|
RECONSTRUCTION OF URETHRA
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 53415
|
| Hospital Charge Code |
76102856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$1,848.03 |
| Rate for Payer: Aetna Commercial |
$1,848.03
|
| Rate for Payer: Ambetter Exchange |
$1,065.13
|
| Rate for Payer: Anthem Medicaid |
$889.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,065.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,065.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,278.16
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,625.28
|
| Rate for Payer: Healthspan PPO |
$1,477.67
|
| Rate for Payer: Humana Medicaid |
$889.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,541.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,065.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$906.96
|
| Rate for Payer: Molina Healthcare Passport |
$889.18
|
| Rate for Payer: Multiplan PHCS |
$675.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,384.67
|
| Rate for Payer: UHCCP Medicaid |
$393.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$898.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,065.13
|
|
|
RECONSTRUCT NAIL BED W GRAFT
|
Facility
|
OP
|
$5,475.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
76100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$5,256.00 |
| Rate for Payer: Aetna Commercial |
$4,215.75
|
| Rate for Payer: Anthem Medicaid |
$1,882.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,270.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,737.50
|
| Rate for Payer: Cash Price |
$2,737.50
|
| Rate for Payer: Cigna Commercial |
$4,544.25
|
| Rate for Payer: First Health Commercial |
$5,201.25
|
| Rate for Payer: Humana Commercial |
$4,653.75
|
| Rate for Payer: Humana KY Medicaid |
$1,882.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,902.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,489.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,040.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,920.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,818.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,763.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,777.75
|
| Rate for Payer: PHCS Commercial |
$5,256.00
|
| Rate for Payer: United Healthcare All Payer |
$4,818.00
|
|
|
RECONSTRUCT NAIL BED W GRAFT
|
Facility
|
IP
|
$5,475.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
76100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,642.50 |
| Max. Negotiated Rate |
$5,256.00 |
| Rate for Payer: Aetna Commercial |
$4,215.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,270.50
|
| Rate for Payer: Cash Price |
$2,737.50
|
| Rate for Payer: Cigna Commercial |
$4,544.25
|
| Rate for Payer: First Health Commercial |
$5,201.25
|
| Rate for Payer: Humana Commercial |
$4,653.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,489.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,040.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,818.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,763.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,777.75
|
| Rate for Payer: PHCS Commercial |
$5,256.00
|
| Rate for Payer: United Healthcare All Payer |
$4,818.00
|
|
|
RECONSTRUCT NAIL BED W GRAFT
|
Professional
|
Both
|
$5,475.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
76100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.73 |
| Max. Negotiated Rate |
$3,285.00 |
| Rate for Payer: Aetna Commercial |
$292.63
|
| Rate for Payer: Ambetter Exchange |
$177.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.73
|
| Rate for Payer: Anthem Medicaid |
$158.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.98
|
| Rate for Payer: Cash Price |
$2,737.50
|
| Rate for Payer: Cash Price |
$2,737.50
|
| Rate for Payer: Cigna Commercial |
$346.04
|
| Rate for Payer: Healthspan PPO |
$302.03
|
| Rate for Payer: Humana Medicaid |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.26
|
| Rate for Payer: Molina Healthcare Passport |
$158.10
|
| Rate for Payer: Multiplan PHCS |
$3,285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.72
|
| Rate for Payer: UHCCP Medicaid |
$116.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.48
|
|
|
RECONSTRUCT NAIL BED W GRAFT(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
761P0102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.73 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$292.63
|
| Rate for Payer: Ambetter Exchange |
$177.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.73
|
| Rate for Payer: Anthem Medicaid |
$158.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.98
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$346.04
|
| Rate for Payer: Healthspan PPO |
$302.03
|
| Rate for Payer: Humana Medicaid |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$232.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.26
|
| Rate for Payer: Molina Healthcare Passport |
$158.10
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.72
|
| Rate for Payer: UHCCP Medicaid |
$116.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.48
|
|
|
RECONSTRUCT NAIL BED W GRAFT(T
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
761T0102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,607.73 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem Medicaid |
$1,607.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Humana KY Medicaid |
$1,607.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,225.75
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
RECONSTRUCT NAIL BED W GRAFT(T
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
761T0102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,402.50 |
| Max. Negotiated Rate |
$4,488.00 |
| Rate for Payer: Aetna Commercial |
$3,599.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,646.50
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna Commercial |
$3,880.25
|
| Rate for Payer: First Health Commercial |
$4,441.25
|
| Rate for Payer: Humana Commercial |
$3,973.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,833.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,114.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,225.75
|
| Rate for Payer: PHCS Commercial |
$4,488.00
|
| Rate for Payer: United Healthcare All Payer |
$4,114.00
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.76 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem Medicaid |
$892.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| 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 |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Humana KY Medicaid |
$892.76
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$901.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$910.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,076.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,791.24
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.80 |
| Max. Negotiated Rate |
$2,492.16 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,076.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,791.24
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
RECONSTRUCT SHOULDER JOINT
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
76100465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$1,989.17 |
| Rate for Payer: Aetna Commercial |
$1,826.23
|
| Rate for Payer: Ambetter Exchange |
$1,136.46
|
| Rate for Payer: Anthem Medicaid |
$986.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,136.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,136.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,363.75
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$1,989.17
|
| Rate for Payer: Healthspan PPO |
$1,654.17
|
| Rate for Payer: Humana Medicaid |
$986.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,516.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,006.68
|
| Rate for Payer: Molina Healthcare Passport |
$986.94
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,477.40
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$996.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,136.46
|
|
|
RECONSTRUCT SHOULDER JOINT(P
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23470
|
| Hospital Charge Code |
761P0465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$1,989.17 |
| Rate for Payer: Aetna Commercial |
$1,826.23
|
| Rate for Payer: Ambetter Exchange |
$1,136.46
|
| Rate for Payer: Anthem Medicaid |
$986.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,136.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,136.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,363.75
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$1,989.17
|
| Rate for Payer: Healthspan PPO |
$1,654.17
|
| Rate for Payer: Humana Medicaid |
$986.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,516.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,006.68
|
| Rate for Payer: Molina Healthcare Passport |
$986.94
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,477.40
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$996.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,136.46
|
|
|
RECONSTRUCT TONGUE FOLD
|
Professional
|
Both
|
$4,361.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,616.60 |
| Rate for Payer: Aetna Commercial |
$357.90
|
| Rate for Payer: Ambetter Exchange |
$234.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.96
|
| Rate for Payer: Anthem Medicaid |
$161.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.93
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: Cigna Commercial |
$365.71
|
| Rate for Payer: Healthspan PPO |
$396.16
|
| Rate for Payer: Humana Medicaid |
$161.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.44
|
| Rate for Payer: Molina Healthcare Passport |
$161.22
|
| Rate for Payer: Multiplan PHCS |
$2,616.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$305.42
|
| Rate for Payer: UHCCP Medicaid |
$163.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.94
|
|
|
RECONSTRUCT TONGUE FOLD
|
Facility
|
IP
|
$4,361.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,308.30 |
| Max. Negotiated Rate |
$4,186.56 |
| Rate for Payer: Aetna Commercial |
$3,357.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.58
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: Cigna Commercial |
$3,619.63
|
| Rate for Payer: First Health Commercial |
$4,142.95
|
| Rate for Payer: Humana Commercial |
$3,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,794.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,009.09
|
| Rate for Payer: PHCS Commercial |
$4,186.56
|
| Rate for Payer: United Healthcare All Payer |
$3,837.68
|
|
|
RECONSTRUCT TONGUE FOLD
|
Facility
|
OP
|
$4,361.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
76101664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,499.75 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,357.97
|
| Rate for Payer: Anthem Medicaid |
$1,499.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: Cash Price |
$2,180.50
|
| Rate for Payer: Cigna Commercial |
$3,619.63
|
| Rate for Payer: First Health Commercial |
$4,142.95
|
| Rate for Payer: Humana Commercial |
$3,706.85
|
| Rate for Payer: Humana KY Medicaid |
$1,499.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,794.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,009.09
|
| Rate for Payer: PHCS Commercial |
$4,186.56
|
| Rate for Payer: United Healthcare All Payer |
$3,837.68
|
|
|
RECONSTRUCT TONGUE FOLD(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761P1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$396.16 |
| Rate for Payer: Aetna Commercial |
$357.90
|
| Rate for Payer: Ambetter Exchange |
$234.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$155.96
|
| Rate for Payer: Anthem Medicaid |
$161.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$234.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$234.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$281.93
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$365.71
|
| Rate for Payer: Healthspan PPO |
$396.16
|
| Rate for Payer: Humana Medicaid |
$161.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$234.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.44
|
| Rate for Payer: Molina Healthcare Passport |
$161.22
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$305.42
|
| Rate for Payer: UHCCP Medicaid |
$163.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$234.94
|
|
|
RECONSTRUCT TONGUE FOLD(T
|
Facility
|
IP
|
$3,861.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761T1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,158.30 |
| Max. Negotiated Rate |
$3,706.56 |
| Rate for Payer: Aetna Commercial |
$2,972.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.58
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cigna Commercial |
$3,204.63
|
| Rate for Payer: First Health Commercial |
$3,667.95
|
| Rate for Payer: Humana Commercial |
$3,281.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,166.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,849.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,359.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,664.09
|
| Rate for Payer: PHCS Commercial |
$3,706.56
|
| Rate for Payer: United Healthcare All Payer |
$3,397.68
|
|
|
RECONSTRUCT TONGUE FOLD(T
|
Facility
|
OP
|
$3,861.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
761T1664
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,327.80 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,972.97
|
| Rate for Payer: Anthem Medicaid |
$1,327.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cigna Commercial |
$3,204.63
|
| Rate for Payer: First Health Commercial |
$3,667.95
|
| Rate for Payer: Humana Commercial |
$3,281.85
|
| Rate for Payer: Humana KY Medicaid |
$1,327.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,166.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,849.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,359.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,664.09
|
| Rate for Payer: PHCS Commercial |
$3,706.56
|
| Rate for Payer: United Healthcare All Payer |
$3,397.68
|
|
|
RECONSTRUCT WRIST JOINT
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Ambetter Exchange |
$688.94
|
| Rate for Payer: Anthem Medicaid |
$591.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$688.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$688.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$826.73
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,164.65
|
| Rate for Payer: Healthspan PPO |
$957.87
|
| Rate for Payer: Humana Medicaid |
$591.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$891.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$688.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.51
|
| Rate for Payer: Molina Healthcare Passport |
$591.68
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$895.62
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$688.94
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.50 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
RECONSTRUCT WRIST JOINT
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.44 |
| Max. Negotiated Rate |
$1,233.39 |
| Rate for Payer: Aetna Commercial |
$1,122.30
|
| Rate for Payer: Ambetter Exchange |
$749.42
|
| Rate for Payer: Anthem Medicaid |
$578.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$749.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$749.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$899.30
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,233.39
|
| Rate for Payer: Healthspan PPO |
$1,016.57
|
| Rate for Payer: Humana Medicaid |
$578.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$969.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$749.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$749.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.01
|
| Rate for Payer: Molina Healthcare Passport |
$578.44
|
| Rate for Payer: Multiplan PHCS |
$1,116.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$974.25
|
| Rate for Payer: UHCCP Medicaid |
$651.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$749.42
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.65 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem Medicaid |
$639.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| 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 |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Humana KY Medicaid |
$639.65
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
76100613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
RECONSTRUCT WRIST JOINT
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
76100614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$713.59 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem Medicaid |
$713.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| 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 |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Humana KY Medicaid |
$713.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
RECONSTRUCT WRIST JOINT(P
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 25445
|
| Hospital Charge Code |
761P0614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Ambetter Exchange |
$688.94
|
| Rate for Payer: Anthem Medicaid |
$591.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$688.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$688.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$826.73
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,164.65
|
| Rate for Payer: Healthspan PPO |
$957.87
|
| Rate for Payer: Humana Medicaid |
$591.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$891.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$688.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.51
|
| Rate for Payer: Molina Healthcare Passport |
$591.68
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$895.62
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$688.94
|
|
|
RECONSTRUCT WRIST JOINT(P
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
HCPCS 25443
|
| Hospital Charge Code |
761P0613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.44 |
| Max. Negotiated Rate |
$1,233.39 |
| Rate for Payer: Aetna Commercial |
$1,122.30
|
| Rate for Payer: Ambetter Exchange |
$749.42
|
| Rate for Payer: Anthem Medicaid |
$578.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$749.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$749.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$899.30
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,233.39
|
| Rate for Payer: Healthspan PPO |
$1,016.57
|
| Rate for Payer: Humana Medicaid |
$578.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$969.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$749.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$749.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.01
|
| Rate for Payer: Molina Healthcare Passport |
$578.44
|
| Rate for Payer: Multiplan PHCS |
$1,116.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$974.25
|
| Rate for Payer: UHCCP Medicaid |
$651.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$749.42
|
|
