|
REPAIR FINGER TENDON(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
761P0694
|
|
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, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$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 |
$6,186.50
|
| 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 |
$7,423.80
|
| 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 FOOT DISLOCATION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
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 FOOT DISLOCATION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.23 |
| Max. Negotiated Rate |
$1,132.05 |
| Rate for Payer: Aetna Commercial |
$1,132.05
|
| Rate for Payer: Anthem Medicaid |
$302.23
|
| 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 |
$1,106.81
|
| Rate for Payer: Healthspan PPO |
$1,025.40
|
| Rate for Payer: Humana Medicaid |
$302.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.27
|
| Rate for Payer: Molina Healthcare Passport |
$302.23
|
| 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 |
$305.25
|
|
|
REPAIR FOOT DISLOCATION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
761P1032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.23 |
| Max. Negotiated Rate |
$1,132.05 |
| Rate for Payer: Aetna Commercial |
$1,132.05
|
| Rate for Payer: Anthem Medicaid |
$302.23
|
| 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 |
$1,106.81
|
| Rate for Payer: Healthspan PPO |
$1,025.40
|
| Rate for Payer: Humana Medicaid |
$302.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.27
|
| Rate for Payer: Molina Healthcare Passport |
$302.23
|
| 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 |
$305.25
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
76100598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
76100598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.69 |
| Max. Negotiated Rate |
$1,316.81 |
| Rate for Payer: Aetna Commercial |
$977.99
|
| Rate for Payer: Anthem Medicaid |
$357.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,316.81
|
| Rate for Payer: Healthspan PPO |
$885.85
|
| Rate for Payer: Humana Medicaid |
$357.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$809.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.84
|
| Rate for Payer: Molina Healthcare Passport |
$357.69
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.27
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
76100598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| 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 |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
REPAIR FOREARM TENDON/MUSCLE(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
761P0598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.69 |
| Max. Negotiated Rate |
$1,316.81 |
| Rate for Payer: Aetna Commercial |
$977.99
|
| Rate for Payer: Anthem Medicaid |
$357.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,316.81
|
| Rate for Payer: Healthspan PPO |
$885.85
|
| Rate for Payer: Humana Medicaid |
$357.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$809.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.84
|
| Rate for Payer: Molina Healthcare Passport |
$357.69
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.27
|
|
|
REPAIR FOREARM TENDON SHEATH
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 25275
|
| Hospital Charge Code |
76102866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
REPAIR FOREARM TENDON SHEATH
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 25275
|
| Hospital Charge Code |
76102866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| 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 |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
REPAIR FOREARM TENDON SHEATH
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 25275
|
| Hospital Charge Code |
76102866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$1,070.11 |
| Rate for Payer: Aetna Commercial |
$973.31
|
| Rate for Payer: Anthem Medicaid |
$466.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$690.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$1,070.11
|
| Rate for Payer: Healthspan PPO |
$881.61
|
| Rate for Payer: Humana Medicaid |
$466.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$834.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$476.06
|
| Rate for Payer: Molina Healthcare Passport |
$466.73
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.00
|
| Rate for Payer: UHCCP Medicaid |
$241.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$471.40
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
OP
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
76100907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.20 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,647.80
|
| Rate for Payer: Anthem Medicaid |
$735.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,669.20
|
| 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 |
$1,070.00
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cigna Commercial |
$1,776.20
|
| Rate for Payer: First Health Commercial |
$2,033.00
|
| Rate for Payer: Humana Commercial |
$1,819.00
|
| Rate for Payer: Humana KY Medicaid |
$735.95
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$743.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,579.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,883.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.40
|
| Rate for Payer: PHCS Commercial |
$2,054.40
|
| Rate for Payer: United Healthcare All Payer |
$1,883.20
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
76100907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.41 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$1,105.41
|
| Rate for Payer: Anthem Medicaid |
$599.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,140.00
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cigna Commercial |
$1,225.77
|
| Rate for Payer: Healthspan PPO |
$1,001.27
|
| Rate for Payer: Humana Medicaid |
$599.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.40
|
| Rate for Payer: Molina Healthcare Passport |
$599.41
|
| Rate for Payer: Multiplan PHCS |
$1,284.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,498.00
|
| Rate for Payer: UHCCP Medicaid |
$749.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.40
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
IP
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
76100907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.20 |
| Max. Negotiated Rate |
$2,054.40 |
| Rate for Payer: Aetna Commercial |
$1,647.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,669.20
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cigna Commercial |
$1,776.20
|
| Rate for Payer: First Health Commercial |
$2,033.00
|
| Rate for Payer: Humana Commercial |
$1,819.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,579.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$642.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,883.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$663.40
|
| Rate for Payer: PHCS Commercial |
$2,054.40
|
| Rate for Payer: United Healthcare All Payer |
$1,883.20
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
IP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
45000164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.29 |
| Max. Negotiated Rate |
$8,575.68 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,769.23
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
OP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
45000164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.29 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem Medicaid |
$3,072.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| 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 |
$4,466.50
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Humana KY Medicaid |
$3,072.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,103.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,769.23
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
REPAIR/GRAFT ACHILLES TENDO(P
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 27652
|
| Hospital Charge Code |
761P0907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.41 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$1,105.41
|
| Rate for Payer: Anthem Medicaid |
$599.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,140.00
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cash Price |
$1,070.00
|
| Rate for Payer: Cigna Commercial |
$1,225.77
|
| Rate for Payer: Healthspan PPO |
$1,001.27
|
| Rate for Payer: Humana Medicaid |
$599.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.40
|
| Rate for Payer: Molina Healthcare Passport |
$599.41
|
| Rate for Payer: Multiplan PHCS |
$1,284.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,498.00
|
| Rate for Payer: UHCCP Medicaid |
$749.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.40
|
|
|
REPAIR/GRAFT KNEECAP TENDON
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 27381
|
| Hospital Charge Code |
76100830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| 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 |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR/GRAFT KNEECAP TENDON
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 27381
|
| Hospital Charge Code |
76100830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR/GRAFT KNEECAP TENDON
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 27381
|
| Hospital Charge Code |
76100830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.97 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,176.94
|
| Rate for Payer: Anthem Medicaid |
$629.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,296.97
|
| Rate for Payer: Healthspan PPO |
$1,066.05
|
| Rate for Payer: Humana Medicaid |
$629.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$989.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$642.57
|
| Rate for Payer: Molina Healthcare Passport |
$629.97
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$636.27
|
|
|
REPAIR/GRAFT KNEECAP TENDON(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 27381
|
| Hospital Charge Code |
761P0830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.97 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,176.94
|
| Rate for Payer: Anthem Medicaid |
$629.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,296.97
|
| Rate for Payer: Healthspan PPO |
$1,066.05
|
| Rate for Payer: Humana Medicaid |
$629.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$989.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$642.57
|
| Rate for Payer: Molina Healthcare Passport |
$629.97
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$636.27
|
|
|
REPAIR/GRAFT OF THIGH
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 27472
|
| Hospital Charge Code |
76100850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Aetna Commercial |
$1,131.90
|
| Rate for Payer: Anthem Medicaid |
$505.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,146.60
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,220.10
|
| Rate for Payer: First Health Commercial |
$1,396.50
|
| Rate for Payer: Humana Commercial |
$1,249.50
|
| Rate for Payer: Humana KY Medicaid |
$505.53
|
| Rate for Payer: Kentucky WC Medicaid |
$510.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,205.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$515.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,293.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,102.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.70
|
| Rate for Payer: PHCS Commercial |
$1,411.20
|
| Rate for Payer: United Healthcare All Payer |
$1,293.60
|
|
|
REPAIR/GRAFT OF THIGH
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 27472
|
| Hospital Charge Code |
76100850
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$2,072.38 |
| Rate for Payer: Aetna Commercial |
$1,907.81
|
| Rate for Payer: Anthem Medicaid |
$1,090.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,470.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,072.38
|
| Rate for Payer: Healthspan PPO |
$1,728.07
|
| Rate for Payer: Humana Medicaid |
$1,090.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,589.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,112.79
|
| Rate for Payer: Molina Healthcare Passport |
$1,090.97
|
| Rate for Payer: Multiplan PHCS |
$882.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,029.00
|
| Rate for Payer: UHCCP Medicaid |
$514.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,101.88
|
|
