|
REPAIR - COMPLEX - TRUNK - ADD
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
761T0151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.38 |
| Max. Negotiated Rate |
$1,944.96 |
| Rate for Payer: Aetna Commercial |
$1,560.02
|
| Rate for Payer: Anthem Medicaid |
$696.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.28
|
| Rate for Payer: Cash Price |
$1,013.00
|
| Rate for Payer: Cigna Commercial |
$1,681.58
|
| Rate for Payer: First Health Commercial |
$1,924.70
|
| Rate for Payer: Humana Commercial |
$1,722.10
|
| Rate for Payer: Humana KY Medicaid |
$696.74
|
| Rate for Payer: Kentucky WC Medicaid |
$703.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.06
|
| Rate for Payer: PHCS Commercial |
$1,944.96
|
| Rate for Payer: United Healthcare All Payer |
$1,782.88
|
|
|
REPAIR - COMPLEX - TRUNK - ADD
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
761P0151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$110.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.69
|
| Rate for Payer: Anthem Medicaid |
$56.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$136.22
|
| Rate for Payer: Healthspan PPO |
$120.70
|
| Rate for Payer: Humana Medicaid |
$56.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.13
|
| Rate for Payer: Molina Healthcare Passport |
$56.01
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$38.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.57
|
|
|
REPAIR - COMPLEX - TRUNK - ADD
|
Professional
|
Both
|
$2,226.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$2,226.00 |
| Rate for Payer: Aetna Commercial |
$110.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.69
|
| Rate for Payer: Anthem Medicaid |
$56.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,226.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$136.22
|
| Rate for Payer: Healthspan PPO |
$120.70
|
| Rate for Payer: Humana Medicaid |
$56.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$95.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.13
|
| Rate for Payer: Molina Healthcare Passport |
$56.01
|
| Rate for Payer: Multiplan PHCS |
$1,335.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,558.20
|
| Rate for Payer: UHCCP Medicaid |
$38.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.57
|
|
|
REPAIR - COMPLEX - TRUNK - ADD
|
Facility
|
OP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$1,714.02
|
| Rate for Payer: Anthem Medicaid |
$765.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,736.28
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,847.58
|
| Rate for Payer: First Health Commercial |
$2,114.70
|
| Rate for Payer: Humana Commercial |
$1,892.10
|
| Rate for Payer: Humana KY Medicaid |
$765.52
|
| Rate for Payer: Kentucky WC Medicaid |
$773.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,825.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$780.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.06
|
| Rate for Payer: PHCS Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare All Payer |
$1,958.88
|
|
|
REPAIR - COMPLEX - TRUNK - ADD
|
Facility
|
IP
|
$2,226.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$1,714.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,736.28
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$1,847.58
|
| Rate for Payer: First Health Commercial |
$2,114.70
|
| Rate for Payer: Humana Commercial |
$1,892.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,825.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.06
|
| Rate for Payer: PHCS Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare All Payer |
$1,958.88
|
|
|
REPAIR DEFECT OF ARM ARTERY
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 35045
|
| Hospital Charge Code |
76102712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$1,705.30 |
| Rate for Payer: Aetna Commercial |
$1,705.30
|
| Rate for Payer: Anthem Medicaid |
$684.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$1,621.83
|
| Rate for Payer: Healthspan PPO |
$1,676.64
|
| Rate for Payer: Humana Medicaid |
$684.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,330.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.55
|
| Rate for Payer: Molina Healthcare Passport |
$684.85
|
| Rate for Payer: Multiplan PHCS |
$714.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.00
|
| Rate for Payer: UHCCP Medicaid |
$416.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.70
|
|
|
REPAIR DEFECT OF ARTERY
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
76101356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.19 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,754.84
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,679.87
|
| Rate for Payer: Healthspan PPO |
$1,725.35
|
| Rate for Payer: Humana Medicaid |
$731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,359.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$745.81
|
| Rate for Payer: Molina Healthcare Passport |
$731.19
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.50
|
|
|
REPAIR DEFECT OF ARTERY
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
76101356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
REPAIR DEFECT OF ARTERY
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
76101356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
REPAIR DEFECT OF ARTERY(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
761P1356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.19 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,754.84
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,679.87
|
| Rate for Payer: Healthspan PPO |
$1,725.35
|
| Rate for Payer: Humana Medicaid |
$731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,359.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$745.81
|
| Rate for Payer: Molina Healthcare Passport |
$731.19
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.50
|
|
|
REPAIR DEFORMITY OF TOE
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
36001269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.38 |
| Max. Negotiated Rate |
$644.70 |
| Rate for Payer: Aetna Commercial |
$559.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.07
|
| Rate for Payer: Anthem Medicaid |
$181.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$634.07
|
| Rate for Payer: Healthspan PPO |
$644.70
|
| Rate for Payer: Humana Medicaid |
$181.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.01
|
| Rate for Payer: Molina Healthcare Passport |
$181.38
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$192.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.19
|
|
|
REPAIR DEFORMITY OF TOE
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
360P1269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.38 |
| Max. Negotiated Rate |
$644.70 |
| Rate for Payer: Aetna Commercial |
$559.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.07
|
| Rate for Payer: Anthem Medicaid |
$181.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$634.07
|
| Rate for Payer: Healthspan PPO |
$644.70
|
| Rate for Payer: Humana Medicaid |
$181.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.01
|
| Rate for Payer: Molina Healthcare Passport |
$181.38
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$192.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.19
|
|
|
REPAIR EARDRUM STRUCTURES
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REPAIR EARDRUM STRUCTURES
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,730.87 |
| Rate for Payer: Aetna Commercial |
$1,730.87
|
| Rate for Payer: Anthem Medicaid |
$875.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,714.46
|
| Rate for Payer: Healthspan PPO |
$1,535.36
|
| Rate for Payer: Humana Medicaid |
$875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,556.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.55
|
| Rate for Payer: Molina Healthcare Passport |
$875.05
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.80
|
|
|
REPAIR EARDRUM STRUCTURES
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REPAIR EARDRUM STRUCTURES(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
761P2431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,730.87 |
| Rate for Payer: Aetna Commercial |
$1,730.87
|
| Rate for Payer: Anthem Medicaid |
$875.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,714.46
|
| Rate for Payer: Healthspan PPO |
$1,535.36
|
| Rate for Payer: Humana Medicaid |
$875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,556.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.55
|
| Rate for Payer: Molina Healthcare Passport |
$875.05
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.80
|
|
|
REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 67917
|
| Hospital Charge Code |
76102754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$679.24 |
| Rate for Payer: Aetna Commercial |
$628.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$263.62
|
| Rate for Payer: Anthem Medicaid |
$383.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$616.31
|
| Rate for Payer: Healthspan PPO |
$679.24
|
| Rate for Payer: Humana Medicaid |
$383.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$599.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$391.08
|
| Rate for Payer: Molina Healthcare Passport |
$383.41
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$276.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$387.24
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$952.78
|
| Rate for Payer: Anthem Medicaid |
$488.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$997.39
|
| Rate for Payer: Healthspan PPO |
$863.01
|
| Rate for Payer: Humana Medicaid |
$488.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$810.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.43
|
| Rate for Payer: Molina Healthcare Passport |
$488.66
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.55
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
761P0524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$952.78
|
| Rate for Payer: Anthem Medicaid |
$488.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$997.39
|
| Rate for Payer: Healthspan PPO |
$863.01
|
| Rate for Payer: Humana Medicaid |
$488.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$810.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.43
|
| Rate for Payer: Molina Healthcare Passport |
$488.66
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.55
|
|
|
REPAIR ELBOW PERC
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$211.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$213.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REPAIR ELBOW PERC
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REPAIR ELBOW PERC
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$689.10 |
| Rate for Payer: Aetna Commercial |
$635.57
|
| Rate for Payer: Anthem Medicaid |
$323.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$689.10
|
| Rate for Payer: Healthspan PPO |
$575.69
|
| Rate for Payer: Humana Medicaid |
$323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$330.17
|
| Rate for Payer: Molina Healthcare Passport |
$323.70
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.50
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.94
|
|
|
REPAIR ELBOW PERC(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
761P0523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$689.10 |
| Rate for Payer: Aetna Commercial |
$635.57
|
| Rate for Payer: Anthem Medicaid |
$323.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$689.10
|
| Rate for Payer: Healthspan PPO |
$575.69
|
| Rate for Payer: Humana Medicaid |
$323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$330.17
|
| Rate for Payer: Molina Healthcare Passport |
$323.70
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.50
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.94
|
|
