|
RECON ROTAT CUFF AVULSION CHR
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
RECON ROTAT CUFF AVULSION CHR
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
RECON SCREW 2.7*16 NL
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
RECON SCREW 2.7*16 NL
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
RECONST LWR JAW W/FIXATION
|
Facility
|
OP
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$4,004.00
|
| Rate for Payer: Anthem Medicaid |
$1,788.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,056.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$4,316.00
|
| Rate for Payer: First Health Commercial |
$4,940.00
|
| Rate for Payer: Humana Commercial |
$4,420.00
|
| Rate for Payer: Humana KY Medicaid |
$1,788.28
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,806.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,264.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,837.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,824.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,612.00
|
| Rate for Payer: PHCS Commercial |
$4,992.00
|
| Rate for Payer: United Healthcare All Payer |
$4,576.00
|
|
|
RECONST LWR JAW W/FIXATION
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.86 |
| Max. Negotiated Rate |
$5,200.00 |
| Rate for Payer: Aetna Commercial |
$2,112.09
|
| Rate for Payer: Anthem Medicaid |
$929.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,200.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$2,309.13
|
| Rate for Payer: Healthspan PPO |
$1,913.10
|
| Rate for Payer: Humana Medicaid |
$929.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,828.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.46
|
| Rate for Payer: Molina Healthcare Passport |
$929.86
|
| Rate for Payer: Multiplan PHCS |
$3,120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,640.00
|
| Rate for Payer: UHCCP Medicaid |
$1,820.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$939.16
|
|
|
RECONST LWR JAW W/FIXATION
|
Facility
|
IP
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$4,992.00 |
| Rate for Payer: Aetna Commercial |
$4,004.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,056.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$4,316.00
|
| Rate for Payer: First Health Commercial |
$4,940.00
|
| Rate for Payer: Humana Commercial |
$4,420.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,264.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,837.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,612.00
|
| Rate for Payer: PHCS Commercial |
$4,992.00
|
| Rate for Payer: United Healthcare All Payer |
$4,576.00
|
|
|
RECONST LWR JAW W/FIXATION(P
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
761P0375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.86 |
| Max. Negotiated Rate |
$5,200.00 |
| Rate for Payer: Aetna Commercial |
$2,112.09
|
| Rate for Payer: Anthem Medicaid |
$929.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,200.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$2,309.13
|
| Rate for Payer: Healthspan PPO |
$1,913.10
|
| Rate for Payer: Humana Medicaid |
$929.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,828.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.46
|
| Rate for Payer: Molina Healthcare Passport |
$929.86
|
| Rate for Payer: Multiplan PHCS |
$3,120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,640.00
|
| Rate for Payer: UHCCP Medicaid |
$1,820.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$939.16
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$471.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.20
|
| Rate for Payer: Anthem Medicaid |
$227.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$511.06
|
| Rate for Payer: Healthspan PPO |
$589.37
|
| Rate for Payer: Humana Medicaid |
$227.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.53
|
| Rate for Payer: Molina Healthcare Passport |
$227.97
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$148.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.25
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
RECONS, TOE(S); POLYDACTYLY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
761P1010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$471.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.20
|
| Rate for Payer: Anthem Medicaid |
$227.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$511.06
|
| Rate for Payer: Healthspan PPO |
$589.37
|
| Rate for Payer: Humana Medicaid |
$227.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.53
|
| Rate for Payer: Molina Healthcare Passport |
$227.97
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$148.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.25
|
|
|
RECONSTRUCT EXTRA FINGER
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RECONSTRUCT EXTRA FINGER
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RECONSTRUCT EXTRA FINGER
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$1,523.19 |
| Rate for Payer: Aetna Commercial |
$1,379.47
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,523.19
|
| Rate for Payer: Healthspan PPO |
$1,249.51
|
| Rate for Payer: Humana Medicaid |
$425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.26
|
| Rate for Payer: Molina Healthcare Passport |
$425.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.01
|
|
|
RECONSTRUCT EXTRA FINGER(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
761P0719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$1,523.19 |
| Rate for Payer: Aetna Commercial |
$1,379.47
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,523.19
|
| Rate for Payer: Healthspan PPO |
$1,249.51
|
| Rate for Payer: Humana Medicaid |
$425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.26
|
| Rate for Payer: Molina Healthcare Passport |
$425.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.01
|
|
|
RECONSTRUCT FINGER JOINT
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.93 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$978.15
|
| Rate for Payer: Anthem Medicaid |
$354.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,184.60
|
| Rate for Payer: Healthspan PPO |
$885.99
|
| Rate for Payer: Humana Medicaid |
$354.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.03
|
| Rate for Payer: Molina Healthcare Passport |
$354.93
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.48
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$1,286.40 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem Medicaid |
$460.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Humana KY Medicaid |
$460.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$470.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RECONSTRUCT FINGER JOINT(P
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
761P0717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.93 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$978.15
|
| Rate for Payer: Anthem Medicaid |
$354.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,184.60
|
| Rate for Payer: Healthspan PPO |
$885.99
|
| Rate for Payer: Humana Medicaid |
$354.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.03
|
| Rate for Payer: Molina Healthcare Passport |
$354.93
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.48
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$1,003.99
|
| Rate for Payer: Anthem Medicaid |
$594.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,103.98
|
| Rate for Payer: Healthspan PPO |
$909.40
|
| Rate for Payer: Humana Medicaid |
$594.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$606.42
|
| Rate for Payer: Molina Healthcare Passport |
$594.53
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$600.48
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
RECONSTRUCT HEAD OF RADIUS(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
761P0527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$1,003.99
|
| Rate for Payer: Anthem Medicaid |
$594.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,103.98
|
| Rate for Payer: Healthspan PPO |
$909.40
|
| Rate for Payer: Humana Medicaid |
$594.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$606.42
|
| Rate for Payer: Molina Healthcare Passport |
$594.53
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$600.48
|
|
|
RECONSTRUCTION - CHEST WALL
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32820
|
| Hospital Charge Code |
76101233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,169.03 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$2,223.38
|
| Rate for Payer: Anthem Medicaid |
$1,169.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,700.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$2,168.52
|
| Rate for Payer: Healthspan PPO |
$1,735.95
|
| Rate for Payer: Humana Medicaid |
$1,169.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,853.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,192.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,169.03
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,590.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,180.72
|
|
