|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.26 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem Medicaid |
$1,341.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Humana KY Medicaid |
$1,341.90
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.62
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$2,419.56
|
| 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: 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 |
$930.60
|
| 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
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.68 |
| Max. Negotiated Rate |
$3,902.00 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.68
|
| Rate for Payer: Anthem Medicaid |
$237.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,902.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$400.59
|
| Rate for Payer: Healthspan PPO |
$524.12
|
| Rate for Payer: Humana Medicaid |
$237.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.21
|
| Rate for Payer: Molina Healthcare Passport |
$237.46
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,731.40
|
| Rate for Payer: UHCCP Medicaid |
$147.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.83
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.26 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.62
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
761P0023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.68 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.68
|
| Rate for Payer: Anthem Medicaid |
$237.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$400.59
|
| Rate for Payer: Healthspan PPO |
$524.12
|
| Rate for Payer: Humana Medicaid |
$237.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.21
|
| Rate for Payer: Molina Healthcare Passport |
$237.46
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$147.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.83
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$760.35
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.11 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.39
|
| Rate for Payer: Anthem Medicaid |
$35.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.00
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$69.39
|
| Rate for Payer: Humana Medicaid |
$35.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.05
|
| Rate for Payer: Molina Healthcare Passport |
$35.34
|
| Rate for Payer: Multiplan PHCS |
$240.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.70
|
| Rate for Payer: UHCCP Medicaid |
$11.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.69
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem Medicaid |
$137.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Humana KY Medicaid |
$137.90
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.31
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.31
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
761T2499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Aetna Commercial |
$231.77
|
| Rate for Payer: Anthem Medicaid |
$103.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$249.83
|
| Rate for Payer: First Health Commercial |
$285.95
|
| Rate for Payer: Humana Commercial |
$255.85
|
| Rate for Payer: Humana KY Medicaid |
$103.51
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$104.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.88
|
| Rate for Payer: Ohio Health Group HMO |
$225.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.31
|
| Rate for Payer: PHCS Commercial |
$288.96
|
| Rate for Payer: United Healthcare All Payer |
$264.88
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
761P2499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.39
|
| Rate for Payer: Anthem Medicaid |
$35.34
|
| 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 |
$69.39
|
| Rate for Payer: Humana Medicaid |
$35.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.05
|
| Rate for Payer: Molina Healthcare Passport |
$35.34
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$11.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.69
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
761T2499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$288.96 |
| Rate for Payer: Aetna Commercial |
$231.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.78
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cigna Commercial |
$249.83
|
| Rate for Payer: First Health Commercial |
$285.95
|
| Rate for Payer: Humana Commercial |
$255.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.88
|
| Rate for Payer: Ohio Health Group HMO |
$225.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.31
|
| Rate for Payer: PHCS Commercial |
$288.96
|
| Rate for Payer: United Healthcare All Payer |
$264.88
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
45000313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.90
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Anthem Medicaid |
$8.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$390.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$47.46
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$8.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.43
|
| Rate for Payer: Molina Healthcare Passport |
$8.26
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.34
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
45000313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem Medicaid |
$134.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Humana KY Medicaid |
$134.12
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.90
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
DEBRIDEMENT NON-SELECTIVE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
43000042
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON-SELECTIVE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
43000042
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON-SELECTIVE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
42000073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON-SELECTIVE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
42000073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
DEBRIDEMENT NON SELECTIVE(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
761P2501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Anthem Medicaid |
$8.26
|
| 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 |
$47.46
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$8.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.43
|
| Rate for Payer: Molina Healthcare Passport |
$8.26
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.34
|
|
|
DEBRIDEMENT NON SELECTIVE(T
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
761T2501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
