Rate for Payer: United Healthcare All Payer |
$2,787.84
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761T0031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$2,025.60 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.80
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cigna Commercial |
$1,751.30
|
| Rate for Payer: First Health Commercial |
$2,004.50
|
| Rate for Payer: Humana Commercial |
$1,793.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.10
|
| Rate for Payer: PHCS Commercial |
$2,025.60
|
| Rate for Payer: United Healthcare All Payer |
$1,856.80
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Professional
|
Both
|
$2,255.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.32
|
| Rate for Payer: Anthem Medicaid |
$57.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,255.00
|
| Rate for Payer: Cash Price |
$1,127.50
|
| Rate for Payer: Cash Price |
$1,127.50
|
| Rate for Payer: Cigna Commercial |
$112.54
|
| Rate for Payer: Healthspan PPO |
$85.25
|
| Rate for Payer: Humana Medicaid |
$57.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.02
|
| Rate for Payer: Molina Healthcare Passport |
$57.86
|
| Rate for Payer: Multiplan PHCS |
$1,353.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,578.50
|
| Rate for Payer: UHCCP Medicaid |
$51.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.44
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761T0031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$2,025.60 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Anthem Medicaid |
$725.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.80
|
| Rate for Payer: Cash Price |
$1,055.00
|
| Rate for Payer: Cigna Commercial |
$1,751.30
|
| Rate for Payer: First Health Commercial |
$2,004.50
|
| Rate for Payer: Humana Commercial |
$1,793.50
|
| Rate for Payer: Humana KY Medicaid |
$725.63
|
| Rate for Payer: Kentucky WC Medicaid |
$733.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.10
|
| Rate for Payer: PHCS Commercial |
$2,025.60
|
| Rate for Payer: United Healthcare All Payer |
$1,856.80
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$2,164.80 |
| Rate for Payer: Aetna Commercial |
$1,736.35
|
| Rate for Payer: Anthem Medicaid |
$775.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,758.90
|
| Rate for Payer: Cash Price |
$1,127.50
|
| Rate for Payer: Cigna Commercial |
$1,871.65
|
| Rate for Payer: First Health Commercial |
$2,142.25
|
| Rate for Payer: Humana Commercial |
$1,916.75
|
| Rate for Payer: Humana KY Medicaid |
$775.49
|
| Rate for Payer: Kentucky WC Medicaid |
$783.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,849.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,664.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$791.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,984.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,691.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.05
|
| Rate for Payer: PHCS Commercial |
$2,164.80
|
| Rate for Payer: United Healthcare All Payer |
$1,984.40
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761P0031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.32
|
| Rate for Payer: Anthem Medicaid |
$57.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$112.54
|
| Rate for Payer: Healthspan PPO |
$85.25
|
| Rate for Payer: Humana Medicaid |
$57.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.02
|
| Rate for Payer: Molina Healthcare Passport |
$57.86
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.50
|
| Rate for Payer: UHCCP Medicaid |
$51.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.44
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$2,164.80 |
| Rate for Payer: Aetna Commercial |
$1,736.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,758.90
|
| Rate for Payer: Cash Price |
$1,127.50
|
| Rate for Payer: Cigna Commercial |
$1,871.65
|
| Rate for Payer: First Health Commercial |
$2,142.25
|
| Rate for Payer: Humana Commercial |
$1,916.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,849.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,664.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,984.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,691.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.05
|
| Rate for Payer: PHCS Commercial |
$2,164.80
|
| Rate for Payer: United Healthcare All Payer |
$1,984.40
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10%
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10%
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10%
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
76100017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10%
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
76100017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.73
|
| Rate for Payer: Anthem Medicaid |
$33.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Healthspan PPO |
$60.79
|
| Rate for Payer: Humana Medicaid |
$33.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.70
|
| Rate for Payer: Molina Healthcare Passport |
$33.04
|
| Rate for Payer: Multiplan PHCS |
$505.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$589.40
|
| Rate for Payer: UHCCP Medicaid |
$21.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.37
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10%
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
76100017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
761P0017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.73
|
| Rate for Payer: Anthem Medicaid |
$33.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Healthspan PPO |
$60.79
|
| Rate for Payer: Humana Medicaid |
$33.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.70
|
| Rate for Payer: Molina Healthcare Passport |
$33.04
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$21.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.37
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10(T
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
761T0017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DEBRIDE EXT ECZEM SKIN TO 10(T
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
761T0017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
OP
|
$3,102.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
761T0023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.26 |
| Max. Negotiated Rate |
$2,977.92 |
| Rate for Payer: Aetna Commercial |
$2,388.54
|
| Rate for Payer: Anthem Medicaid |
$1,066.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,419.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,551.00
|
| Rate for Payer: Cash Price |
$1,551.00
|
| Rate for Payer: Cigna Commercial |
$2,574.66
|
| Rate for Payer: First Health Commercial |
$2,946.90
|
| Rate for Payer: Humana Commercial |
$2,636.70
|
| Rate for Payer: Humana KY Medicaid |
$1,066.78
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,077.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,543.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,289.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,729.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,326.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.62
|
| Rate for Payer: PHCS Commercial |
$2,977.92
|
| Rate for Payer: United Healthcare All Payer |
$2,729.76
|
|
