|
DEBR BONE 1ST 20 SQ CM OR <
|
Facility
|
OP
|
$4,024.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,383.85 |
| Max. Negotiated Rate |
$3,863.04 |
| Rate for Payer: Aetna Commercial |
$3,098.48
|
| Rate for Payer: Anthem Medicaid |
$1,383.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,138.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cigna Commercial |
$3,339.92
|
| Rate for Payer: First Health Commercial |
$3,822.80
|
| Rate for Payer: Humana Commercial |
$3,420.40
|
| Rate for Payer: Humana KY Medicaid |
$1,383.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,397.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,299.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,969.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,541.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,500.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,776.56
|
| Rate for Payer: PHCS Commercial |
$3,863.04
|
| Rate for Payer: United Healthcare All Payer |
$3,541.12
|
|
|
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 |
$463.23 |
| Rate for Payer: Aetna Commercial |
$463.23
|
| Rate for Payer: Ambetter Exchange |
$212.65
|
| 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 Individual/Medicaid |
$212.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.65
|
| 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 |
$276.44
|
| Rate for Payer: UHCCP Medicaid |
$122.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$155.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.65
|
|
|
DEBR BONE 1ST 20 SQ CM OR <(T
|
Facility
|
OP
|
$3,374.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761T0028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,160.32 |
| Max. Negotiated Rate |
$3,239.04 |
| Rate for Payer: Aetna Commercial |
$2,597.98
|
| Rate for Payer: Anthem Medicaid |
$1,160.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: Cigna Commercial |
$2,800.42
|
| Rate for Payer: First Health Commercial |
$3,205.30
|
| Rate for Payer: Humana Commercial |
$2,867.90
|
| Rate for Payer: Humana KY Medicaid |
$1,160.32
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,172.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,969.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,328.06
|
| Rate for Payer: PHCS Commercial |
$3,239.04
|
| Rate for Payer: United Healthcare All Payer |
$2,969.12
|
|
|
DEBR BONE 1ST 20 SQ CM OR <(T
|
Facility
|
IP
|
$3,374.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761T0028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,012.20 |
| Max. Negotiated Rate |
$3,239.04 |
| Rate for Payer: Aetna Commercial |
$2,597.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.72
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: Cigna Commercial |
$2,800.42
|
| Rate for Payer: First Health Commercial |
$3,205.30
|
| Rate for Payer: Humana Commercial |
$2,867.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,969.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,328.06
|
| Rate for Payer: PHCS Commercial |
$3,239.04
|
| Rate for Payer: United Healthcare All Payer |
$2,969.12
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
OP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$1,841.84
|
| Rate for Payer: Anthem Medicaid |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,865.76
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: First Health Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial |
$2,033.20
|
| Rate for Payer: Humana KY Medicaid |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$830.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.48
|
| Rate for Payer: PHCS Commercial |
$2,296.32
|
| Rate for Payer: United Healthcare All Payer |
$2,104.96
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
IP
|
$2,247.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761T0031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.10 |
| Max. Negotiated Rate |
$2,157.12 |
| Rate for Payer: Aetna Commercial |
$1,730.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.66
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cigna Commercial |
$1,865.01
|
| Rate for Payer: First Health Commercial |
$2,134.65
|
| Rate for Payer: Humana Commercial |
$1,909.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,842.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,977.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.43
|
| Rate for Payer: PHCS Commercial |
$2,157.12
|
| Rate for Payer: United Healthcare All Payer |
$1,977.36
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Professional
|
Both
|
$2,392.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Ambetter Exchange |
$91.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.32
|
| Rate for Payer: Anthem Medicaid |
$77.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.06
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$112.54
|
| Rate for Payer: Healthspan PPO |
$85.25
|
| Rate for Payer: Humana Medicaid |
$77.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.68
|
| Rate for Payer: Molina Healthcare Passport |
$77.14
|
| Rate for Payer: Multiplan PHCS |
$1,435.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.24
|
| Rate for Payer: UHCCP Medicaid |
$51.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.72
|
|
|
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 |
$119.24 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Ambetter Exchange |
$91.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.32
|
| Rate for Payer: Anthem Medicaid |
$77.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.06
|
| 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 |
$77.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.68
|
| Rate for Payer: Molina Healthcare Passport |
$77.14
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.24
|
| Rate for Payer: UHCCP Medicaid |
$51.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.72
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
OP
|
$2,247.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761T0031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.10 |
| Max. Negotiated Rate |
$2,157.12 |
| Rate for Payer: Aetna Commercial |
$1,730.19
|
| Rate for Payer: Anthem Medicaid |
$772.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.66
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cigna Commercial |
$1,865.01
|
| Rate for Payer: First Health Commercial |
$2,134.65
|
| Rate for Payer: Humana Commercial |
$1,909.95
|
| Rate for Payer: Humana KY Medicaid |
$772.74
|
| Rate for Payer: Kentucky WC Medicaid |
$780.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,842.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,977.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.43
|
| Rate for Payer: PHCS Commercial |
$2,157.12
|
| Rate for Payer: United Healthcare All Payer |
$1,977.36
|
|
|
DEBR BONE UP TO EA AD 20 SQ CM
|
Facility
|
IP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
76100031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.60 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$1,841.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,865.76
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: First Health Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial |
$2,033.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.48
|
| Rate for Payer: PHCS Commercial |
$2,296.32
|
| Rate for Payer: United Healthcare All Payer |
$2,104.96
|
|
|
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 |
$252.60 |
| 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 |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
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 |
$255.17 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| 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 |
$565.60
|
| 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 |
$678.72
|
| 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 |
$593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.98
|
| 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 |
$222.60 |
| 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 |
$593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.98
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
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 |
$289.56 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| 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 |
$565.60
|
| 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 |
$678.72
|
| 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 |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| 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 |
$505.20 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Ambetter Exchange |
$25.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.73
|
| Rate for Payer: Anthem Medicaid |
$38.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| 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 |
$38.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.17
|
| Rate for Payer: Molina Healthcare Passport |
$38.40
|
| Rate for Payer: Multiplan PHCS |
$505.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.10
|
| Rate for Payer: UHCCP Medicaid |
$21.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.46
|
|
|
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 |
$70.04 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Ambetter Exchange |
$25.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.73
|
| Rate for Payer: Anthem Medicaid |
$38.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| 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 |
$38.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.17
|
| Rate for Payer: Molina Healthcare Passport |
$38.40
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.10
|
| Rate for Payer: UHCCP Medicaid |
$21.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.46
|
|
|
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 |
$255.17 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| 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 |
$565.60
|
| 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 |
$678.72
|
| 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 |
$593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.98
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
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 |
$222.60 |
| 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 |
$593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.98
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
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 |
$524.12 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Ambetter Exchange |
$260.45
|
| 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 Individual/Medicaid |
$260.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$260.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.45
|
| 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 |
$338.58
|
| Rate for Payer: UHCCP Medicaid |
$147.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.45
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,939.84 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem Medicaid |
$1,411.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Humana KY Medicaid |
$1,411.37
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,231.20 |
| Max. Negotiated Rate |
$3,939.84 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
761T0023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$991.20 |
| Max. Negotiated Rate |
$3,171.84 |
| Rate for Payer: Aetna Commercial |
$2,544.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.12
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Cigna Commercial |
$2,742.32
|
| Rate for Payer: First Health Commercial |
$3,138.80
|
| Rate for Payer: Humana Commercial |
$2,808.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,709.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,438.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,907.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,874.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.76
|
| Rate for Payer: PHCS Commercial |
$3,171.84
|
| Rate for Payer: United Healthcare All Payer |
$2,907.52
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Professional
|
Both
|
$4,104.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.68 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Ambetter Exchange |
$260.45
|
| 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 Individual/Medicaid |
$260.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.54
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$260.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.21
|
| Rate for Payer: Molina Healthcare Passport |
$237.46
|
| Rate for Payer: Multiplan PHCS |
$2,462.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.58
|
| Rate for Payer: UHCCP Medicaid |
$147.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.45
|
|
|
DEBRIDEMENT AND REMOVAL FORIEG
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
761T0023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,171.84 |
| Rate for Payer: Aetna Commercial |
$2,544.08
|
| Rate for Payer: Anthem Medicaid |
$1,136.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Cigna Commercial |
$2,742.32
|
| Rate for Payer: First Health Commercial |
$3,138.80
|
| Rate for Payer: Humana Commercial |
$2,808.40
|
| Rate for Payer: Humana KY Medicaid |
$1,136.25
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,709.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,438.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,907.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,874.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.76
|
| Rate for Payer: PHCS Commercial |
$3,171.84
|
| Rate for Payer: United Healthcare All Payer |
$2,907.52
|
|
|
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
|
$910.14
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
|
