|
REIMPLANT URETER IN BLADDER
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 50785
|
| Hospital Charge Code |
76102812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$1,180.80 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.30
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
REIMPLANT URETER IN BLADDER(P
|
Professional
|
Both
|
$2,750.00
|
|
|
Service Code
|
HCPCS 50780
|
| Hospital Charge Code |
761P2057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$907.44 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,780.98
|
| Rate for Payer: Anthem Medicaid |
$907.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,750.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna Commercial |
$1,592.01
|
| Rate for Payer: Healthspan PPO |
$1,424.05
|
| Rate for Payer: Humana Medicaid |
$907.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,503.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$925.59
|
| Rate for Payer: Molina Healthcare Passport |
$907.44
|
| Rate for Payer: Multiplan PHCS |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,925.00
|
| Rate for Payer: UHCCP Medicaid |
$962.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$916.51
|
|
|
REINFORCE HIP BONES
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 27187
|
| Hospital Charge Code |
76102931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$857.50 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$1,483.22
|
| Rate for Payer: Anthem Medicaid |
$867.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$1,617.06
|
| Rate for Payer: Healthspan PPO |
$1,343.48
|
| Rate for Payer: Humana Medicaid |
$867.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,238.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$884.83
|
| Rate for Payer: Molina Healthcare Passport |
$867.48
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$876.15
|
|
|
REINFORCE HIP BONES
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 27187
|
| Hospital Charge Code |
76102931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
REINFORCE HIP BONES
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 27187
|
| Hospital Charge Code |
76102931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.56
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
REINFORCE TIBIA
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 27745
|
| Hospital Charge Code |
76100922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,121.04
|
| Rate for Payer: Anthem Medicaid |
$549.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,020.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,227.28
|
| Rate for Payer: Healthspan PPO |
$1,015.42
|
| Rate for Payer: Humana Medicaid |
$549.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.90
|
| Rate for Payer: Molina Healthcare Passport |
$549.90
|
| Rate for Payer: Multiplan PHCS |
$1,212.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,414.00
|
| Rate for Payer: UHCCP Medicaid |
$707.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$555.40
|
|
|
REINFORCE TIBIA
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 27745
|
| Hospital Charge Code |
76100922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$1,939.20 |
| Rate for Payer: Aetna Commercial |
$1,555.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,676.60
|
| Rate for Payer: First Health Commercial |
$1,919.00
|
| Rate for Payer: Humana Commercial |
$1,717.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,656.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,777.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.20
|
| Rate for Payer: PHCS Commercial |
$1,939.20
|
| Rate for Payer: United Healthcare All Payer |
$1,777.60
|
|
|
REINFORCE TIBIA
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 27745
|
| Hospital Charge Code |
76100922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,555.40
|
| Rate for Payer: Anthem Medicaid |
$694.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,575.60
|
| 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 |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,676.60
|
| Rate for Payer: First Health Commercial |
$1,919.00
|
| Rate for Payer: Humana Commercial |
$1,717.00
|
| Rate for Payer: Humana KY Medicaid |
$694.68
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$701.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,656.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,777.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.20
|
| Rate for Payer: PHCS Commercial |
$1,939.20
|
| Rate for Payer: United Healthcare All Payer |
$1,777.60
|
|
|
REINFORCE TIBIA(P
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 27745
|
| Hospital Charge Code |
761P0922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,121.04
|
| Rate for Payer: Anthem Medicaid |
$549.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,020.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,227.28
|
| Rate for Payer: Healthspan PPO |
$1,015.42
|
| Rate for Payer: Humana Medicaid |
$549.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.90
|
| Rate for Payer: Molina Healthcare Passport |
$549.90
|
| Rate for Payer: Multiplan PHCS |
$1,212.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,414.00
|
| Rate for Payer: UHCCP Medicaid |
$707.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$555.40
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
RELAFEN (NABUMETONE 500MG/1TAB
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 591367001
|
| Hospital Charge Code |
25001298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
RELAFEN (NABUMETONE 500MG/1TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 591367001
|
| Hospital Charge Code |
25001298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
RELEASE FACIAL NERVE
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 69720
|
| Hospital Charge Code |
761P2615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$1,679.98 |
| Rate for Payer: Aetna Commercial |
$1,679.98
|
| Rate for Payer: Anthem Medicaid |
$933.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,370.00
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cigna Commercial |
$1,659.99
|
| Rate for Payer: Healthspan PPO |
$1,490.22
|
| Rate for Payer: Humana Medicaid |
$933.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,503.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$952.45
|
| Rate for Payer: Molina Healthcare Passport |
$933.77
|
| Rate for Payer: Multiplan PHCS |
$822.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.00
|
| Rate for Payer: UHCCP Medicaid |
$479.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.11
|
|
|
RELEASE FACIAL NERVE
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 69720
|
| Hospital Charge Code |
76102615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$1,315.20 |
| Rate for Payer: Aetna Commercial |
$1,054.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,068.60
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cigna Commercial |
$1,137.10
|
| Rate for Payer: First Health Commercial |
$1,301.50
|
| Rate for Payer: Humana Commercial |
$1,164.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,123.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,011.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,205.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.70
|
| Rate for Payer: PHCS Commercial |
$1,315.20
|
| Rate for Payer: United Healthcare All Payer |
$1,205.60
|
|
|
RELEASE FACIAL NERVE
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 69720
|
| Hospital Charge Code |
76102615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$1,679.98 |
| Rate for Payer: Aetna Commercial |
$1,679.98
|
| Rate for Payer: Anthem Medicaid |
$933.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,370.00
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cigna Commercial |
$1,659.99
|
| Rate for Payer: Healthspan PPO |
$1,490.22
|
| Rate for Payer: Humana Medicaid |
$933.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,503.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$952.45
|
| Rate for Payer: Molina Healthcare Passport |
$933.77
|
| Rate for Payer: Multiplan PHCS |
$822.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.00
|
| Rate for Payer: UHCCP Medicaid |
$479.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.11
|
|
|
RELEASE FACIAL NERVE
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 69720
|
| Hospital Charge Code |
76102615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,054.90
|
| Rate for Payer: Anthem Medicaid |
$471.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,068.60
|
| 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 |
$685.00
|
| Rate for Payer: Cash Price |
$685.00
|
| Rate for Payer: Cigna Commercial |
$1,137.10
|
| Rate for Payer: First Health Commercial |
$1,301.50
|
| Rate for Payer: Humana Commercial |
$1,164.50
|
| Rate for Payer: Humana KY Medicaid |
$471.14
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$475.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,123.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,011.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$480.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,205.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.70
|
| Rate for Payer: PHCS Commercial |
$1,315.20
|
| Rate for Payer: United Healthcare All Payer |
$1,205.60
|
|
|
RELEASE FINGER CONTRACTURE
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
76100712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RELEASE FINGER CONTRACTURE
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
76100712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.59 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$910.98
|
| Rate for Payer: Anthem Medicaid |
$260.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,166.62
|
| Rate for Payer: Healthspan PPO |
$825.15
|
| Rate for Payer: Humana Medicaid |
$260.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.80
|
| Rate for Payer: Molina Healthcare Passport |
$260.59
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.20
|
|
|
RELEASE FINGER CONTRACTURE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
76100712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RELEASE FINGER CONTRACTURE(P
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
761P0712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.59 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$910.98
|
| Rate for Payer: Anthem Medicaid |
$260.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,166.62
|
| Rate for Payer: Healthspan PPO |
$825.15
|
| Rate for Payer: Humana Medicaid |
$260.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$784.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.80
|
| Rate for Payer: Molina Healthcare Passport |
$260.59
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.20
|
|
|
RELEASE HAND/FINGER TENDON
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
76100702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| 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 |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
RELEASE HAND/FINGER TENDON
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
76100702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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 |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
RELEASE HAND/FINGER TENDON
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
76100702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.36 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$801.59
|
| Rate for Payer: Anthem Medicaid |
$222.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,043.80
|
| Rate for Payer: Healthspan PPO |
$726.07
|
| Rate for Payer: Humana Medicaid |
$222.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.81
|
| Rate for Payer: Molina Healthcare Passport |
$222.36
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.58
|
|
|
RELEASE HAND/FINGER TENDON(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
761P0702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.36 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$801.59
|
| Rate for Payer: Anthem Medicaid |
$222.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,043.80
|
| Rate for Payer: Healthspan PPO |
$726.07
|
| Rate for Payer: Humana Medicaid |
$222.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.81
|
| Rate for Payer: Molina Healthcare Passport |
$222.36
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.58
|
|
|
RELEASE MUSCLES OF HAND
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.20
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
