|
FUSION OF FINGER JNT ADD-ON
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.19 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$161.95
|
| Rate for Payer: Ambetter Exchange |
$96.19
|
| Rate for Payer: Anthem Medicaid |
$121.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.43
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$176.28
|
| Rate for Payer: Healthspan PPO |
$146.70
|
| Rate for Payer: Humana Medicaid |
$121.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.75
|
| Rate for Payer: Molina Healthcare Passport |
$121.32
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.05
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.19
|
|
|
FUSION OF FINGER JNT ADD-ON(P
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
761P0754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.19 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$161.95
|
| Rate for Payer: Ambetter Exchange |
$96.19
|
| Rate for Payer: Anthem Medicaid |
$121.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.43
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$176.28
|
| Rate for Payer: Healthspan PPO |
$146.70
|
| Rate for Payer: Humana Medicaid |
$121.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.75
|
| Rate for Payer: Molina Healthcare Passport |
$121.32
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.05
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.19
|
|
|
FUSION OF FINGER JOINT
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
76100753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$973.22 |
| Rate for Payer: Aetna Commercial |
$778.46
|
| Rate for Payer: Ambetter Exchange |
$564.52
|
| Rate for Payer: Anthem Medicaid |
$263.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.42
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$973.22
|
| Rate for Payer: Healthspan PPO |
$705.12
|
| Rate for Payer: Humana Medicaid |
$263.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$564.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.88
|
| Rate for Payer: Molina Healthcare Passport |
$263.61
|
| Rate for Payer: Multiplan PHCS |
$654.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$733.88
|
| Rate for Payer: UHCCP Medicaid |
$381.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.52
|
|
|
FUSION OF FINGER JOINT
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
76100753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,046.40 |
| Rate for Payer: Aetna Commercial |
$839.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.20
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$904.70
|
| Rate for Payer: First Health Commercial |
$1,035.50
|
| Rate for Payer: Humana Commercial |
$926.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$804.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.20
|
| Rate for Payer: Ohio Health Group HMO |
$817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.10
|
| Rate for Payer: PHCS Commercial |
$1,046.40
|
| Rate for Payer: United Healthcare All Payer |
$959.20
|
|
|
FUSION OF FINGER JOINT
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
76100753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$839.30
|
| Rate for Payer: Anthem Medicaid |
$374.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$904.70
|
| Rate for Payer: First Health Commercial |
$1,035.50
|
| Rate for Payer: Humana Commercial |
$926.50
|
| Rate for Payer: Humana KY Medicaid |
$374.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$378.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$804.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.20
|
| Rate for Payer: Ohio Health Group HMO |
$817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.10
|
| Rate for Payer: PHCS Commercial |
$1,046.40
|
| Rate for Payer: United Healthcare All Payer |
$959.20
|
|
|
FUSION OF FINGER JOINT(P
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
761P0753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.61 |
| Max. Negotiated Rate |
$973.22 |
| Rate for Payer: Aetna Commercial |
$778.46
|
| Rate for Payer: Ambetter Exchange |
$564.52
|
| Rate for Payer: Anthem Medicaid |
$263.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.42
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$973.22
|
| Rate for Payer: Healthspan PPO |
$705.12
|
| Rate for Payer: Humana Medicaid |
$263.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$674.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$564.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.88
|
| Rate for Payer: Molina Healthcare Passport |
$263.61
|
| Rate for Payer: Multiplan PHCS |
$654.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$733.88
|
| Rate for Payer: UHCCP Medicaid |
$381.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.52
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26471
|
| Hospital Charge Code |
76100704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
FUSION OF FINGER TENDONS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26471
|
| Hospital Charge Code |
76100704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.45 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$858.25
|
| Rate for Payer: Ambetter Exchange |
$612.19
|
| Rate for Payer: Anthem Medicaid |
$290.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$734.63
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Healthspan PPO |
$777.39
|
| Rate for Payer: Humana Medicaid |
$290.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$739.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.26
|
| Rate for Payer: Molina Healthcare Passport |
$290.45
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.85
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.19
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26471
|
| Hospital Charge Code |
76100704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
FUSION OF FINGER TENDONS(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26471
|
| Hospital Charge Code |
761P0704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.45 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$858.25
|
| Rate for Payer: Ambetter Exchange |
$612.19
|
| Rate for Payer: Anthem Medicaid |
$290.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$734.63
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Healthspan PPO |
$777.39
|
| Rate for Payer: Humana Medicaid |
$290.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$739.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.26
|
| Rate for Payer: Molina Healthcare Passport |
$290.45
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.85
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.19
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 28740
|
| Hospital Charge Code |
76101038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 28735
|
| Hospital Charge Code |
76102753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$1,306.03 |
| Rate for Payer: Aetna Commercial |
$1,204.41
|
| Rate for Payer: Ambetter Exchange |
$741.17
|
| Rate for Payer: Anthem Medicaid |
$590.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$741.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$741.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$889.40
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$1,306.03
|
| Rate for Payer: Healthspan PPO |
$1,090.94
|
| Rate for Payer: Humana Medicaid |
$590.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$990.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$741.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$602.37
|
| Rate for Payer: Molina Healthcare Passport |
$590.56
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$963.52
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$596.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$741.17
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 28730
|
| Hospital Charge Code |
76101037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.50 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.25
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 28730
|
| Hospital Charge Code |
76101037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.23 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem Medicaid |
$593.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Humana KY Medicaid |
$593.23
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$599.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$605.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.25
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 28740
|
| Hospital Charge Code |
76101038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 28740
|
| Hospital Charge Code |
76101038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.61 |
| Max. Negotiated Rate |
$1,074.64 |
| Rate for Payer: Aetna Commercial |
$939.15
|
| Rate for Payer: Ambetter Exchange |
$583.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$315.61
|
| Rate for Payer: Anthem Medicaid |
$337.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$583.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$583.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$700.73
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,021.19
|
| Rate for Payer: Healthspan PPO |
$1,074.64
|
| Rate for Payer: Humana Medicaid |
$337.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$583.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$344.04
|
| Rate for Payer: Molina Healthcare Passport |
$337.29
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$759.12
|
| Rate for Payer: UHCCP Medicaid |
$331.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$583.94
|
|
|
FUSION OF FOOT BONES
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 28730
|
| Hospital Charge Code |
76101037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.51 |
| Max. Negotiated Rate |
$1,360.98 |
| Rate for Payer: Aetna Commercial |
$1,255.83
|
| Rate for Payer: Ambetter Exchange |
$687.68
|
| Rate for Payer: Anthem Medicaid |
$564.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.22
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,360.98
|
| Rate for Payer: Healthspan PPO |
$1,137.51
|
| Rate for Payer: Humana Medicaid |
$564.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,048.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$575.80
|
| Rate for Payer: Molina Healthcare Passport |
$564.51
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.98
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.68
|
|
|
FUSION OF FOOT BONES(P
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 28730
|
| Hospital Charge Code |
761P1037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.51 |
| Max. Negotiated Rate |
$1,360.98 |
| Rate for Payer: Aetna Commercial |
$1,255.83
|
| Rate for Payer: Ambetter Exchange |
$687.68
|
| Rate for Payer: Anthem Medicaid |
$564.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.22
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,360.98
|
| Rate for Payer: Healthspan PPO |
$1,137.51
|
| Rate for Payer: Humana Medicaid |
$564.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,048.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$575.80
|
| Rate for Payer: Molina Healthcare Passport |
$564.51
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.98
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.68
|
|
|
FUSION OF FOOT BONES(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 28740
|
| Hospital Charge Code |
761P1038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.61 |
| Max. Negotiated Rate |
$1,074.64 |
| Rate for Payer: Aetna Commercial |
$939.15
|
| Rate for Payer: Ambetter Exchange |
$583.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$315.61
|
| Rate for Payer: Anthem Medicaid |
$337.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$583.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$583.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$700.73
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,021.19
|
| Rate for Payer: Healthspan PPO |
$1,074.64
|
| Rate for Payer: Humana Medicaid |
$337.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$583.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$344.04
|
| Rate for Payer: Molina Healthcare Passport |
$337.29
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$759.12
|
| Rate for Payer: UHCCP Medicaid |
$331.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$583.94
|
|
|
FUSION OF HAND BONES
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 25820
|
| Hospital Charge Code |
76100648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.84 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
FUSION OF HAND BONES
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 25820
|
| Hospital Charge Code |
76100648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$994.96 |
| Rate for Payer: Aetna Commercial |
$885.97
|
| Rate for Payer: Ambetter Exchange |
$615.09
|
| Rate for Payer: Anthem Medicaid |
$484.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$615.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$738.11
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$994.96
|
| Rate for Payer: Healthspan PPO |
$802.50
|
| Rate for Payer: Humana Medicaid |
$484.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$752.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$615.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.15
|
| Rate for Payer: Molina Healthcare Passport |
$484.46
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$799.62
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$615.09
|
|
|
FUSION OF HAND BONES
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 25820
|
| Hospital Charge Code |
76100648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
FUSION OF HAND BONES(P
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 25820
|
| Hospital Charge Code |
761P0648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$994.96 |
| Rate for Payer: Aetna Commercial |
$885.97
|
| Rate for Payer: Ambetter Exchange |
$615.09
|
| Rate for Payer: Anthem Medicaid |
$484.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$615.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$738.11
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$994.96
|
| Rate for Payer: Healthspan PPO |
$802.50
|
| Rate for Payer: Humana Medicaid |
$484.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$752.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$615.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.15
|
| Rate for Payer: Molina Healthcare Passport |
$484.46
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$799.62
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$615.09
|
|
|
FUSION OF KNUCKLE
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 26850
|
| Hospital Charge Code |
76100752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$1,189.75 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Ambetter Exchange |
$682.72
|
| Rate for Payer: Anthem Medicaid |
$335.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.26
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,189.75
|
| Rate for Payer: Healthspan PPO |
$887.76
|
| Rate for Payer: Humana Medicaid |
$335.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$682.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.15
|
| Rate for Payer: Molina Healthcare Passport |
$335.44
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.54
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.72
|
|
|
FUSION OF KNUCKLE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 26850
|
| Hospital Charge Code |
76100752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.30
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
