|
RELEASE MUSCLES OF HAND
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| 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 |
$560.00
|
| 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: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| 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 |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| 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
|
|
|
RELEASE MUSCLES OF HAND
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$829.59
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,014.43
|
| Rate for Payer: Healthspan PPO |
$751.43
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$718.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
|
|
RELEASE MUSCLES OF HAND(P
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
761P0720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$829.59
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,014.43
|
| Rate for Payer: Healthspan PPO |
$751.43
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$718.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
|
|
RELEASE OF BIG TOE
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
76100998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
RELEASE OF BIG TOE
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
76100998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| 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 |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| 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 |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.57 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$509.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.57
|
| Rate for Payer: Anthem Medicaid |
$175.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: Healthspan PPO |
$597.43
|
| Rate for Payer: Humana Medicaid |
$175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$413.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.76
|
| Rate for Payer: Molina Healthcare Passport |
$175.25
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$178.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.00
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
RELEASE OF FOOT CONTRACTURE(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
761P0999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.57 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$509.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.57
|
| Rate for Payer: Anthem Medicaid |
$175.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: Healthspan PPO |
$597.43
|
| Rate for Payer: Humana Medicaid |
$175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$413.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.76
|
| Rate for Payer: Molina Healthcare Passport |
$175.25
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$178.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.00
|
|
|
RELEASE OF FOOT TENDON
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.45
|
| Rate for Payer: Anthem Medicaid |
$170.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$988.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$430.61
|
| Rate for Payer: Healthspan PPO |
$483.47
|
| Rate for Payer: Humana Medicaid |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$314.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.40
|
| Rate for Payer: Molina Healthcare Passport |
$170.00
|
| Rate for Payer: Multiplan PHCS |
$592.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$691.60
|
| Rate for Payer: UHCCP Medicaid |
$141.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.70
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$948.48 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$770.64
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$820.04
|
| Rate for Payer: First Health Commercial |
$938.60
|
| Rate for Payer: Humana Commercial |
$839.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$869.44
|
| Rate for Payer: Ohio Health Group HMO |
$741.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.28
|
| Rate for Payer: PHCS Commercial |
$948.48
|
| Rate for Payer: United Healthcare All Payer |
$869.44
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Anthem Medicaid |
$339.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$770.64
|
| 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 |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$820.04
|
| Rate for Payer: First Health Commercial |
$938.60
|
| Rate for Payer: Humana Commercial |
$839.80
|
| Rate for Payer: Humana KY Medicaid |
$339.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$343.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$869.44
|
| Rate for Payer: Ohio Health Group HMO |
$741.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.28
|
| Rate for Payer: PHCS Commercial |
$948.48
|
| Rate for Payer: United Healthcare All Payer |
$869.44
|
|
|
RELEASE OF SHOULDER LIGAMEN(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
761P0458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.16 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,029.04
|
| Rate for Payer: Anthem Medicaid |
$438.16
|
| 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 |
$1,193.68
|
| Rate for Payer: Healthspan PPO |
$932.09
|
| Rate for Payer: Humana Medicaid |
$438.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.92
|
| Rate for Payer: Molina Healthcare Passport |
$438.16
|
| 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 |
$442.54
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
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
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.16 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,029.04
|
| Rate for Payer: Anthem Medicaid |
$438.16
|
| 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 |
$1,193.68
|
| Rate for Payer: Healthspan PPO |
$932.09
|
| Rate for Payer: Humana Medicaid |
$438.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.92
|
| Rate for Payer: Molina Healthcare Passport |
$438.16
|
| 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 |
$442.54
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$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 |
$6,186.50
|
| 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 |
$7,423.80
|
| 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
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| 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 |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$432.48
|
| Rate for Payer: Anthem Medicaid |
$179.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$483.08
|
| Rate for Payer: Healthspan PPO |
$391.73
|
| Rate for Payer: Humana Medicaid |
$179.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$373.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.88
|
| Rate for Payer: Molina Healthcare Passport |
$179.29
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.08
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RELEASE PALM CONTRACTURE(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
761P0658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$432.48
|
| Rate for Payer: Anthem Medicaid |
$179.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$483.08
|
| Rate for Payer: Healthspan PPO |
$391.73
|
| Rate for Payer: Humana Medicaid |
$179.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$373.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.88
|
| Rate for Payer: Molina Healthcare Passport |
$179.29
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.08
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
76100701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,047.20
|
| Rate for Payer: Anthem Medicaid |
$467.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.80
|
| 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 |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,292.00
|
| Rate for Payer: Humana Commercial |
$1,156.00
|
| Rate for Payer: Humana KY Medicaid |
$467.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$472.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,003.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,196.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.60
|
| Rate for Payer: PHCS Commercial |
$1,305.60
|
| Rate for Payer: United Healthcare All Payer |
$1,196.80
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
76100701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Aetna Commercial |
$1,047.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.80
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,292.00
|
| Rate for Payer: Humana Commercial |
$1,156.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,003.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,196.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.60
|
| Rate for Payer: PHCS Commercial |
$1,305.60
|
| Rate for Payer: United Healthcare All Payer |
$1,196.80
|
|
|
RELEASE PALM & FINGER TENDON
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
76100701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$1,573.76 |
| Rate for Payer: Aetna Commercial |
$1,322.13
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,360.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Commercial |
$1,573.76
|
| Rate for Payer: Healthspan PPO |
$1,197.57
|
| Rate for Payer: Humana Medicaid |
$283.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,160.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.39
|
| Rate for Payer: Molina Healthcare Passport |
$283.72
|
| Rate for Payer: Multiplan PHCS |
$816.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$952.00
|
| Rate for Payer: UHCCP Medicaid |
$476.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$286.56
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 26440
|
| Hospital Charge Code |
76100700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.95 |
| Max. Negotiated Rate |
$1,358.40 |
| Rate for Payer: Aetna Commercial |
$1,089.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,103.70
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cigna Commercial |
$1,174.45
|
| Rate for Payer: First Health Commercial |
$1,344.25
|
| Rate for Payer: Humana Commercial |
$1,202.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,160.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,044.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$424.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,245.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,061.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.65
|
| Rate for Payer: PHCS Commercial |
$1,358.40
|
| Rate for Payer: United Healthcare All Payer |
$1,245.20
|
|
|
RELEASE PALM/FINGER TENDON
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 26440
|
| Hospital Charge Code |
76100700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.95 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,089.55
|
| Rate for Payer: Anthem Medicaid |
$486.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,103.70
|
| 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 |
$707.50
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cigna Commercial |
$1,174.45
|
| Rate for Payer: First Health Commercial |
$1,344.25
|
| Rate for Payer: Humana Commercial |
$1,202.75
|
| Rate for Payer: Humana KY Medicaid |
$486.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$491.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,160.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,044.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$496.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,245.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,061.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.65
|
| Rate for Payer: PHCS Commercial |
$1,358.40
|
| Rate for Payer: United Healthcare All Payer |
$1,245.20
|
|
