|
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
|
$3,702.27
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$791.84
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
|
|
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 |
$69.39 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Ambetter Exchange |
$33.36
|
| 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 Individual/Medicaid |
$33.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.03
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$33.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| 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 |
$43.37
|
| Rate for Payer: UHCCP Medicaid |
$11.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.36
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
761T2499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.49
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.30 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Ambetter Exchange |
$33.36
|
| 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 Individual/Medicaid |
$33.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.03
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$33.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.05
|
| Rate for Payer: Molina Healthcare Passport |
$35.34
|
| Rate for Payer: Multiplan PHCS |
$252.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.37
|
| Rate for Payer: UHCCP Medicaid |
$11.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.36
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
761T2499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.39 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem Medicaid |
$110.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Humana KY Medicaid |
$110.39
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.49
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
DEBRIDEMENT NEC TIS 20 CM OR <
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
76102499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem Medicaid |
$144.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Humana KY Medicaid |
$144.78
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.66 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Humana KY Medicaid |
$140.66
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$142.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.21
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.21
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
45000313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
45000313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
DEBRIDEMENT NON SELECTIVE
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
76102501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$286.30 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Anthem Medicaid |
$8.26
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cash Price |
$204.50
|
| 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 |
$245.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.30
|
| Rate for Payer: UHCCP Medicaid |
$143.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.34
|
|
|
DEBRIDEMENT NON-SELECTIVE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
42000073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.00 |
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
$99.73 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
$87.00 |
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
43000042
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$99.73 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
$70.00 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Anthem Medicaid |
$8.26
|
| 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
|
$309.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
761T2501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
DEBRIDEMENT NON SELECTIVE(T
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
761T2501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 6 OR MORE
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
CPT 11721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
|
|
DEBRIDEMENT SEL < EQ 20SQ CM
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
43000029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.51 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$240.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.69
|
| 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 |
$90.30 |
| 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 |
$240.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.69
|
| 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
|
$516.82
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.69
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
