|
REPAIR ELBOW W/DEB OPEN
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 24358
|
| Hospital Charge Code |
76102708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$810.15 |
| Rate for Payer: Aetna Commercial |
$752.88
|
| Rate for Payer: Anthem Medicaid |
$382.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$730.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$810.15
|
| Rate for Payer: Healthspan PPO |
$681.95
|
| Rate for Payer: Humana Medicaid |
$382.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.10
|
| Rate for Payer: Molina Healthcare Passport |
$382.45
|
| Rate for Payer: Multiplan PHCS |
$438.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.00
|
| Rate for Payer: UHCCP Medicaid |
$255.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.27
|
|
|
REPAIR ENTROPION EXTENSIVE
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 67924
|
| Hospital Charge Code |
76102755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Aetna Commercial |
$591.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$235.24
|
| Rate for Payer: Anthem Medicaid |
$369.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.00
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$578.96
|
| Rate for Payer: Healthspan PPO |
$675.52
|
| Rate for Payer: Humana Medicaid |
$369.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$376.99
|
| Rate for Payer: Molina Healthcare Passport |
$369.60
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.50
|
| Rate for Payer: UHCCP Medicaid |
$247.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.30
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$788.31
|
| Rate for Payer: Anthem Medicaid |
$228.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.08
|
| Rate for Payer: Healthspan PPO |
$714.04
|
| Rate for Payer: Humana Medicaid |
$228.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.45
|
| Rate for Payer: Molina Healthcare Passport |
$228.87
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.16
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR - EXTENSOR TENDON - H(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
761P0693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$788.31
|
| Rate for Payer: Anthem Medicaid |
$228.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.08
|
| Rate for Payer: Healthspan PPO |
$714.04
|
| Rate for Payer: Humana Medicaid |
$228.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.45
|
| Rate for Payer: Molina Healthcare Passport |
$228.87
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.16
|
|
|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$595.00
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$357.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$416.50
|
| Rate for Payer: UHCCP Medicaid |
$208.25
|
|
|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
REPAIR EYELID DEFECT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
REPAIR EYELID DEFECT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
REPAIR EYELID DEFECT
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.21 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$380.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$164.21
|
| Rate for Payer: Anthem Medicaid |
$238.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$372.26
|
| Rate for Payer: Healthspan PPO |
$448.83
|
| Rate for Payer: Humana Medicaid |
$238.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$362.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.54
|
| Rate for Payer: Molina Healthcare Passport |
$238.76
|
| Rate for Payer: Multiplan PHCS |
$297.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$346.50
|
| Rate for Payer: UHCCP Medicaid |
$172.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.15
|
|
|
REPAIR FIBULA NONUNION
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
REPAIR FIBULA NONUNION
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$1,404.60 |
| Rate for Payer: Aetna Commercial |
$1,342.78
|
| Rate for Payer: Anthem Medicaid |
$691.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,404.60
|
| Rate for Payer: Healthspan PPO |
$1,216.27
|
| Rate for Payer: Humana Medicaid |
$691.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,196.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.44
|
| Rate for Payer: Molina Healthcare Passport |
$691.61
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.53
|
|
|
REPAIR FIBULA NONUNION
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
REPAIR FIBULA NONUNION(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
761P0921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$1,404.60 |
| Rate for Payer: Aetna Commercial |
$1,342.78
|
| Rate for Payer: Anthem Medicaid |
$691.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,404.60
|
| Rate for Payer: Healthspan PPO |
$1,216.27
|
| Rate for Payer: Humana Medicaid |
$691.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,196.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.44
|
| Rate for Payer: Molina Healthcare Passport |
$691.61
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.53
|
|
|
REPAIR FINGER/HAND TENDON
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$1,182.59 |
| Rate for Payer: Aetna Commercial |
$813.62
|
| Rate for Payer: Anthem Medicaid |
$367.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$1,182.59
|
| Rate for Payer: Healthspan PPO |
$736.96
|
| Rate for Payer: Humana Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$658.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.54
|
| Rate for Payer: Molina Healthcare Passport |
$367.20
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.87
|
|
|
REPAIR FINGER/HAND TENDON
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR FINGER/HAND TENDON
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
761P2602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$1,182.59 |
| Rate for Payer: Aetna Commercial |
$813.62
|
| Rate for Payer: Anthem Medicaid |
$367.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$1,182.59
|
| Rate for Payer: Healthspan PPO |
$736.96
|
| Rate for Payer: Humana Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$658.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.54
|
| Rate for Payer: Molina Healthcare Passport |
$367.20
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.87
|
|
|
REPAIR FINGER/HAND TENDON
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR FINGER TENDON
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.32 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$787.91
|
| Rate for Payer: Anthem Medicaid |
$228.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.44
|
| Rate for Payer: Healthspan PPO |
$713.68
|
| Rate for Payer: Humana Medicaid |
$228.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.89
|
| Rate for Payer: Molina Healthcare Passport |
$228.32
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.60
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
45000138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
45000138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
