|
RELEASE HAND/FINGER TENDON(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26445
|
| Hospital Charge Code |
761P0702
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.36 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: Aetna Commercial |
$801.59
|
| Rate for Payer: Ambetter Exchange |
$554.17
|
| Rate for Payer: Anthem Medicaid |
$222.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$554.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$665.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,043.80
|
| Rate for Payer: Healthspan PPO |
$726.07
|
| Rate for Payer: Humana Medicaid |
$222.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$554.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.81
|
| Rate for Payer: Molina Healthcare Passport |
$222.36
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.42
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$554.17
|
|
|
RELEASE MUSCLES OF HAND
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.17 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
RELEASE MUSCLES OF HAND
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
RELEASE MUSCLES OF HAND
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
76100720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$1,014.43 |
| Rate for Payer: Aetna Commercial |
$829.59
|
| Rate for Payer: Ambetter Exchange |
$595.99
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$715.19
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,014.43
|
| Rate for Payer: Healthspan PPO |
$751.43
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$718.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$774.79
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.99
|
|
|
RELEASE MUSCLES OF HAND(P
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 26593
|
| Hospital Charge Code |
761P0720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$1,014.43 |
| Rate for Payer: Aetna Commercial |
$829.59
|
| Rate for Payer: Ambetter Exchange |
$595.99
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$715.19
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,014.43
|
| Rate for Payer: Healthspan PPO |
$751.43
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$718.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$774.79
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.99
|
|
|
RELEASE OF BIG TOE
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
76100998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
RELEASE OF BIG TOE
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
76100998
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.57 |
| Max. Negotiated Rate |
$597.43 |
| Rate for Payer: Aetna Commercial |
$509.72
|
| Rate for Payer: Ambetter Exchange |
$317.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.57
|
| Rate for Payer: Anthem Medicaid |
$210.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$381.49
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: Healthspan PPO |
$597.43
|
| Rate for Payer: Humana Medicaid |
$210.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$413.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.73
|
| Rate for Payer: Molina Healthcare Passport |
$210.52
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.28
|
| Rate for Payer: UHCCP Medicaid |
$178.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.91
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.91 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
76100999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
RELEASE OF FOOT CONTRACTURE(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 28270
|
| Hospital Charge Code |
761P0999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.57 |
| Max. Negotiated Rate |
$597.43 |
| Rate for Payer: Aetna Commercial |
$509.72
|
| Rate for Payer: Ambetter Exchange |
$317.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.57
|
| Rate for Payer: Anthem Medicaid |
$210.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$381.49
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: Healthspan PPO |
$597.43
|
| Rate for Payer: Humana Medicaid |
$210.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$413.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.73
|
| Rate for Payer: Molina Healthcare Passport |
$210.52
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.28
|
| Rate for Payer: UHCCP Medicaid |
$178.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.91
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.77 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Anthem Medicaid |
$339.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$770.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$820.04
|
| Rate for Payer: First Health Commercial |
$938.60
|
| Rate for Payer: Humana Commercial |
$839.80
|
| Rate for Payer: Humana KY Medicaid |
$339.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$343.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$869.44
|
| Rate for Payer: Ohio Health Group HMO |
$741.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.72
|
| Rate for Payer: PHCS Commercial |
$948.48
|
| Rate for Payer: United Healthcare All Payer |
$869.44
|
|
|
RELEASE OF FOOT TENDON
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Ambetter Exchange |
$251.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.45
|
| Rate for Payer: Anthem Medicaid |
$170.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$251.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$251.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$302.39
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$430.61
|
| Rate for Payer: Healthspan PPO |
$483.47
|
| Rate for Payer: Humana Medicaid |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$314.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$251.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.40
|
| Rate for Payer: Molina Healthcare Passport |
$170.00
|
| Rate for Payer: Multiplan PHCS |
$592.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$327.59
|
| Rate for Payer: UHCCP Medicaid |
$141.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$251.99
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
HCPCS 28225
|
| Hospital Charge Code |
76102909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$948.48 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$770.64
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cigna Commercial |
$820.04
|
| Rate for Payer: First Health Commercial |
$938.60
|
| Rate for Payer: Humana Commercial |
$839.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$869.44
|
| Rate for Payer: Ohio Health Group HMO |
$741.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.72
|
| Rate for Payer: PHCS Commercial |
$948.48
|
| Rate for Payer: United Healthcare All Payer |
$869.44
|
|
|
RELEASE OF LOWER LEG TENDON
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 27680
|
| Hospital Charge Code |
76102976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$714.62 |
| Rate for Payer: Aetna Commercial |
$640.76
|
| Rate for Payer: Ambetter Exchange |
$403.48
|
| Rate for Payer: Anthem Medicaid |
$282.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$403.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$403.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.18
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$714.62
|
| Rate for Payer: Healthspan PPO |
$580.39
|
| Rate for Payer: Humana Medicaid |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$535.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$403.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.56
|
| Rate for Payer: Molina Healthcare Passport |
$282.90
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$524.52
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$403.48
|
|
|
RELEASE OF SHOULDER LIGAMEN(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
761P0458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.16 |
| Max. Negotiated Rate |
$1,193.68 |
| Rate for Payer: Aetna Commercial |
$1,029.04
|
| Rate for Payer: Ambetter Exchange |
$668.47
|
| Rate for Payer: Anthem Medicaid |
$438.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$668.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$668.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$802.16
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,193.68
|
| Rate for Payer: Healthspan PPO |
$932.09
|
| Rate for Payer: Humana Medicaid |
$438.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$668.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.92
|
| Rate for Payer: Molina Healthcare Passport |
$438.16
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$869.01
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$668.47
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.16 |
| Max. Negotiated Rate |
$1,193.68 |
| Rate for Payer: Aetna Commercial |
$1,029.04
|
| Rate for Payer: Ambetter Exchange |
$668.47
|
| Rate for Payer: Anthem Medicaid |
$438.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$668.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$668.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$802.16
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,193.68
|
| Rate for Payer: Healthspan PPO |
$932.09
|
| Rate for Payer: Humana Medicaid |
$438.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$668.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.92
|
| Rate for Payer: Molina Healthcare Passport |
$438.16
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$869.01
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$668.47
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RELEASE PALM CONTRACTURE
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RELEASE PALM CONTRACTURE
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
76100658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$432.48
|
| Rate for Payer: Ambetter Exchange |
$303.29
|
| Rate for Payer: Anthem Medicaid |
$179.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.95
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$483.08
|
| Rate for Payer: Healthspan PPO |
$391.73
|
| Rate for Payer: Humana Medicaid |
$179.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$373.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.88
|
| Rate for Payer: Molina Healthcare Passport |
$179.29
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.28
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.29
|
|
|
RELEASE PALM CONTRACTURE(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26040
|
| Hospital Charge Code |
761P0658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.29 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$432.48
|
| Rate for Payer: Ambetter Exchange |
$303.29
|
| Rate for Payer: Anthem Medicaid |
$179.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.95
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$483.08
|
| Rate for Payer: Healthspan PPO |
$391.73
|
| Rate for Payer: Humana Medicaid |
$179.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$373.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.88
|
| Rate for Payer: Molina Healthcare Passport |
$179.29
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.28
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.29
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
76100701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Aetna Commercial |
$1,047.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.80
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,292.00
|
| Rate for Payer: Humana Commercial |
$1,156.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,003.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,196.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$938.40
|
| Rate for Payer: PHCS Commercial |
$1,305.60
|
| Rate for Payer: United Healthcare All Payer |
$1,196.80
|
|
|
RELEASE PALM & FINGER TENDON
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS 26442
|
| Hospital Charge Code |
76100701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.70 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,047.20
|
| Rate for Payer: Anthem Medicaid |
$467.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cigna Commercial |
$1,128.80
|
| Rate for Payer: First Health Commercial |
$1,292.00
|
| Rate for Payer: Humana Commercial |
$1,156.00
|
| Rate for Payer: Humana KY Medicaid |
$467.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$472.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,003.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,196.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$938.40
|
| Rate for Payer: PHCS Commercial |
$1,305.60
|
| Rate for Payer: United Healthcare All Payer |
$1,196.80
|
|
