|
REPAIR ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
76100456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,239.99
|
| Rate for Payer: Anthem Medicaid |
$685.14
|
| 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 |
$1,459.47
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$685.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,023.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.84
|
| Rate for Payer: Molina Healthcare Passport |
$685.14
|
| 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 |
$691.99
|
|
|
REPAIR ROTATOR CUFF ACUTE
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
76100456
|
|
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 ROTATOR CUFF ACUTE(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
761P0456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,239.99
|
| Rate for Payer: Anthem Medicaid |
$685.14
|
| 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 |
$1,459.47
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$685.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,023.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.84
|
| Rate for Payer: Molina Healthcare Passport |
$685.14
|
| 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 |
$691.99
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,297.90
|
| Rate for Payer: Anthem Medicaid |
$783.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: Healthspan PPO |
$1,175.62
|
| Rate for Payer: Humana Medicaid |
$783.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$799.13
|
| Rate for Payer: Molina Healthcare Passport |
$783.46
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.29
|
|
|
REPAIR ROTATOR CUFF CHRONIC(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
761P0457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,297.90
|
| Rate for Payer: Anthem Medicaid |
$783.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: Healthspan PPO |
$1,175.62
|
| Rate for Payer: Humana Medicaid |
$783.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$799.13
|
| Rate for Payer: Molina Healthcare Passport |
$783.46
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.29
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR SALIVARY DUCT
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.87 |
| Max. Negotiated Rate |
$1,655.00 |
| Rate for Payer: Aetna Commercial |
$661.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$359.87
|
| Rate for Payer: Anthem Medicaid |
$391.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,655.00
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$660.93
|
| Rate for Payer: Healthspan PPO |
$661.76
|
| Rate for Payer: Humana Medicaid |
$391.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.31
|
| Rate for Payer: Molina Healthcare Passport |
$391.48
|
| Rate for Payer: Multiplan PHCS |
$993.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.50
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.39
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.15 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem Medicaid |
$569.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Humana KY Medicaid |
$569.15
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$574.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$580.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.05
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR SALIVARY DUCT
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.02 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$493.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$250.02
|
| Rate for Payer: Anthem Medicaid |
$254.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Healthspan PPO |
$508.07
|
| Rate for Payer: Humana Medicaid |
$254.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.03
|
| Rate for Payer: Molina Healthcare Passport |
$254.93
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$262.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.48
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.15 |
| Max. Negotiated Rate |
$1,588.80 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.05
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
REPAIR SALIVARY DUCT(P
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
761P1693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.87 |
| Max. Negotiated Rate |
$1,655.00 |
| Rate for Payer: Aetna Commercial |
$661.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$359.87
|
| Rate for Payer: Anthem Medicaid |
$391.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,655.00
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$660.93
|
| Rate for Payer: Healthspan PPO |
$661.76
|
| Rate for Payer: Humana Medicaid |
$391.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.31
|
| Rate for Payer: Molina Healthcare Passport |
$391.48
|
| Rate for Payer: Multiplan PHCS |
$993.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.50
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.39
|
|
|
REPAIR SALIVARY DUCT(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
761P1692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.02 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$493.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$250.02
|
| Rate for Payer: Anthem Medicaid |
$254.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Healthspan PPO |
$508.07
|
| Rate for Payer: Humana Medicaid |
$254.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.03
|
| Rate for Payer: Molina Healthcare Passport |
$254.93
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$262.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.48
|
|
|
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27654
|
|
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, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27698
|
|
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 SHOULDER CAPSULE
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 23465
|
| Hospital Charge Code |
76102729
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$401.45 |
| Max. Negotiated Rate |
$1,820.43 |
| Rate for Payer: Aetna Commercial |
$1,678.63
|
| Rate for Payer: Anthem Medicaid |
$878.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,147.00
|
| Rate for Payer: Cash Price |
$573.50
|
| Rate for Payer: Cash Price |
$573.50
|
| Rate for Payer: Cigna Commercial |
$1,820.43
|
| Rate for Payer: Healthspan PPO |
$1,520.48
|
| Rate for Payer: Humana Medicaid |
$878.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$896.53
|
| Rate for Payer: Molina Healthcare Passport |
$878.95
|
| Rate for Payer: Multiplan PHCS |
$688.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$802.90
|
| Rate for Payer: UHCCP Medicaid |
$401.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$887.74
|
|
|
REPAIR SHOULDER CAPSULE
|
Professional
|
Both
|
$1,095.00
|
|
|
Service Code
|
HCPCS 23462
|
| Hospital Charge Code |
76102760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$1,748.14 |
| Rate for Payer: Aetna Commercial |
$1,607.46
|
| Rate for Payer: Anthem Medicaid |
$895.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,095.00
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cigna Commercial |
$1,748.14
|
| Rate for Payer: Healthspan PPO |
$1,456.02
|
| Rate for Payer: Humana Medicaid |
$895.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,343.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$912.98
|
| Rate for Payer: Molina Healthcare Passport |
$895.08
|
| Rate for Payer: Multiplan PHCS |
$657.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$766.50
|
| Rate for Payer: UHCCP Medicaid |
$383.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$904.03
|
|
|
REPAIR SPICA BODY CAST/JACKE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761P1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$67.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.80
|
| Rate for Payer: Anthem Medicaid |
$24.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$24.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.49
|
| Rate for Payer: Molina Healthcare Passport |
$24.01
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$22.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.25
|
|
|
REPAIR SPICA BODY CAST/JACKE(T
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761T1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPAIR SPICA BODY CAST/JACKE(T
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761T1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$67.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.80
|
| Rate for Payer: Anthem Medicaid |
$24.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$24.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.49
|
| Rate for Payer: Molina Healthcare Passport |
$24.01
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$22.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.25
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
