|
RECON CONT ACT HA RG 52MM R
|
Facility
|
IP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 52MM R
|
Facility
|
OP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem Medicaid |
$4,517.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Humana KY Medicaid |
$4,517.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON ROTAT CUFF AVULSION CH(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
761P0459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$820.33 |
| Max. Negotiated Rate |
$1,694.43 |
| Rate for Payer: Aetna Commercial |
$1,445.33
|
| Rate for Payer: Ambetter Exchange |
$928.26
|
| Rate for Payer: Anthem Medicaid |
$820.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$928.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,113.91
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,694.43
|
| Rate for Payer: Healthspan PPO |
$1,309.16
|
| Rate for Payer: Humana Medicaid |
$820.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,208.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$928.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.74
|
| Rate for Payer: Molina Healthcare Passport |
$820.33
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,206.74
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$828.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$928.26
|
|
|
RECON ROTAT CUFF AVULSION CHR
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$820.33 |
| Max. Negotiated Rate |
$1,694.43 |
| Rate for Payer: Aetna Commercial |
$1,445.33
|
| Rate for Payer: Ambetter Exchange |
$928.26
|
| Rate for Payer: Anthem Medicaid |
$820.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$928.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,113.91
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,694.43
|
| Rate for Payer: Healthspan PPO |
$1,309.16
|
| Rate for Payer: Humana Medicaid |
$820.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,208.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$928.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.74
|
| Rate for Payer: Molina Healthcare Passport |
$820.33
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,206.74
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$828.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$928.26
|
|
|
RECON ROTAT CUFF AVULSION CHR
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.15 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
RECON ROTAT CUFF AVULSION CHR
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
RECON SCREW 2.7*16 NL
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
RECON SCREW 2.7*16 NL
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
RECONST LWR JAW W/FIXATION
|
Facility
|
IP
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,560.00 |
| Max. Negotiated Rate |
$4,992.00 |
| Rate for Payer: Aetna Commercial |
$4,004.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,056.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$4,316.00
|
| Rate for Payer: First Health Commercial |
$4,940.00
|
| Rate for Payer: Humana Commercial |
$4,420.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,264.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,837.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,524.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,588.00
|
| Rate for Payer: PHCS Commercial |
$4,992.00
|
| Rate for Payer: United Healthcare All Payer |
$4,576.00
|
|
|
RECONST LWR JAW W/FIXATION
|
Facility
|
OP
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,788.28 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$4,004.00
|
| Rate for Payer: Anthem Medicaid |
$1,788.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,056.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$4,316.00
|
| Rate for Payer: First Health Commercial |
$4,940.00
|
| Rate for Payer: Humana Commercial |
$4,420.00
|
| Rate for Payer: Humana KY Medicaid |
$1,788.28
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,806.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,264.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,837.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,824.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,524.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,588.00
|
| Rate for Payer: PHCS Commercial |
$4,992.00
|
| Rate for Payer: United Healthcare All Payer |
$4,576.00
|
|
|
RECONST LWR JAW W/FIXATION
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.86 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,112.09
|
| Rate for Payer: Ambetter Exchange |
$1,332.53
|
| Rate for Payer: Anthem Medicaid |
$929.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,332.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,332.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,599.04
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$2,309.13
|
| Rate for Payer: Healthspan PPO |
$1,913.10
|
| Rate for Payer: Humana Medicaid |
$929.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,828.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,332.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.46
|
| Rate for Payer: Molina Healthcare Passport |
$929.86
|
| Rate for Payer: Multiplan PHCS |
$3,120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.29
|
| Rate for Payer: UHCCP Medicaid |
$1,820.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$939.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,332.53
|
|
|
RECONST LWR JAW W/FIXATION(P
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 21196
|
| Hospital Charge Code |
761P0375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$929.86 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,112.09
|
| Rate for Payer: Ambetter Exchange |
$1,332.53
|
| Rate for Payer: Anthem Medicaid |
$929.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,332.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,332.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,599.04
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cigna Commercial |
$2,309.13
|
| Rate for Payer: Healthspan PPO |
$1,913.10
|
| Rate for Payer: Humana Medicaid |
$929.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,828.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,332.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$948.46
|
| Rate for Payer: Molina Healthcare Passport |
$929.86
|
| Rate for Payer: Multiplan PHCS |
$3,120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.29
|
| Rate for Payer: UHCCP Medicaid |
$1,820.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$939.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,332.53
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$471.38
|
| Rate for Payer: Ambetter Exchange |
$265.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.20
|
| Rate for Payer: Anthem Medicaid |
$227.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$265.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$318.49
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$511.06
|
| Rate for Payer: Healthspan PPO |
$589.37
|
| Rate for Payer: Humana Medicaid |
$227.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$265.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.53
|
| Rate for Payer: Molina Healthcare Passport |
$227.97
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$345.03
|
| Rate for Payer: UHCCP Medicaid |
$148.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$265.41
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
RECONS, TOE(S); POLYDACTYLY
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
76101010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
RECONS, TOE(S); POLYDACTYLY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
761P1010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$471.38
|
| Rate for Payer: Ambetter Exchange |
$265.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.20
|
| Rate for Payer: Anthem Medicaid |
$227.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$265.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$318.49
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$511.06
|
| Rate for Payer: Healthspan PPO |
$589.37
|
| Rate for Payer: Humana Medicaid |
$227.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$265.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.53
|
| Rate for Payer: Molina Healthcare Passport |
$227.97
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$345.03
|
| Rate for Payer: UHCCP Medicaid |
$148.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$265.41
|
|
|
RECONSTRUCT EXTRA FINGER
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RECONSTRUCT EXTRA FINGER
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RECONSTRUCT EXTRA FINGER
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
76100719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$1,523.19 |
| Rate for Payer: Aetna Commercial |
$1,379.47
|
| Rate for Payer: Ambetter Exchange |
$994.41
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$994.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$994.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,193.29
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,523.19
|
| Rate for Payer: Healthspan PPO |
$1,249.51
|
| Rate for Payer: Humana Medicaid |
$425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$994.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.26
|
| Rate for Payer: Molina Healthcare Passport |
$425.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,292.73
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$994.41
|
|
|
RECONSTRUCT EXTRA FINGER(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
761P0719
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$1,523.19 |
| Rate for Payer: Aetna Commercial |
$1,379.47
|
| Rate for Payer: Ambetter Exchange |
$994.41
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$994.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$994.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,193.29
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,523.19
|
| Rate for Payer: Healthspan PPO |
$1,249.51
|
| Rate for Payer: Humana Medicaid |
$425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$994.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.26
|
| Rate for Payer: Molina Healthcare Passport |
$425.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,292.73
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$994.41
|
|
|
RECONSTRUCT FINGER JOINT
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.93 |
| Max. Negotiated Rate |
$1,184.60 |
| Rate for Payer: Aetna Commercial |
$978.15
|
| Rate for Payer: Ambetter Exchange |
$680.70
|
| Rate for Payer: Anthem Medicaid |
$354.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$680.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$816.84
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,184.60
|
| Rate for Payer: Healthspan PPO |
$885.99
|
| Rate for Payer: Humana Medicaid |
$354.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$680.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.03
|
| Rate for Payer: Molina Healthcare Passport |
$354.93
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$884.91
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$680.70
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.83 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem Medicaid |
$460.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Humana KY Medicaid |
$460.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$470.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.60
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
76100717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.00 |
| Max. Negotiated Rate |
$1,286.40 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.60
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RECONSTRUCT FINGER JOINT(P
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 26545
|
| Hospital Charge Code |
761P0717
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.93 |
| Max. Negotiated Rate |
$1,184.60 |
| Rate for Payer: Aetna Commercial |
$978.15
|
| Rate for Payer: Ambetter Exchange |
$680.70
|
| Rate for Payer: Anthem Medicaid |
$354.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$680.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$816.84
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,184.60
|
| Rate for Payer: Healthspan PPO |
$885.99
|
| Rate for Payer: Humana Medicaid |
$354.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$680.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.03
|
| Rate for Payer: Molina Healthcare Passport |
$354.93
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$884.91
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$680.70
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.50 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
