|
REPAIR OF CHEST WALL HERNIA
|
Facility
|
IP
|
$7,090.80
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.80 |
| Max. Negotiated Rate |
$6,807.17 |
| Rate for Payer: Aetna Commercial |
$5,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.82
|
| Rate for Payer: Cash Price |
$3,545.40
|
| Rate for Payer: Cigna Commercial |
$5,885.36
|
| Rate for Payer: First Health Commercial |
$6,736.26
|
| Rate for Payer: Humana Commercial |
$6,027.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.15
|
| Rate for Payer: PHCS Commercial |
$6,807.17
|
| Rate for Payer: United Healthcare All Payer |
$6,239.90
|
|
|
REPAIR OF CHEST WALL HERNIA(T
|
Facility
|
OP
|
$7,090.80
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
761T0409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$6,807.17 |
| Rate for Payer: Aetna Commercial |
$5,459.92
|
| Rate for Payer: Anthem Medicaid |
$2,438.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$3,545.40
|
| Rate for Payer: Cash Price |
$3,545.40
|
| Rate for Payer: Cigna Commercial |
$5,885.36
|
| Rate for Payer: First Health Commercial |
$6,736.26
|
| Rate for Payer: Humana Commercial |
$6,027.18
|
| Rate for Payer: Humana KY Medicaid |
$2,438.53
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.15
|
| Rate for Payer: PHCS Commercial |
$6,807.17
|
| Rate for Payer: United Healthcare All Payer |
$6,239.90
|
|
|
REPAIR OF CHEST WALL HERNIA(T
|
Facility
|
IP
|
$7,090.80
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
761T0409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.80 |
| Max. Negotiated Rate |
$6,807.17 |
| Rate for Payer: Aetna Commercial |
$5,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.82
|
| Rate for Payer: Cash Price |
$3,545.40
|
| Rate for Payer: Cigna Commercial |
$5,885.36
|
| Rate for Payer: First Health Commercial |
$6,736.26
|
| Rate for Payer: Humana Commercial |
$6,027.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.15
|
| Rate for Payer: PHCS Commercial |
$6,807.17
|
| Rate for Payer: United Healthcare All Payer |
$6,239.90
|
|
|
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 26540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
REPAIR OF DIGIT NERVE
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
76102372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
REPAIR OF DIGIT NERVE
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
76102372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.50 |
| Max. Negotiated Rate |
$1,066.15 |
| Rate for Payer: Aetna Commercial |
$1,066.15
|
| Rate for Payer: Anthem Medicaid |
$363.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$1,052.96
|
| Rate for Payer: Healthspan PPO |
$832.42
|
| Rate for Payer: Humana Medicaid |
$363.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$862.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.93
|
| Rate for Payer: Molina Healthcare Passport |
$363.66
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.30
|
|
|
REPAIR OF DIGIT NERVE
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
76102372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
REPAIR OF DIGIT NERVE(P
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
761P2372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.50 |
| Max. Negotiated Rate |
$1,066.15 |
| Rate for Payer: Aetna Commercial |
$1,066.15
|
| Rate for Payer: Anthem Medicaid |
$363.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$1,052.96
|
| Rate for Payer: Healthspan PPO |
$832.42
|
| Rate for Payer: Humana Medicaid |
$363.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$862.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.93
|
| Rate for Payer: Molina Healthcare Passport |
$363.66
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.30
|
|
|
REPAIR OF EARDRUM
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 69620
|
| Hospital Charge Code |
76102429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.05 |
| Max. Negotiated Rate |
$852.47 |
| Rate for Payer: Aetna Commercial |
$697.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.05
|
| Rate for Payer: Anthem Medicaid |
$393.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.00
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$694.30
|
| Rate for Payer: Healthspan PPO |
$852.47
|
| Rate for Payer: Humana Medicaid |
$393.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$623.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$401.36
|
| Rate for Payer: Molina Healthcare Passport |
$393.49
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$267.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$397.42
|
|
|
REPAIR OF FINGER TEN WGRAFT
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 26420
|
| Hospital Charge Code |
76100695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
REPAIR OF FINGER TEN WGRAFT
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 26420
|
| Hospital Charge Code |
76100695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
REPAIR OF FINGER TEN WGRAFT
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 26420
|
| Hospital Charge Code |
76100695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.59 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,003.52
|
| Rate for Payer: Anthem Medicaid |
$362.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,251.92
|
| Rate for Payer: Healthspan PPO |
$908.98
|
| Rate for Payer: Humana Medicaid |
$362.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.84
|
| Rate for Payer: Molina Healthcare Passport |
$362.59
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.22
|
|
|
REPAIR OF FINGER TEN WGRAFT(P
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 26420
|
| Hospital Charge Code |
761P0695
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.59 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,003.52
|
| Rate for Payer: Anthem Medicaid |
$362.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,251.92
|
| Rate for Payer: Healthspan PPO |
$908.98
|
| Rate for Payer: Humana Medicaid |
$362.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.84
|
| Rate for Payer: Molina Healthcare Passport |
$362.59
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.22
|
|
|
REPAIR OF FLEXOR TENDON
|
Facility
|
IP
|
$4,088.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
45000137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$3,924.48 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.28
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
REPAIR OF FLEXOR TENDON
|
Facility
|
OP
|
$4,088.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
45000137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$3,924.48 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem Medicaid |
$1,405.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Humana KY Medicaid |
$1,405.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.28
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
REPAIR OF FLEXOR TENDON
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
76100687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR OF FLEXOR TENDON
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
76100687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR OF FLEXOR TENDON
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
76100687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.03 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$992.51
|
| Rate for Payer: Anthem Medicaid |
$347.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,254.91
|
| Rate for Payer: Healthspan PPO |
$898.99
|
| Rate for Payer: Humana Medicaid |
$347.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$856.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.97
|
| Rate for Payer: Molina Healthcare Passport |
$347.03
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.50
|
|
|
REPAIR OF FLEXOR TENDON(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26350
|
| Hospital Charge Code |
761P0687
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.03 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$992.51
|
| Rate for Payer: Anthem Medicaid |
$347.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,254.91
|
| Rate for Payer: Healthspan PPO |
$898.99
|
| Rate for Payer: Humana Medicaid |
$347.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$856.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.97
|
| Rate for Payer: Molina Healthcare Passport |
$347.03
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.50
|
|
|
REPAIR OF HAMMERTOE
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
76101000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$489.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.18
|
| Rate for Payer: Anthem Medicaid |
$256.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$529.96
|
| Rate for Payer: Healthspan PPO |
$578.36
|
| Rate for Payer: Humana Medicaid |
$256.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.21
|
| Rate for Payer: Molina Healthcare Passport |
$256.09
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$204.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.65
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
76101000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem Medicaid |
$299.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Humana KY Medicaid |
$299.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$302.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.70
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
76101000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.70
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
REPAIR OF HAMMERTOE(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
761P1000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$489.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.18
|
| Rate for Payer: Anthem Medicaid |
$256.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$529.96
|
| Rate for Payer: Healthspan PPO |
$578.36
|
| Rate for Payer: Humana Medicaid |
$256.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.21
|
| Rate for Payer: Molina Healthcare Passport |
$256.09
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$204.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.65
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 64834
|
| Hospital Charge Code |
76102373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$1,113.60 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.60
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 64834
|
| Hospital Charge Code |
76102373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$893.20
|
| Rate for Payer: Anthem Medicaid |
$398.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$962.80
|
| Rate for Payer: First Health Commercial |
$1,102.00
|
| Rate for Payer: Humana Commercial |
$986.00
|
| Rate for Payer: Humana KY Medicaid |
$398.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,760.51
|
| Rate for Payer: Kentucky WC Medicaid |
$402.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$951.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.80
|
| Rate for Payer: Ohio Health Group HMO |
$870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.60
|
| Rate for Payer: PHCS Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Payer |
$1,020.80
|
|
