|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM
|
Facility
|
OP
|
$760.35
|
|
|
Service Code
|
CPT 12036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.11 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
CPT 12031
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
CPT 12032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
CPT 12034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 12037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
REPAIR INTERM. NECK - HAND -
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$815.04 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.22
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.19
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
REPAIR INTERM. NECK - HAND -
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$815.04 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem Medicaid |
$291.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| Rate for Payer: Humana KY Medicaid |
$291.97
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$294.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.19
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
REPAIR INTERM. NECK - HAND -
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$849.00 |
| Rate for Payer: Aetna Commercial |
$239.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.85
|
| Rate for Payer: Anthem Medicaid |
$81.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$849.00
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$295.96
|
| Rate for Payer: Healthspan PPO |
$272.20
|
| Rate for Payer: Humana Medicaid |
$81.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.92
|
| Rate for Payer: Molina Healthcare Passport |
$81.29
|
| Rate for Payer: Multiplan PHCS |
$509.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.30
|
| Rate for Payer: UHCCP Medicaid |
$76.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.10
|
|
|
REPAIR INTERM. NECK - HAND -
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPAIR INTERM. NECK - HAND -
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPAIR INTERM. NECK - HAND -(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
761P0138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$239.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.85
|
| Rate for Payer: Anthem Medicaid |
$81.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$295.96
|
| Rate for Payer: Healthspan PPO |
$272.20
|
| Rate for Payer: Humana Medicaid |
$81.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.92
|
| Rate for Payer: Molina Healthcare Passport |
$81.29
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$76.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.10
|
|
|
REPAIR INTERM. NECK - HAND -(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
761T0138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPAIR INTERM. NECK - HAND -(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
761T0138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPAIR - LACERATION OF DIAPH(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 39501
|
| Hospital Charge Code |
761P1621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.01 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,258.26
|
| Rate for Payer: Anthem Medicaid |
$692.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,289.99
|
| Rate for Payer: Healthspan PPO |
$1,006.09
|
| Rate for Payer: Humana Medicaid |
$692.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,096.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.85
|
| Rate for Payer: Molina Healthcare Passport |
$692.01
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.93
|
|
|
REPAIR - LACERATION OF DIAPHR
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 39501
|
| Hospital Charge Code |
76101621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REPAIR - LACERATION OF DIAPHR
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 39501
|
| Hospital Charge Code |
76101621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REPAIR - LACERATION OF DIAPHR
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 39501
|
| Hospital Charge Code |
76101621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.01 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,258.26
|
| Rate for Payer: Anthem Medicaid |
$692.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,289.99
|
| Rate for Payer: Healthspan PPO |
$1,006.09
|
| Rate for Payer: Humana Medicaid |
$692.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,096.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.85
|
| Rate for Payer: Molina Healthcare Passport |
$692.01
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.93
|
|
|
REPAIR LAC OF PALATE UP TO 2CM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
45000258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REPAIR LAC OF PALATE UP TO 2CM
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
76101676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REPAIR LAC OF PALATE UP TO 2CM
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
76101676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REPAIR LAC OF PALATE UP TO 2CM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
45000258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REPAIR LAC PALATE >2 CM/COMP
|
Facility
|
OP
|
$7,243.00
|
|
|
Service Code
|
HCPCS 42182
|
| Hospital Charge Code |
45000259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$941.59 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$5,577.11
|
| Rate for Payer: Anthem Medicaid |
$2,490.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.54
|
| 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 |
$3,621.50
|
| Rate for Payer: Cash Price |
$3,621.50
|
| Rate for Payer: Cigna Commercial |
$6,011.69
|
| Rate for Payer: First Health Commercial |
$6,880.85
|
| Rate for Payer: Humana Commercial |
$6,156.55
|
| Rate for Payer: Humana KY Medicaid |
$2,490.87
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.33
|
| Rate for Payer: PHCS Commercial |
$6,953.28
|
| Rate for Payer: United Healthcare All Payer |
$6,373.84
|
|
|
REPAIR LAC PALATE >2 CM/COMP
|
Facility
|
IP
|
$7,243.00
|
|
|
Service Code
|
HCPCS 42182
|
| Hospital Charge Code |
45000259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$941.59 |
| Max. Negotiated Rate |
$6,953.28 |
| Rate for Payer: Aetna Commercial |
$5,577.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.54
|
| Rate for Payer: Cash Price |
$3,621.50
|
| Rate for Payer: Cigna Commercial |
$6,011.69
|
| Rate for Payer: First Health Commercial |
$6,880.85
|
| Rate for Payer: Humana Commercial |
$6,156.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.33
|
| Rate for Payer: PHCS Commercial |
$6,953.28
|
| Rate for Payer: United Healthcare All Payer |
$6,373.84
|
|
|
REPAIR LAC PALATE >2 CM/COMP
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 42182
|
| Hospital Charge Code |
76101677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Anthem Medicaid |
$247.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.60
|
| 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 |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Humana Commercial |
$612.00
|
| Rate for Payer: Humana KY Medicaid |
$247.61
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$250.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.60
|
| Rate for Payer: Ohio Health Group HMO |
$540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.20
|
| Rate for Payer: PHCS Commercial |
$691.20
|
| Rate for Payer: United Healthcare All Payer |
$633.60
|
|
|
REPAIR LAC PALATE >2 CM/COMP
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 42182
|
| Hospital Charge Code |
76101677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.60
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Humana Commercial |
$612.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.60
|
| Rate for Payer: Ohio Health Group HMO |
$540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.20
|
| Rate for Payer: PHCS Commercial |
$691.20
|
| Rate for Payer: United Healthcare All Payer |
$633.60
|
|
