|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$69.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$100.50
|
| 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: Humana KY Medicaid |
$69.12
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$69.83
|
| 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 |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.51
|
| 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
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Ambetter Exchange |
$13.71
|
| 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 Individual/Medicaid |
$13.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.45
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$13.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare Passport |
$18.20
|
| Rate for Payer: Multiplan PHCS |
$120.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.82
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.71
|
|
|
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 |
$45.00 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Ambetter Exchange |
$13.71
|
| 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 Individual/Medicaid |
$13.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$13.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.71
|
| 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 |
$17.82
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.71
|
|
|
DEBRIDE NAIL ANY METHOD 1-5(T
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
761T0094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.33 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$43.33
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$43.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
DEBRIDE NAIL ANY METHOD 1-5(T
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
761T0094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
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 |
$45.00 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Ambetter Exchange |
$13.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.52
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.74
|
| 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 |
$20.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.07
|
| Rate for Payer: Molina Healthcare Passport |
$20.66
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.95
|
|
|
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 |
$45.00 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Ambetter Exchange |
$13.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.52
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.74
|
| 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 |
$20.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.07
|
| Rate for Payer: Molina Healthcare Passport |
$20.66
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.95
|
|
|
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 |
$22.50 |
| 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 |
$26.05
|
| 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 |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
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 |
$22.50 |
| 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 |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
IP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,233.60 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,577.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.28
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
OP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem Medicaid |
$1,414.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Humana KY Medicaid |
$1,414.12
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,428.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,442.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,577.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.28
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Professional
|
Both
|
$4,112.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$2,467.20 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Ambetter Exchange |
$282.37
|
| 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 Individual/Medicaid |
$282.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.84
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$282.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.68
|
| Rate for Payer: Molina Healthcare Passport |
$283.02
|
| Rate for Payer: Multiplan PHCS |
$2,467.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.08
|
| Rate for Payer: UHCCP Medicaid |
$158.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.37
|
|
|
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: Ambetter Exchange |
$282.37
|
| 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 Individual/Medicaid |
$282.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$282.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.37
|
| 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 |
$367.08
|
| Rate for Payer: UHCCP Medicaid |
$158.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.37
|
|
|
DEBRIDE SKIN MUSC AT FX SIT(T
|
Facility
|
IP
|
$3,607.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
761T0024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.10 |
| Max. Negotiated Rate |
$3,462.72 |
| Rate for Payer: Aetna Commercial |
$2,777.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,813.46
|
| Rate for Payer: Cash Price |
$1,803.50
|
| Rate for Payer: Cigna Commercial |
$2,993.81
|
| Rate for Payer: First Health Commercial |
$3,426.65
|
| Rate for Payer: Humana Commercial |
$3,065.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,957.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,661.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,082.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,174.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,705.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,885.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,138.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,488.83
|
| Rate for Payer: PHCS Commercial |
$3,462.72
|
| Rate for Payer: United Healthcare All Payer |
$3,174.16
|
|
|
DEBRIDE SKIN MUSC AT FX SIT(T
|
Facility
|
OP
|
$3,607.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
761T0024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,462.72 |
| Rate for Payer: Aetna Commercial |
$2,777.39
|
| Rate for Payer: Anthem Medicaid |
$1,240.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,813.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,803.50
|
| Rate for Payer: Cash Price |
$1,803.50
|
| Rate for Payer: Cigna Commercial |
$2,993.81
|
| Rate for Payer: First Health Commercial |
$3,426.65
|
| Rate for Payer: Humana Commercial |
$3,065.95
|
| Rate for Payer: Humana KY Medicaid |
$1,240.45
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,253.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,957.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,661.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,265.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,174.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,705.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,885.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,138.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,488.83
|
| Rate for Payer: PHCS Commercial |
$3,462.72
|
| Rate for Payer: United Healthcare All Payer |
$3,174.16
|
|
|
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 |
$48.00 |
| 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 |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| 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 |
42000072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.00 |
| 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 |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| 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 |
$48.00 |
| 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 |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| 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 |
$48.00 |
| 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 |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
DEBRID SEL GREAT EQ 20 SQCM
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
76102500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem Medicaid |
$171.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.44
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Humana KY Medicaid |
$171.26
|
| Rate for Payer: Kentucky WC Medicaid |
$173.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.62
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
DEBRID SEL GREAT EQ 20 SQCM
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
76102500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Ambetter Exchange |
$22.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.72
|
| Rate for Payer: Anthem Medicaid |
$45.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.42
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$87.22
|
| Rate for Payer: Humana Medicaid |
$45.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.09
|
| Rate for Payer: Molina Healthcare Passport |
$45.19
|
| Rate for Payer: Multiplan PHCS |
$298.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.70
|
| Rate for Payer: UHCCP Medicaid |
$12.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.85
|
|
|
DEBRID SEL GREAT EQ 20 SQCM
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
76102500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.40 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.44
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.62
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
DEBRID SEL GREAT EQ 20 SQCM(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
761P2500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$87.22 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Ambetter Exchange |
$22.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.72
|
| Rate for Payer: Anthem Medicaid |
$45.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.42
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$87.22
|
| Rate for Payer: Humana Medicaid |
$45.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.09
|
| Rate for Payer: Molina Healthcare Passport |
$45.19
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.70
|
| Rate for Payer: UHCCP Medicaid |
$12.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.85
|
|
|
DEBRID SEL GREAT EQ 20 SQCM(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
761T2500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
DEBRID SEL GREAT EQ 20 SQCM(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
761T2500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
