|
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27405
|
|
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 RADIUS OR ULNA
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
76100611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.90 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,280.29
|
| Rate for Payer: Anthem Medicaid |
$633.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,656.26
|
| Rate for Payer: Healthspan PPO |
$1,159.67
|
| Rate for Payer: Humana Medicaid |
$633.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,037.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.58
|
| Rate for Payer: Molina Healthcare Passport |
$633.90
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.24
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
76100611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| 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 |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REPAIR RADIUS OR ULNA
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
76100611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REPAIR RADIUS OR ULNA(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 25400
|
| Hospital Charge Code |
761P0611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.90 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,280.29
|
| Rate for Payer: Anthem Medicaid |
$633.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,656.26
|
| Rate for Payer: Healthspan PPO |
$1,159.67
|
| Rate for Payer: Humana Medicaid |
$633.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,037.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.58
|
| Rate for Payer: Molina Healthcare Passport |
$633.90
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.24
|
|
|
REPAIR RADIUS & ULNA
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25415
|
| Hospital Charge Code |
76102671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.25 |
| Max. Negotiated Rate |
$1,903.65 |
| Rate for Payer: Aetna Commercial |
$1,530.33
|
| Rate for Payer: Anthem Medicaid |
$723.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,175.00
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$1,903.65
|
| Rate for Payer: Healthspan PPO |
$1,386.16
|
| Rate for Payer: Humana Medicaid |
$723.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,261.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$738.34
|
| Rate for Payer: Molina Healthcare Passport |
$723.86
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$822.50
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$731.10
|
|
|
REPAIR RECUR. FEMORAL HERNIA
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49555
|
| Hospital Charge Code |
76102019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.34 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$854.63
|
| Rate for Payer: Anthem Medicaid |
$407.34
|
| 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 |
$796.53
|
| Rate for Payer: Healthspan PPO |
$720.72
|
| Rate for Payer: Humana Medicaid |
$407.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$415.49
|
| Rate for Payer: Molina Healthcare Passport |
$407.34
|
| 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 |
$411.41
|
|
|
REPAIR RECUR. FEMORAL HERNIA
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49555
|
| Hospital Charge Code |
76102019
|
|
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 RECUR. FEMORAL HERNIA
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49555
|
| Hospital Charge Code |
76102019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| 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 |
$2,991.76
|
| 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 |
$3,590.11
|
| 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 RECUR. FEMORAL HERNIA(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49555
|
| Hospital Charge Code |
761P2019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.34 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$854.63
|
| Rate for Payer: Anthem Medicaid |
$407.34
|
| 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 |
$796.53
|
| Rate for Payer: Healthspan PPO |
$720.72
|
| Rate for Payer: Humana Medicaid |
$407.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$415.49
|
| Rate for Payer: Molina Healthcare Passport |
$407.34
|
| 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 |
$411.41
|
|
|
REPAIR RECUR ING. HERNIA
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
76102014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.92 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$904.06
|
| Rate for Payer: Anthem Medicaid |
$397.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$842.32
|
| Rate for Payer: Healthspan PPO |
$762.41
|
| Rate for Payer: Humana Medicaid |
$397.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$799.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.88
|
| Rate for Payer: Molina Healthcare Passport |
$397.92
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.90
|
|
|
REPAIR RECUR ING. HERNIA
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
76102014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REPAIR RECUR ING. HERNIA
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
76102014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REPAIR RECUR ING. HERNIA(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 49520
|
| Hospital Charge Code |
761P2014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.92 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$904.06
|
| Rate for Payer: Anthem Medicaid |
$397.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$842.32
|
| Rate for Payer: Healthspan PPO |
$762.41
|
| Rate for Payer: Humana Medicaid |
$397.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$799.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.88
|
| Rate for Payer: Molina Healthcare Passport |
$397.92
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.90
|
|
|
REPAIR RECURRENT ING. HERNIA
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
76102015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR RECURRENT ING. HERNIA
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
76102015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$9,159.29 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,542.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,159.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,832.17
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$6,542.35
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,850.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR RECURRENT ING. HERNIA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
76102015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,104.49
|
| Rate for Payer: Anthem Medicaid |
$438.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,032.27
|
| Rate for Payer: Healthspan PPO |
$931.43
|
| Rate for Payer: Humana Medicaid |
$438.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$972.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.90
|
| Rate for Payer: Molina Healthcare Passport |
$438.14
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.52
|
|
|
REPAIR RECURRENT ING. HERNIA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
761P2015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,104.49
|
| Rate for Payer: Anthem Medicaid |
$438.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,032.27
|
| Rate for Payer: Healthspan PPO |
$931.43
|
| Rate for Payer: Humana Medicaid |
$438.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$972.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.90
|
| Rate for Payer: Molina Healthcare Passport |
$438.14
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.52
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$9,159.29
|
|
|
Service Code
|
CPT 49521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,542.35 |
| Max. Negotiated Rate |
$9,159.29 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,542.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,159.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,832.17
|
| Rate for Payer: Humana Medicare Advantage |
$6,542.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,850.82
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$4,188.46
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,991.76 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
|
|
REPAIR/REVISE WRIST JOINT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
76100606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| 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: Humana Medicare Advantage |
$6,186.50
|
| 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 |
$7,423.80
|
| 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/REVISE WRIST JOINT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
76100606
|
|
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/REVISE WRIST JOINT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
76100606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,385.91
|
| Rate for Payer: Anthem Medicaid |
$556.11
|
| 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 |
$1,541.63
|
| Rate for Payer: Healthspan PPO |
$1,255.34
|
| Rate for Payer: Humana Medicaid |
$556.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,211.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$567.23
|
| Rate for Payer: Molina Healthcare Passport |
$556.11
|
| 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 |
$561.67
|
|
|
REPAIR/REVISE WRIST JOINT(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
761P0606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,385.91
|
| Rate for Payer: Anthem Medicaid |
$556.11
|
| 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 |
$1,541.63
|
| Rate for Payer: Healthspan PPO |
$1,255.34
|
| Rate for Payer: Humana Medicaid |
$556.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,211.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$567.23
|
| Rate for Payer: Molina Healthcare Passport |
$556.11
|
| 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 |
$561.67
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
76100456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| 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 |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
