|
RELEASE PALM/FINGER TENDON
|
Professional
|
Both
|
$1,415.00
|
|
|
Service Code
|
HCPCS 26440
|
| Hospital Charge Code |
76100700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.77 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna Commercial |
$866.83
|
| Rate for Payer: Anthem Medicaid |
$249.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,415.00
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cigna Commercial |
$1,111.63
|
| Rate for Payer: Healthspan PPO |
$785.16
|
| Rate for Payer: Humana Medicaid |
$249.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$746.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.77
|
| Rate for Payer: Molina Healthcare Passport |
$249.77
|
| Rate for Payer: Multiplan PHCS |
$849.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$990.50
|
| Rate for Payer: UHCCP Medicaid |
$495.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.27
|
|
|
RELEASE PALM/FINGER TENDON(P
|
Professional
|
Both
|
$1,415.00
|
|
|
Service Code
|
HCPCS 26440
|
| Hospital Charge Code |
761P0700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.77 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna Commercial |
$866.83
|
| Rate for Payer: Anthem Medicaid |
$249.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,415.00
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cash Price |
$707.50
|
| Rate for Payer: Cigna Commercial |
$1,111.63
|
| Rate for Payer: Healthspan PPO |
$785.16
|
| Rate for Payer: Humana Medicaid |
$249.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$746.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.77
|
| Rate for Payer: Molina Healthcare Passport |
$249.77
|
| Rate for Payer: Multiplan PHCS |
$849.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$990.50
|
| Rate for Payer: UHCCP Medicaid |
$495.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.27
|
|
|
RELEASE PALM & FINGER TENDO(P
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
761P0701
|
|
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, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$2,337.51
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,669.65 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
|
|
RELEASE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
76100603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| 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 |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
RELEASE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
76100603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
RELEASE WRIST/FOREARM TENDON
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
76100603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.13 |
| Max. Negotiated Rate |
$1,156.83 |
| Rate for Payer: Aetna Commercial |
$832.76
|
| Rate for Payer: Anthem Medicaid |
$278.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,156.83
|
| Rate for Payer: Healthspan PPO |
$754.30
|
| Rate for Payer: Humana Medicaid |
$278.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$283.69
|
| Rate for Payer: Molina Healthcare Passport |
$278.13
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$280.91
|
|
|
RELEASE WRIST/FOREARM TENDO(P
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
761P0603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.13 |
| Max. Negotiated Rate |
$1,156.83 |
| Rate for Payer: Aetna Commercial |
$832.76
|
| Rate for Payer: Anthem Medicaid |
$278.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,156.83
|
| Rate for Payer: Healthspan PPO |
$754.30
|
| Rate for Payer: Humana Medicaid |
$278.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$283.69
|
| Rate for Payer: Molina Healthcare Passport |
$278.13
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$280.91
|
|
|
RELEUKO 1mcg (300mcg PFS)
|
Facility
|
IP
|
$866.55
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
25004322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.65 |
| Max. Negotiated Rate |
$831.89 |
| Rate for Payer: Aetna Commercial |
$667.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.91
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Cigna Commercial |
$719.24
|
| Rate for Payer: First Health Commercial |
$823.22
|
| Rate for Payer: Humana Commercial |
$736.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.56
|
| Rate for Payer: Ohio Health Group HMO |
$649.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.63
|
| Rate for Payer: PHCS Commercial |
$831.89
|
| Rate for Payer: United Healthcare All Payer |
$762.56
|
|
|
RELEUKO 1mcg (300mcg PFS)
|
Facility
|
OP
|
$866.55
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
25004322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$831.89 |
| Rate for Payer: Aetna Commercial |
$667.24
|
| Rate for Payer: Anthem Medicaid |
$298.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Cash Price |
$433.28
|
| Rate for Payer: Cigna Commercial |
$719.24
|
| Rate for Payer: First Health Commercial |
$823.22
|
| Rate for Payer: Humana Commercial |
$736.57
|
| Rate for Payer: Humana KY Medicaid |
$298.01
|
| Rate for Payer: Humana Medicare Advantage |
$0.54
|
| Rate for Payer: Kentucky WC Medicaid |
$301.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.56
|
| Rate for Payer: Ohio Health Group HMO |
$649.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.63
|
| Rate for Payer: PHCS Commercial |
$831.89
|
| Rate for Payer: United Healthcare All Payer |
$762.56
|
|
|
RELEUKO 1mcg (480mcg PFS)
|
Facility
|
OP
|
$1,386.48
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
25004323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1,331.02 |
| Rate for Payer: Aetna Commercial |
$1,067.59
|
| Rate for Payer: Anthem Medicaid |
$476.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,081.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$693.24
|
| Rate for Payer: Cash Price |
$693.24
|
| Rate for Payer: Cigna Commercial |
$1,150.78
|
| Rate for Payer: First Health Commercial |
$1,317.16
|
| Rate for Payer: Humana Commercial |
$1,178.51
|
| Rate for Payer: Humana KY Medicaid |
$476.81
|
| Rate for Payer: Humana Medicare Advantage |
$0.54
|
| Rate for Payer: Kentucky WC Medicaid |
$481.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,136.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,023.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$486.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,039.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.81
|
| Rate for Payer: PHCS Commercial |
$1,331.02
|
| Rate for Payer: United Healthcare All Payer |
$1,220.10
|
|
|
RELEUKO 1mcg (480mcg PFS)
|
Facility
|
IP
|
$1,386.48
|
|
|
Service Code
|
HCPCS Q5125
|
| Hospital Charge Code |
25004323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.24 |
| Max. Negotiated Rate |
$1,331.02 |
| Rate for Payer: Aetna Commercial |
$1,067.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,081.45
|
| Rate for Payer: Cash Price |
$693.24
|
| Rate for Payer: Cigna Commercial |
$1,150.78
|
| Rate for Payer: First Health Commercial |
$1,317.16
|
| Rate for Payer: Humana Commercial |
$1,178.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,136.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,023.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$415.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,039.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.81
|
| Rate for Payer: PHCS Commercial |
$1,331.02
|
| Rate for Payer: United Healthcare All Payer |
$1,220.10
|
|
|
RELIEVE BLADDER CONTRACTURE
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 52640
|
| Hospital Charge Code |
76102895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.28
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
RELIEVE BLADDER CONTRACTURE
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 52640
|
| Hospital Charge Code |
76102895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem Medicaid |
$270.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Humana KY Medicaid |
$270.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.28
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
RELIEVE BLADDER CONTRACTURE
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 52640
|
| Hospital Charge Code |
76102895
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$494.38
|
| Rate for Payer: Anthem Medicaid |
$364.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$788.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$577.41
|
| Rate for Payer: Healthspan PPO |
$395.30
|
| Rate for Payer: Humana Medicaid |
$364.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$403.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$372.06
|
| Rate for Payer: Molina Healthcare Passport |
$364.76
|
| Rate for Payer: Multiplan PHCS |
$472.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$551.60
|
| Rate for Payer: UHCCP Medicaid |
$275.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$368.41
|
|
|
RELIEVE PRESSURE ON NERVE(S)
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
76102365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$519.77
|
| Rate for Payer: Anthem Medicaid |
$311.00
|
| 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 |
$462.87
|
| Rate for Payer: Healthspan PPO |
$405.82
|
| Rate for Payer: Humana Medicaid |
$311.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.22
|
| Rate for Payer: Molina Healthcare Passport |
$311.00
|
| 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 |
$314.11
|
|
|
RELIEVE PRESSURE ON NERVE(S)
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
76102365
|
|
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
|
|
|
RELIEVE PRESSURE ON NERVE(S)
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
76102365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| 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 |
$1,669.65
|
| 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 |
$2,003.58
|
| 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
|
|
|
RELIEVE PRESSURE ON NERVE(S(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
761P2365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$519.77
|
| Rate for Payer: Anthem Medicaid |
$311.00
|
| 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 |
$462.87
|
| Rate for Payer: Healthspan PPO |
$405.82
|
| Rate for Payer: Humana Medicaid |
$311.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$317.22
|
| Rate for Payer: Molina Healthcare Passport |
$311.00
|
| 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 |
$314.11
|
|
|
RELISTOR (12MG/0.6ML V)0.1 MG
|
Facility
|
IP
|
$588.31
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
25002230
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$564.78 |
| Rate for Payer: Aetna Commercial |
$453.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.88
|
| Rate for Payer: Cash Price |
$294.15
|
| Rate for Payer: Cigna Commercial |
$488.30
|
| Rate for Payer: First Health Commercial |
$558.89
|
| Rate for Payer: Humana Commercial |
$500.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.71
|
| Rate for Payer: Ohio Health Group HMO |
$441.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.38
|
| Rate for Payer: PHCS Commercial |
$564.78
|
| Rate for Payer: United Healthcare All Payer |
$517.71
|
|
|
RELISTOR (12MG/0.6ML V)0.1 MG
|
Facility
|
OP
|
$588.31
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
25002230
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$564.78 |
| Rate for Payer: Aetna Commercial |
$453.00
|
| Rate for Payer: Anthem Medicaid |
$202.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$294.15
|
| Rate for Payer: Cash Price |
$294.15
|
| Rate for Payer: Cigna Commercial |
$488.30
|
| Rate for Payer: First Health Commercial |
$558.89
|
| Rate for Payer: Humana Commercial |
$500.06
|
| Rate for Payer: Humana KY Medicaid |
$202.32
|
| Rate for Payer: Humana Medicare Advantage |
$1.20
|
| Rate for Payer: Kentucky WC Medicaid |
$204.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.71
|
| Rate for Payer: Ohio Health Group HMO |
$441.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.38
|
| Rate for Payer: PHCS Commercial |
$564.78
|
| Rate for Payer: United Healthcare All Payer |
$517.71
|
|
|
RELOCATE POCKET FOR DEFIB
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RELOCATE POCKET FOR DEFIB
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem Medicaid |
$357.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: Healthspan PPO |
$704.74
|
| Rate for Payer: Humana Medicaid |
$357.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.75
|
| Rate for Payer: Molina Healthcare Passport |
$357.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.18
|
|
|
RELOCATE POCKET FOR DEFIB
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RELOCATE POCKET FOR DEFIB(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
761P1255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem Medicaid |
$357.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: Healthspan PPO |
$704.74
|
| Rate for Payer: Humana Medicaid |
$357.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.75
|
| Rate for Payer: Molina Healthcare Passport |
$357.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.18
|
|
