|
REPAIR LIVER WOUND(P
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 47350
|
| Hospital Charge Code |
761P1951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.59 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$1,964.93
|
| Rate for Payer: Anthem Medicaid |
$567.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,240.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,823.19
|
| Rate for Payer: Healthspan PPO |
$1,657.06
|
| Rate for Payer: Humana Medicaid |
$567.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$578.94
|
| Rate for Payer: Molina Healthcare Passport |
$567.59
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,568.00
|
| Rate for Payer: UHCCP Medicaid |
$784.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$573.27
|
|
|
REPAIR LIVER WOUND(P
|
Professional
|
Both
|
$6,175.00
|
|
|
Service Code
|
HCPCS 47361
|
| Hospital Charge Code |
761P1952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,297.15 |
| Max. Negotiated Rate |
$6,175.00 |
| Rate for Payer: Aetna Commercial |
$4,406.06
|
| Rate for Payer: Anthem Medicaid |
$1,297.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,175.00
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cigna Commercial |
$4,116.29
|
| Rate for Payer: Healthspan PPO |
$3,715.70
|
| Rate for Payer: Humana Medicaid |
$1,297.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,865.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,323.09
|
| Rate for Payer: Molina Healthcare Passport |
$1,297.15
|
| Rate for Payer: Multiplan PHCS |
$3,705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,322.50
|
| Rate for Payer: UHCCP Medicaid |
$2,161.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,310.12
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
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 LOWER LEG TENDONS
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
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 LOWER LEG TENDONS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$921.58
|
| Rate for Payer: Anthem Medicaid |
$461.41
|
| 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 |
$1,010.14
|
| Rate for Payer: Healthspan PPO |
$834.75
|
| Rate for Payer: Humana Medicaid |
$461.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.64
|
| Rate for Payer: Molina Healthcare Passport |
$461.41
|
| 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 |
$466.02
|
|
|
REPAIR LOWER LEG TENDONS(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
761P0911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$921.58
|
| Rate for Payer: Anthem Medicaid |
$461.41
|
| 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 |
$1,010.14
|
| Rate for Payer: Healthspan PPO |
$834.75
|
| Rate for Payer: Humana Medicaid |
$461.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.64
|
| Rate for Payer: Molina Healthcare Passport |
$461.41
|
| 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 |
$466.02
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.44 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,299.76
|
| Rate for Payer: Anthem Medicaid |
$580.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$1,401.04
|
| Rate for Payer: First Health Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial |
$1,434.80
|
| Rate for Payer: Humana KY Medicaid |
$580.50
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$586.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.28
|
| Rate for Payer: PHCS Commercial |
$1,620.48
|
| Rate for Payer: United Healthcare All Payer |
$1,485.44
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.44 |
| Max. Negotiated Rate |
$1,620.48 |
| Rate for Payer: Aetna Commercial |
$1,299.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.64
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$1,401.04
|
| Rate for Payer: First Health Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial |
$1,434.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.28
|
| Rate for Payer: PHCS Commercial |
$1,620.48
|
| Rate for Payer: United Healthcare All Payer |
$1,485.44
|
|
|
REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$1,688.00 |
| Rate for Payer: Aetna Commercial |
$967.13
|
| Rate for Payer: Anthem Medicaid |
$398.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,688.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$904.09
|
| Rate for Payer: Healthspan PPO |
$815.60
|
| Rate for Payer: Humana Medicaid |
$398.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$856.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.78
|
| Rate for Payer: Molina Healthcare Passport |
$398.80
|
| Rate for Payer: Multiplan PHCS |
$1,012.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,181.60
|
| Rate for Payer: UHCCP Medicaid |
$590.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.79
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$6,985.45
|
|
|
Service Code
|
CPT 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,989.61 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$6,985.45
|
|
|
Service Code
|
CPT 49540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,989.61 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.54 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,551.72
|
| Rate for Payer: Anthem Medicaid |
$615.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,461.65
|
| Rate for Payer: Healthspan PPO |
$1,211.54
|
| Rate for Payer: Humana Medicaid |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,295.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$627.85
|
| Rate for Payer: Molina Healthcare Passport |
$615.54
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$621.70
|
|
|
REPAIR LUNG HERNIA CHEST WAL(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
761P1231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.54 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,551.72
|
| Rate for Payer: Anthem Medicaid |
$615.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,461.65
|
| Rate for Payer: Healthspan PPO |
$1,211.54
|
| Rate for Payer: Humana Medicaid |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,295.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$627.85
|
| Rate for Payer: Molina Healthcare Passport |
$615.54
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$621.70
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.45
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,282.22 |
| Rate for Payer: Aetna Commercial |
$1,282.22
|
| Rate for Payer: Anthem Medicaid |
$553.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$795.00
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,132.51
|
| Rate for Payer: Healthspan PPO |
$1,241.52
|
| Rate for Payer: Humana Medicaid |
$553.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,077.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.75
|
| Rate for Payer: Molina Healthcare Passport |
$553.68
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$556.50
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.22
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.45
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR MV
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPAIR MV
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPAIR MV
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,763.15 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,060.67
|
| Rate for Payer: Anthem Medicaid |
$1,763.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,810.98
|
| Rate for Payer: Healthspan PPO |
$3,992.42
|
| Rate for Payer: Humana Medicaid |
$1,763.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,382.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.15
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.78
|
|
|
REPAIR MV(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
761P1290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,763.15 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,060.67
|
| Rate for Payer: Anthem Medicaid |
$1,763.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,810.98
|
| Rate for Payer: Healthspan PPO |
$3,992.42
|
| Rate for Payer: Humana Medicaid |
$1,763.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,382.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.15
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.78
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.04 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$877.01
|
| Rate for Payer: Anthem Medicaid |
$385.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$865.33
|
| Rate for Payer: Healthspan PPO |
$739.60
|
| Rate for Payer: Humana Medicaid |
$385.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$790.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.74
|
| Rate for Payer: Molina Healthcare Passport |
$385.04
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.89
|
|
