|
DEBRIDEMENT NON SELECTIVE(T
|
Facility
|
IP
|
$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 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 OF NAIL(S) BY ANY METHOD(S); 6 OR MORE
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 11721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
|
|
DEBRIDEMENT SEL < EQ 20SQ CM
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
43000029
|
|
Hospital Revenue Code
|
430
|
| 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 SEL < EQ 20SQ CM
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
43000029
|
|
Hospital Revenue Code
|
430
|
| 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, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.44
|
| Rate for Payer: Anthem Medicaid |
$18.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Healthspan PPO |
$35.02
|
| Rate for Payer: Humana Medicaid |
$18.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare Passport |
$18.20
|
| Rate for Payer: Multiplan PHCS |
$116.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.80
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.38
|
|
|
DEBRIDE NAIL ANY METHOD 1-5(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
761P0094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.44
|
| Rate for Payer: Anthem Medicaid |
$18.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Healthspan PPO |
$35.02
|
| Rate for Payer: Humana Medicaid |
$18.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare Passport |
$18.20
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.38
|
|
|
DEBRIDE NAIL ANY METHOD 1-5(T
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
761T0094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
DEBRIDE NAIL ANY METHOD 1-5(T
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
761T0094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
DEBRIDE SKIN EACH ADD 10% BODY
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
76100018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
DEBRIDE SKIN EACH ADD 10% BODY
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
76100018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
DEBRIDE SKIN EACH ADD 10% BODY
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
761P0018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.52
|
| Rate for Payer: Anthem Medicaid |
$17.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$30.88
|
| Rate for Payer: Healthspan PPO |
$25.97
|
| Rate for Payer: Humana Medicaid |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.52
|
| Rate for Payer: Molina Healthcare Passport |
$17.18
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.35
|
|
|
DEBRIDE SKIN EACH ADD 10% BODY
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
76100018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.52
|
| Rate for Payer: Anthem Medicaid |
$17.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$30.88
|
| Rate for Payer: Healthspan PPO |
$25.97
|
| Rate for Payer: Humana Medicaid |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.52
|
| Rate for Payer: Molina Healthcare Passport |
$17.18
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.35
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna Commercial |
$3,072.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,112.20
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$3,311.70
|
| Rate for Payer: First Health Commercial |
$3,790.50
|
| Rate for Payer: Humana Commercial |
$3,391.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,944.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,511.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,992.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.90
|
| Rate for Payer: PHCS Commercial |
$3,830.40
|
| Rate for Payer: United Healthcare All Payer |
$3,511.20
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Aetna Commercial |
$3,072.30
|
| Rate for Payer: Anthem Medicaid |
$1,372.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,112.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$3,311.70
|
| Rate for Payer: First Health Commercial |
$3,790.50
|
| Rate for Payer: Humana Commercial |
$3,391.50
|
| Rate for Payer: Humana KY Medicaid |
$1,372.16
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,386.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,271.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,944.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,511.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,992.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.90
|
| Rate for Payer: PHCS Commercial |
$3,830.40
|
| Rate for Payer: United Healthcare All Payer |
$3,511.20
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Professional
|
Both
|
$3,990.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$151.06
|
| Rate for Payer: Anthem Medicaid |
$283.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,990.00
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: Healthspan PPO |
$584.69
|
| Rate for Payer: Humana Medicaid |
$283.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.68
|
| Rate for Payer: Molina Healthcare Passport |
$283.02
|
| Rate for Payer: Multiplan PHCS |
$2,394.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,793.00
|
| Rate for Payer: UHCCP Medicaid |
$158.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.85
|
|
|
DEBRIDE SKIN MUSC AT FX SIT(P
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
761P0024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$584.69 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$151.06
|
| Rate for Payer: Anthem Medicaid |
$283.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.00
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: Healthspan PPO |
$584.69
|
| Rate for Payer: Humana Medicaid |
$283.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.68
|
| Rate for Payer: Molina Healthcare Passport |
$283.02
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$353.50
|
| Rate for Payer: UHCCP Medicaid |
$158.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.85
|
|
|
DEBRIDE SKIN MUSC AT FX SIT(T
|
Facility
|
IP
|
$3,485.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
761T0024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.05 |
| Max. Negotiated Rate |
$3,345.60 |
| Rate for Payer: Aetna Commercial |
$2,683.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.30
|
| Rate for Payer: Cash Price |
$1,742.50
|
| Rate for Payer: Cigna Commercial |
$2,892.55
|
| Rate for Payer: First Health Commercial |
$3,310.75
|
| Rate for Payer: Humana Commercial |
$2,962.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,857.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,571.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.35
|
| Rate for Payer: PHCS Commercial |
$3,345.60
|
| Rate for Payer: United Healthcare All Payer |
$3,066.80
|
|
|
DEBRIDE SKIN MUSC AT FX SIT(T
|
Facility
|
OP
|
$3,485.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
761T0024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.05 |
| Max. Negotiated Rate |
$3,345.60 |
| Rate for Payer: Aetna Commercial |
$2,683.45
|
| Rate for Payer: Anthem Medicaid |
$1,198.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,742.50
|
| Rate for Payer: Cash Price |
$1,742.50
|
| Rate for Payer: Cigna Commercial |
$2,892.55
|
| Rate for Payer: First Health Commercial |
$3,310.75
|
| Rate for Payer: Humana Commercial |
$2,962.25
|
| Rate for Payer: Humana KY Medicaid |
$1,198.49
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,857.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,571.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,222.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.35
|
| Rate for Payer: PHCS Commercial |
$3,345.60
|
| Rate for Payer: United Healthcare All Payer |
$3,066.80
|
|
|
DEBRIDMNT SEL GREAT EQ 20SQ CM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
42000072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DEBRIDMNT SEL GREAT EQ 20SQ CM
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
42000072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DEBRIDMNT SEL GREAT EQ 20SQ CM
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
43000041
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DEBRIDMNT SEL GREAT EQ 20SQ CM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
43000041
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
