|
RECONSTRUCT SHOULDER JOINT
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$2,596.00 |
| Rate for Payer: Aetna Commercial |
$1,826.23
|
| Rate for Payer: Anthem Medicaid |
$986.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,596.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$1,989.17
|
| Rate for Payer: Healthspan PPO |
$1,654.17
|
| Rate for Payer: Humana Medicaid |
$986.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,516.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,006.68
|
| Rate for Payer: Molina Healthcare Passport |
$986.94
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.20
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$996.81
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$2,492.16 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.76
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem Medicaid |
$892.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| 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 |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Humana KY Medicaid |
$892.76
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$901.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$910.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.76
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
RECONSTRUCT SHOULDER JOINT(P
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
761P0465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$2,596.00 |
| Rate for Payer: Aetna Commercial |
$1,826.23
|
| Rate for Payer: Anthem Medicaid |
$986.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,596.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$1,989.17
|
| Rate for Payer: Healthspan PPO |
$1,654.17
|
| Rate for Payer: Humana Medicaid |
$986.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,516.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,006.68
|
| Rate for Payer: Molina Healthcare Passport |
$986.94
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.20
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$996.81
|
|
|
RECONSTRUCT TONGUE FOLD
|
Professional
|
Both
|
$4,252.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$4,252.00 |
| Rate for Payer: Aetna Commercial |
$357.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.96
|
| Rate for Payer: Anthem Medicaid |
$161.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,252.00
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cigna Commercial |
$365.71
|
| Rate for Payer: Healthspan PPO |
$396.16
|
| Rate for Payer: Humana Medicaid |
$161.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.44
|
| Rate for Payer: Molina Healthcare Passport |
$161.22
|
| Rate for Payer: Multiplan PHCS |
$2,551.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,976.40
|
| Rate for Payer: UHCCP Medicaid |
$163.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.83
|
|
|
RECONSTRUCT TONGUE FOLD
|
Facility
|
IP
|
$4,252.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.76 |
| Max. Negotiated Rate |
$4,081.92 |
| Rate for Payer: Aetna Commercial |
$3,274.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.56
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cigna Commercial |
$3,529.16
|
| Rate for Payer: First Health Commercial |
$4,039.40
|
| Rate for Payer: Humana Commercial |
$3,614.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,137.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.12
|
| Rate for Payer: PHCS Commercial |
$4,081.92
|
| Rate for Payer: United Healthcare All Payer |
$3,741.76
|
|
|
RECONSTRUCT TONGUE FOLD
|
Facility
|
OP
|
$4,252.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.76 |
| Max. Negotiated Rate |
$4,081.92 |
| Rate for Payer: Aetna Commercial |
$3,274.04
|
| Rate for Payer: Anthem Medicaid |
$1,462.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cash Price |
$2,126.00
|
| Rate for Payer: Cigna Commercial |
$3,529.16
|
| Rate for Payer: First Health Commercial |
$4,039.40
|
| Rate for Payer: Humana Commercial |
$3,614.20
|
| Rate for Payer: Humana KY Medicaid |
$1,462.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,477.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,137.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.12
|
| Rate for Payer: PHCS Commercial |
$4,081.92
|
| Rate for Payer: United Healthcare All Payer |
$3,741.76
|
|
|
RECONSTRUCT TONGUE FOLD(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761P1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$357.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.96
|
| Rate for Payer: Anthem Medicaid |
$161.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$365.71
|
| Rate for Payer: Healthspan PPO |
$396.16
|
| Rate for Payer: Humana Medicaid |
$161.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.44
|
| Rate for Payer: Molina Healthcare Passport |
$161.22
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$163.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.83
|
|
|
RECONSTRUCT TONGUE FOLD(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761T1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
RECONSTRUCT TONGUE FOLD(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761T1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.25
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
RECONSTRUCT WRIST JOINT
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$2,075.00 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Anthem Medicaid |
$591.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,075.00
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,164.65
|
| Rate for Payer: Healthspan PPO |
$957.87
|
| Rate for Payer: Humana Medicaid |
$591.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$891.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.51
|
| Rate for Payer: Molina Healthcare Passport |
$591.68
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,452.50
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.60
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem Medicaid |
$713.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| 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 |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Humana KY Medicaid |
$713.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$720.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.25
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
RECONSTRUCT WRIST JOINT
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.44 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,122.30
|
| Rate for Payer: Anthem Medicaid |
$578.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,860.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,233.39
|
| Rate for Payer: Healthspan PPO |
$1,016.57
|
| Rate for Payer: Humana Medicaid |
$578.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$969.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.01
|
| Rate for Payer: Molina Healthcare Passport |
$578.44
|
| Rate for Payer: Multiplan PHCS |
$1,116.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,302.00
|
| Rate for Payer: UHCCP Medicaid |
$651.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.22
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem Medicaid |
$639.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| 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 |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Humana KY Medicaid |
$639.65
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.60
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.60
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
RECONSTRUCT WRIST JOINT(P
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
761P0613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.44 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,122.30
|
| Rate for Payer: Anthem Medicaid |
$578.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,860.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,233.39
|
| Rate for Payer: Healthspan PPO |
$1,016.57
|
| Rate for Payer: Humana Medicaid |
$578.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$969.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.01
|
| Rate for Payer: Molina Healthcare Passport |
$578.44
|
| Rate for Payer: Multiplan PHCS |
$1,116.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,302.00
|
| Rate for Payer: UHCCP Medicaid |
$651.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.22
|
|
|
RECONSTRUCT WRIST JOINT(P
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
761P0614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$2,075.00 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Anthem Medicaid |
$591.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,075.00
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,164.65
|
| Rate for Payer: Healthspan PPO |
$957.87
|
| Rate for Payer: Humana Medicaid |
$591.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$891.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.51
|
| Rate for Payer: Molina Healthcare Passport |
$591.68
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,452.50
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.60
|
|
|
RECOVERY IVC FILTER
|
Facility
|
IP
|
$7,891.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
RECOVERY IVC FILTER
|
Facility
|
OP
|
$7,891.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem Medicaid |
$2,713.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Humana KY Medicaid |
$2,713.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$24,326.43
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$16,507.22 |
| Max. Negotiated Rate |
$24,326.43 |
| Rate for Payer: Anthem Medicaid |
$16,507.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,376.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,326.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,457.63
|
| Rate for Payer: Humana KY Medicaid |
$16,507.22
|
| Rate for Payer: Humana Medicare Advantage |
$17,376.02
|
| Rate for Payer: Kentucky WC Medicaid |
$16,672.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,851.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,837.36
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$42,748.76
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$29,008.09 |
| Max. Negotiated Rate |
$42,748.76 |
| Rate for Payer: Anthem Medicaid |
$29,008.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30,534.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$42,748.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$41,222.02
|
| Rate for Payer: Humana KY Medicaid |
$29,008.09
|
| Rate for Payer: Humana Medicare Advantage |
$30,534.83
|
| Rate for Payer: Kentucky WC Medicaid |
$29,298.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,641.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,588.25
|
|
