|
REPAIR/GRAFT OF THIGH
|
Facility
|
IP
|
$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 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: 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: 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 MUSCLE
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
76100832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
76100832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,347.68 |
| Rate for Payer: Aetna Commercial |
$1,220.14
|
| Rate for Payer: Anthem Medicaid |
$667.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,347.68
|
| Rate for Payer: Healthspan PPO |
$1,105.19
|
| Rate for Payer: Humana Medicaid |
$667.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.33
|
| Rate for Payer: Molina Healthcare Passport |
$667.97
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.65
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
76100832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REPAIR/GRAFT OF THIGH MUSCL(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
761P0832
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,347.68 |
| Rate for Payer: Aetna Commercial |
$1,220.14
|
| Rate for Payer: Anthem Medicaid |
$667.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,347.68
|
| Rate for Payer: Healthspan PPO |
$1,105.19
|
| Rate for Payer: Humana Medicaid |
$667.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,028.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$681.33
|
| Rate for Payer: Molina Healthcare Passport |
$667.97
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$674.65
|
|
|
REPAIR/GRAFT OF THIGH(P
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 27472
|
| Hospital Charge Code |
761P0850
|
|
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
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.25
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
REPAIR/GRAFT OF TIBIA
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.25 |
| Max. Negotiated Rate |
$2,094.30 |
| Rate for Payer: Aetna Commercial |
$1,931.77
|
| Rate for Payer: Anthem Medicaid |
$840.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$2,094.30
|
| Rate for Payer: Healthspan PPO |
$1,749.77
|
| Rate for Payer: Humana Medicaid |
$840.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.65
|
| Rate for Payer: Molina Healthcare Passport |
$840.83
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$849.24
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.25
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
REPAIR/GRAFT OF TIBIA(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
761P0920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.25 |
| Max. Negotiated Rate |
$2,094.30 |
| Rate for Payer: Aetna Commercial |
$1,931.77
|
| Rate for Payer: Anthem Medicaid |
$840.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$2,094.30
|
| Rate for Payer: Healthspan PPO |
$1,749.77
|
| Rate for Payer: Humana Medicaid |
$840.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.65
|
| Rate for Payer: Molina Healthcare Passport |
$840.83
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$849.24
|
|
|
REPAIR/GRAFT WRIST BONE
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.15 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,141.50
|
| Rate for Payer: Anthem Medicaid |
$571.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,295.75
|
| Rate for Payer: Healthspan PPO |
$1,033.95
|
| Rate for Payer: Humana Medicaid |
$571.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$954.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.57
|
| Rate for Payer: Molina Healthcare Passport |
$571.15
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.86
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| 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 |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REPAIR/GRAFT WRIST BONE(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
761P0612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.15 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,141.50
|
| Rate for Payer: Anthem Medicaid |
$571.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,295.75
|
| Rate for Payer: Healthspan PPO |
$1,033.95
|
| Rate for Payer: Humana Medicaid |
$571.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$954.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.57
|
| Rate for Payer: Molina Healthcare Passport |
$571.15
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.86
|
|
|
REPAIR HAND JOINT
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem Medicaid |
$502.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| 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 |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Humana KY Medicaid |
$502.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$507.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
REPAIR HAND JOINT
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.25 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna Commercial |
$928.43
|
| Rate for Payer: Anthem Medicaid |
$382.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,460.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,133.28
|
| Rate for Payer: Healthspan PPO |
$840.96
|
| Rate for Payer: Humana Medicaid |
$382.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$795.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.90
|
| Rate for Payer: Molina Healthcare Passport |
$382.25
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.00
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.07
|
|
|
REPAIR HAND JOINT
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
REPAIR HAND JOINT(P
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
761P0715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.25 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna Commercial |
$928.43
|
| Rate for Payer: Anthem Medicaid |
$382.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,460.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,133.28
|
| Rate for Payer: Healthspan PPO |
$840.96
|
| Rate for Payer: Humana Medicaid |
$382.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$795.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.90
|
| Rate for Payer: Molina Healthcare Passport |
$382.25
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.00
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.07
|
|
|
REPAIR HAND JOINT WITH GRAF(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
761P0716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.86 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$960.40
|
| Rate for Payer: Anthem Medicaid |
$362.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,165.23
|
| Rate for Payer: Healthspan PPO |
$869.91
|
| Rate for Payer: Humana Medicaid |
$362.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$823.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.12
|
| Rate for Payer: Molina Healthcare Passport |
$362.86
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.49
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.86 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$960.40
|
| Rate for Payer: Anthem Medicaid |
$362.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,165.23
|
| Rate for Payer: Healthspan PPO |
$869.91
|
| Rate for Payer: Humana Medicaid |
$362.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$823.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.12
|
| Rate for Payer: Molina Healthcare Passport |
$362.86
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.49
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$1,747.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
761T0159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$1,677.12 |
| Rate for Payer: Aetna Commercial |
$1,345.19
|
| Rate for Payer: Anthem Medicaid |
$600.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$873.50
|
| Rate for Payer: Cash Price |
$873.50
|
| Rate for Payer: Cigna Commercial |
$1,450.01
|
| Rate for Payer: First Health Commercial |
$1,659.65
|
| Rate for Payer: Humana Commercial |
$1,484.95
|
| Rate for Payer: Humana KY Medicaid |
$600.79
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.57
|
| Rate for Payer: PHCS Commercial |
$1,677.12
|
| Rate for Payer: United Healthcare All Payer |
$1,537.36
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$1,747.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$1,677.12 |
| Rate for Payer: Aetna Commercial |
$1,345.19
|
| Rate for Payer: Anthem Medicaid |
$600.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$873.50
|
| Rate for Payer: Cash Price |
$873.50
|
| Rate for Payer: Cigna Commercial |
$1,450.01
|
| Rate for Payer: First Health Commercial |
$1,659.65
|
| Rate for Payer: Humana Commercial |
$1,484.95
|
| Rate for Payer: Humana KY Medicaid |
$600.79
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.57
|
| Rate for Payer: PHCS Commercial |
$1,677.12
|
| Rate for Payer: United Healthcare All Payer |
$1,537.36
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$1,747.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
761T0159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$1,677.12 |
| Rate for Payer: Aetna Commercial |
$1,345.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.66
|
| Rate for Payer: Cash Price |
$873.50
|
| Rate for Payer: Cigna Commercial |
$1,450.01
|
| Rate for Payer: First Health Commercial |
$1,659.65
|
| Rate for Payer: Humana Commercial |
$1,484.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.57
|
| Rate for Payer: PHCS Commercial |
$1,677.12
|
| Rate for Payer: United Healthcare All Payer |
$1,537.36
|
|
