|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.45 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$762.50
|
| 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: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| 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 |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| 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
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
76100527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,103.98 |
| Rate for Payer: Aetna Commercial |
$1,003.99
|
| Rate for Payer: Ambetter Exchange |
$651.14
|
| Rate for Payer: Anthem Medicaid |
$594.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$651.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$651.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$781.37
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,103.98
|
| Rate for Payer: Healthspan PPO |
$909.40
|
| Rate for Payer: Humana Medicaid |
$594.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$651.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$606.42
|
| Rate for Payer: Molina Healthcare Passport |
$594.53
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$846.48
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$600.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$651.14
|
|
|
RECONSTRUCT HEAD OF RADIUS(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24366
|
| Hospital Charge Code |
761P0527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,103.98 |
| Rate for Payer: Aetna Commercial |
$1,003.99
|
| Rate for Payer: Ambetter Exchange |
$651.14
|
| Rate for Payer: Anthem Medicaid |
$594.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$651.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$651.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$781.37
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,103.98
|
| Rate for Payer: Healthspan PPO |
$909.40
|
| Rate for Payer: Humana Medicaid |
$594.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$651.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$606.42
|
| Rate for Payer: Molina Healthcare Passport |
$594.53
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$846.48
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$600.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$651.14
|
|
|
RECONSTRUCTION - CHEST WALL
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32820
|
| Hospital Charge Code |
76101233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,169.03 |
| Max. Negotiated Rate |
$2,223.38 |
| Rate for Payer: Aetna Commercial |
$2,223.38
|
| Rate for Payer: Ambetter Exchange |
$1,313.36
|
| Rate for Payer: Anthem Medicaid |
$1,169.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,313.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,313.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,576.03
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$2,168.52
|
| Rate for Payer: Healthspan PPO |
$1,735.95
|
| Rate for Payer: Humana Medicaid |
$1,169.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,853.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,313.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,192.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,169.03
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,707.37
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,180.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,313.36
|
|
|
RECONSTRUCTION - CHEST WALL
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32820
|
| Hospital Charge Code |
76101233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,110.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,219.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,553.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
RECONSTRUCTION - CHEST WALL
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32820
|
| Hospital Charge Code |
76101233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,110.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem Medicaid |
$1,272.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Humana KY Medicaid |
$1,272.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,219.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,553.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
RECONSTRUCTION - CHEST WALL(P
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32820
|
| Hospital Charge Code |
761P1233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,169.03 |
| Max. Negotiated Rate |
$2,223.38 |
| Rate for Payer: Aetna Commercial |
$2,223.38
|
| Rate for Payer: Ambetter Exchange |
$1,313.36
|
| Rate for Payer: Anthem Medicaid |
$1,169.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,313.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,313.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,576.03
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$2,168.52
|
| Rate for Payer: Healthspan PPO |
$1,735.95
|
| Rate for Payer: Humana Medicaid |
$1,169.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,853.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,313.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,192.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,169.03
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,707.37
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,180.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,313.36
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,652.33
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.95 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
|
|
RECONSTRUCTION OF HIP SOCKE(P
|
Professional
|
Both
|
$3,670.00
|
|
|
Service Code
|
HCPCS 27122
|
| Hospital Charge Code |
761P0779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.97 |
| Max. Negotiated Rate |
$2,202.00 |
| Rate for Payer: Aetna Commercial |
$1,648.89
|
| Rate for Payer: Ambetter Exchange |
$1,047.61
|
| Rate for Payer: Anthem Medicaid |
$934.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,047.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,047.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,257.13
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$1,790.70
|
| Rate for Payer: Healthspan PPO |
$1,493.54
|
| Rate for Payer: Humana Medicaid |
$934.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,379.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,047.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.67
|
| Rate for Payer: Molina Healthcare Passport |
$934.97
|
| Rate for Payer: Multiplan PHCS |
$2,202.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,361.89
|
| Rate for Payer: UHCCP Medicaid |
$1,284.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,047.61
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Professional
|
Both
|
$3,670.00
|
|
|
Service Code
|
HCPCS 27122
|
| Hospital Charge Code |
76100779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.97 |
| Max. Negotiated Rate |
$2,202.00 |
| Rate for Payer: Aetna Commercial |
$1,648.89
|
| Rate for Payer: Ambetter Exchange |
$1,047.61
|
| Rate for Payer: Anthem Medicaid |
$934.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,047.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,047.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,257.13
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$1,790.70
|
| Rate for Payer: Healthspan PPO |
$1,493.54
|
| Rate for Payer: Humana Medicaid |
$934.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,379.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,047.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.67
|
| Rate for Payer: Molina Healthcare Passport |
$934.97
|
| Rate for Payer: Multiplan PHCS |
$2,202.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,361.89
|
| Rate for Payer: UHCCP Medicaid |
$1,284.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,047.61
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
IP
|
$3,670.00
|
|
|
Service Code
|
HCPCS 27122
|
| Hospital Charge Code |
76100779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,101.00 |
| Max. Negotiated Rate |
$3,523.20 |
| Rate for Payer: Aetna Commercial |
$2,825.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.60
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$3,046.10
|
| Rate for Payer: First Health Commercial |
$3,486.50
|
| Rate for Payer: Humana Commercial |
$3,119.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.30
|
| Rate for Payer: PHCS Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Payer |
$3,229.60
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
OP
|
$3,670.00
|
|
|
Service Code
|
HCPCS 27122
|
| Hospital Charge Code |
76100779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,101.00 |
| Max. Negotiated Rate |
$3,523.20 |
| Rate for Payer: Aetna Commercial |
$2,825.90
|
| Rate for Payer: Anthem Medicaid |
$1,262.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.60
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$3,046.10
|
| Rate for Payer: First Health Commercial |
$3,486.50
|
| Rate for Payer: Humana Commercial |
$3,119.50
|
| Rate for Payer: Humana KY Medicaid |
$1,262.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.30
|
| Rate for Payer: PHCS Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Payer |
$3,229.60
|
|
|
RECONSTRUCTION OF STERNUM
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 21740
|
| Hospital Charge Code |
76100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RECONSTRUCTION OF STERNUM
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 21740
|
| Hospital Charge Code |
76100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RECONSTRUCTION OF STERNUM
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 21740
|
| Hospital Charge Code |
76100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,736.42 |
| Rate for Payer: Aetna Commercial |
$1,624.13
|
| Rate for Payer: Ambetter Exchange |
$973.13
|
| Rate for Payer: Anthem Medicaid |
$733.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$973.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$973.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,167.76
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,736.42
|
| Rate for Payer: Healthspan PPO |
$1,471.11
|
| Rate for Payer: Humana Medicaid |
$733.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$973.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.13
|
| Rate for Payer: Molina Healthcare Passport |
$733.46
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,265.07
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$973.13
|
|
|
RECONSTRUCTION OF STERNUM(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 21740
|
| Hospital Charge Code |
761P0405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,736.42 |
| Rate for Payer: Aetna Commercial |
$1,624.13
|
| Rate for Payer: Ambetter Exchange |
$973.13
|
| Rate for Payer: Anthem Medicaid |
$733.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$973.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$973.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,167.76
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,736.42
|
| Rate for Payer: Healthspan PPO |
$1,471.11
|
| Rate for Payer: Humana Medicaid |
$733.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,323.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$973.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.13
|
| Rate for Payer: Molina Healthcare Passport |
$733.46
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,265.07
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$973.13
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS 53410
|
| Hospital Charge Code |
76102806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.18 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem Medicaid |
$342.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Humana KY Medicaid |
$342.18
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$345.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$349.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 53415
|
| Hospital Charge Code |
76102856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
RECONSTRUCTION OF URETHRA
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 53410
|
| Hospital Charge Code |
76102806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.25 |
| Max. Negotiated Rate |
$1,600.40 |
| Rate for Payer: Aetna Commercial |
$1,600.40
|
| Rate for Payer: Ambetter Exchange |
$924.22
|
| Rate for Payer: Anthem Medicaid |
$707.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$924.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$924.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,109.06
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$1,425.80
|
| Rate for Payer: Healthspan PPO |
$1,279.67
|
| Rate for Payer: Humana Medicaid |
$707.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,336.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$924.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$924.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$721.62
|
| Rate for Payer: Molina Healthcare Passport |
$707.47
|
| Rate for Payer: Multiplan PHCS |
$597.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,201.49
|
| Rate for Payer: UHCCP Medicaid |
$348.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$714.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$924.22
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 53415
|
| Hospital Charge Code |
76102856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS 53410
|
| Hospital Charge Code |
76102806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$955.20 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
IP
|
$2,365.00
|
|
|
Service Code
|
HCPCS 53430
|
| Hospital Charge Code |
76102970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.50 |
| Max. Negotiated Rate |
$2,270.40 |
| Rate for Payer: Aetna Commercial |
$1,821.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,844.70
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna Commercial |
$1,962.95
|
| Rate for Payer: First Health Commercial |
$2,246.75
|
| Rate for Payer: Humana Commercial |
$2,010.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,939.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,745.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,081.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,773.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,057.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,631.85
|
| Rate for Payer: PHCS Commercial |
$2,270.40
|
| Rate for Payer: United Healthcare All Payer |
$2,081.20
|
|
|
RECONSTRUCTION OF URETHRA
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
HCPCS 53430
|
| Hospital Charge Code |
76102970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$666.51 |
| Max. Negotiated Rate |
$1,540.39 |
| Rate for Payer: Aetna Commercial |
$1,540.39
|
| Rate for Payer: Ambetter Exchange |
$920.28
|
| Rate for Payer: Anthem Medicaid |
$666.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$920.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,104.34
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna Commercial |
$1,394.64
|
| Rate for Payer: Healthspan PPO |
$1,231.68
|
| Rate for Payer: Humana Medicaid |
$666.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,313.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$920.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$679.84
|
| Rate for Payer: Molina Healthcare Passport |
$666.51
|
| Rate for Payer: Multiplan PHCS |
$1,419.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,196.36
|
| Rate for Payer: UHCCP Medicaid |
$827.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$673.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$920.28
|
|
|
RECONSTRUCTION OF URETHRA
|
Facility
|
OP
|
$2,365.00
|
|
|
Service Code
|
HCPCS 53430
|
| Hospital Charge Code |
76102970
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.32 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$1,821.05
|
| Rate for Payer: Anthem Medicaid |
$813.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,844.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna Commercial |
$1,962.95
|
| Rate for Payer: First Health Commercial |
$2,246.75
|
| Rate for Payer: Humana Commercial |
$2,010.25
|
| Rate for Payer: Humana KY Medicaid |
$813.32
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$821.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,939.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,745.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$829.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,081.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,773.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,057.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,631.85
|
| Rate for Payer: PHCS Commercial |
$2,270.40
|
| Rate for Payer: United Healthcare All Payer |
$2,081.20
|
|
