|
REPAIR OF RUPTURED SPLEEN (SPL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
761P1587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,813.54
|
| Rate for Payer: Anthem Medicaid |
$610.56
|
| 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 |
$1,655.03
|
| Rate for Payer: Healthspan PPO |
$1,450.09
|
| Rate for Payer: Humana Medicaid |
$610.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,617.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.77
|
| Rate for Payer: Molina Healthcare Passport |
$610.56
|
| 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 |
$616.67
|
|
|
REPAIR OF RUPTURED SPLEEN (SPL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,813.54
|
| Rate for Payer: Anthem Medicaid |
$610.56
|
| 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 |
$1,655.03
|
| Rate for Payer: Healthspan PPO |
$1,450.09
|
| Rate for Payer: Humana Medicaid |
$610.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,617.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.77
|
| Rate for Payer: Molina Healthcare Passport |
$610.56
|
| 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 |
$616.67
|
|
|
REPAIR OF RUPTURED SPLEEN (SPL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
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 OF RUPTURED SPLEEN (SPL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
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 OF RUPTURED TENDON
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.43 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,159.68
|
| Rate for Payer: Anthem Medicaid |
$618.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,273.78
|
| Rate for Payer: Healthspan PPO |
$1,050.42
|
| Rate for Payer: Humana Medicaid |
$618.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.80
|
| Rate for Payer: Molina Healthcare Passport |
$618.43
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.61
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
REPAIR OF RUPTURED TENDON
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
76100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
REPAIR OF RUPTURED TENDON(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
761P0521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.43 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,159.68
|
| Rate for Payer: Anthem Medicaid |
$618.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,273.78
|
| Rate for Payer: Healthspan PPO |
$1,050.42
|
| Rate for Payer: Humana Medicaid |
$618.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.80
|
| Rate for Payer: Molina Healthcare Passport |
$618.43
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.61
|
|
|
REPAIR OF THIGH
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.55
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
REPAIR OF THIGH
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.75 |
| Max. Negotiated Rate |
$1,909.10 |
| Rate for Payer: Aetna Commercial |
$1,761.80
|
| Rate for Payer: Anthem Medicaid |
$945.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,205.00
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,909.10
|
| Rate for Payer: Healthspan PPO |
$1,595.81
|
| Rate for Payer: Humana Medicaid |
$945.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,476.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$964.07
|
| Rate for Payer: Molina Healthcare Passport |
$945.17
|
| Rate for Payer: Multiplan PHCS |
$723.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$843.50
|
| Rate for Payer: UHCCP Medicaid |
$421.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$954.62
|
|
|
REPAIR OF THIGH
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 27470
|
| Hospital Charge Code |
76102818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.55
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
REPAIR OF THIGH MUSCLE
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$920.44
|
| Rate for Payer: Anthem Medicaid |
$482.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,023.95
|
| Rate for Payer: Healthspan PPO |
$833.72
|
| Rate for Payer: Humana Medicaid |
$482.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$779.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.64
|
| Rate for Payer: Molina Healthcare Passport |
$482.00
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.82
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| 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 |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
76100831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
REPAIR OF THIGH MUSCLE(P
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
761P0831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$920.44
|
| Rate for Payer: Anthem Medicaid |
$482.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,023.95
|
| Rate for Payer: Healthspan PPO |
$833.72
|
| Rate for Payer: Humana Medicaid |
$482.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$779.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.64
|
| Rate for Payer: Molina Healthcare Passport |
$482.00
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.82
|
|
|
REPAIR OF URETHRAL LESION
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
REPAIR OF URETHRAL LESION
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
REPAIR OF URETHRAL LESION
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 57230
|
| Hospital Charge Code |
76102855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$595.55
|
| Rate for Payer: Anthem Medicaid |
$267.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$567.51
|
| Rate for Payer: Healthspan PPO |
$576.65
|
| Rate for Payer: Humana Medicaid |
$267.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$518.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.67
|
| Rate for Payer: Molina Healthcare Passport |
$267.32
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.99
|
|
|
REPAIR OF WINDPIPE DEFECT
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
41000064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$248.65 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.65
|
| Rate for Payer: Anthem Medicaid |
$333.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$697.01
|
| Rate for Payer: Healthspan PPO |
$713.33
|
| Rate for Payer: Humana Medicaid |
$333.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.03
|
| Rate for Payer: Molina Healthcare Passport |
$333.36
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$261.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.69
|
|
|
REPAIR OF WINDPIPE DEFECT(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 31825
|
| Hospital Charge Code |
410P0064
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$248.65 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.65
|
| Rate for Payer: Anthem Medicaid |
$333.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$697.01
|
| Rate for Payer: Healthspan PPO |
$713.33
|
| Rate for Payer: Humana Medicaid |
$333.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.03
|
| Rate for Payer: Molina Healthcare Passport |
$333.36
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$261.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.69
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
|
|
REPAIR OSTEOCHOND SUB DRILL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
