|
REPAIR ACHILLES TENDON
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
76100906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR ACHILLES TENDON
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
76100906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR ACHILLES TENDON(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
761P0906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,148.57 |
| Rate for Payer: Aetna Commercial |
$1,002.02
|
| Rate for Payer: Ambetter Exchange |
$626.19
|
| Rate for Payer: Anthem Medicaid |
$541.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$626.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$626.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$751.43
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,148.57
|
| Rate for Payer: Healthspan PPO |
$907.61
|
| Rate for Payer: Humana Medicaid |
$541.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$827.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$626.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.10
|
| Rate for Payer: Molina Healthcare Passport |
$541.27
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$814.05
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$626.19
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Facility
|
OP
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,194.38 |
| Max. Negotiated Rate |
$11,708.64 |
| Rate for Payer: Aetna Commercial |
$9,391.31
|
| Rate for Payer: Anthem Medicaid |
$4,194.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$10,123.09
|
| Rate for Payer: First Health Commercial |
$11,586.67
|
| Rate for Payer: Humana Commercial |
$10,367.02
|
| Rate for Payer: Humana KY Medicaid |
$4,194.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,237.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,278.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,732.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,610.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,415.58
|
| Rate for Payer: PHCS Commercial |
$11,708.64
|
| Rate for Payer: United Healthcare All Payer |
$10,732.92
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Professional
|
Both
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$7,317.90 |
| Rate for Payer: Aetna Commercial |
$1,299.66
|
| Rate for Payer: Ambetter Exchange |
$707.65
|
| Rate for Payer: Anthem Medicaid |
$675.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$849.18
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$1,250.74
|
| Rate for Payer: Healthspan PPO |
$1,277.82
|
| Rate for Payer: Humana Medicaid |
$675.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$707.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.81
|
| Rate for Payer: Molina Healthcare Passport |
$675.30
|
| Rate for Payer: Multiplan PHCS |
$7,317.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$919.95
|
| Rate for Payer: UHCCP Medicaid |
$4,268.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$682.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.65
|
|
|
REPAIR - ACQUIRED OR TRAUMATI
|
Facility
|
IP
|
$12,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
76101368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,658.95 |
| Max. Negotiated Rate |
$11,708.64 |
| Rate for Payer: Aetna Commercial |
$9,391.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,513.27
|
| Rate for Payer: Cash Price |
$6,098.25
|
| Rate for Payer: Cigna Commercial |
$10,123.09
|
| Rate for Payer: First Health Commercial |
$11,586.67
|
| Rate for Payer: Humana Commercial |
$10,367.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,001.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,001.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,658.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,732.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,147.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,610.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,415.58
|
| Rate for Payer: PHCS Commercial |
$11,708.64
|
| Rate for Payer: United Healthcare All Payer |
$10,732.92
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761P1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,299.66
|
| Rate for Payer: Ambetter Exchange |
$707.65
|
| Rate for Payer: Anthem Medicaid |
$675.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$849.18
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,250.74
|
| Rate for Payer: Healthspan PPO |
$1,277.82
|
| Rate for Payer: Humana Medicaid |
$675.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$707.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.81
|
| Rate for Payer: Molina Healthcare Passport |
$675.30
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$919.95
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$682.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.65
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(T
|
Facility
|
IP
|
$9,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761T1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,758.95 |
| Max. Negotiated Rate |
$8,828.64 |
| Rate for Payer: Aetna Commercial |
$7,081.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.27
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cigna Commercial |
$7,633.10
|
| Rate for Payer: First Health Commercial |
$8,736.67
|
| Rate for Payer: Humana Commercial |
$7,817.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,758.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,092.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,357.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,000.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,345.59
|
| Rate for Payer: PHCS Commercial |
$8,828.64
|
| Rate for Payer: United Healthcare All Payer |
$8,092.92
|
|
|
REPAIR - ACQUIRED OR TRAUMAT(T
|
Facility
|
OP
|
$9,196.50
|
|
|
Service Code
|
HCPCS 35190
|
| Hospital Charge Code |
761T1368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,162.68 |
| Max. Negotiated Rate |
$8,828.64 |
| Rate for Payer: Aetna Commercial |
$7,081.31
|
| Rate for Payer: Anthem Medicaid |
$3,162.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cash Price |
$4,598.25
|
| Rate for Payer: Cigna Commercial |
$7,633.10
|
| Rate for Payer: First Health Commercial |
$8,736.67
|
| Rate for Payer: Humana Commercial |
$7,817.02
|
| Rate for Payer: Humana KY Medicaid |
$3,162.68
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,194.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,226.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,092.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,357.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,000.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,345.59
|
| Rate for Payer: PHCS Commercial |
$8,828.64
|
| Rate for Payer: United Healthcare All Payer |
$8,092.92
|
|
|
REPAIR ANAL FISTULA
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 46288
|
| Hospital Charge Code |
76103018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.34 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$741.52
|
| Rate for Payer: Ambetter Exchange |
$529.43
|
| Rate for Payer: Anthem Medicaid |
$316.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$529.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$529.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.32
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$669.46
|
| Rate for Payer: Healthspan PPO |
$625.33
|
| Rate for Payer: Humana Medicaid |
$316.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$529.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.67
|
| Rate for Payer: Molina Healthcare Passport |
$316.34
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$688.26
|
| Rate for Payer: UHCCP Medicaid |
$463.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$529.43
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem Medicaid |
$1,444.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Humana KY Medicaid |
$1,444.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
REPAIR ANEURYSM ABDOMINAL
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
76101359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$3,840.92 |
| Rate for Payer: Aetna Commercial |
$3,840.92
|
| Rate for Payer: Ambetter Exchange |
$2,032.76
|
| Rate for Payer: Anthem Medicaid |
$1,571.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,032.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,032.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,439.31
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,639.18
|
| Rate for Payer: Healthspan PPO |
$3,776.38
|
| Rate for Payer: Humana Medicaid |
$1,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,996.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,032.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,032.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,603.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,571.70
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,642.59
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,587.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,032.76
|
|
|
REPAIR ANEURYSM ABDOMINAL(P
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 35082
|
| Hospital Charge Code |
761P1359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$3,840.92 |
| Rate for Payer: Aetna Commercial |
$3,840.92
|
| Rate for Payer: Ambetter Exchange |
$2,032.76
|
| Rate for Payer: Anthem Medicaid |
$1,571.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,032.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,032.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,439.31
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,639.18
|
| Rate for Payer: Healthspan PPO |
$3,776.38
|
| Rate for Payer: Humana Medicaid |
$1,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,996.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,032.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,032.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,603.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,571.70
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,642.59
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,587.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,032.76
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
REPAIR ANEURYSM ARM INCISION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
76101357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,175.29 |
| Rate for Payer: Aetna Commercial |
$2,175.29
|
| Rate for Payer: Ambetter Exchange |
$1,115.85
|
| Rate for Payer: Anthem Medicaid |
$936.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,115.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,339.02
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,078.31
|
| Rate for Payer: Healthspan PPO |
$2,138.74
|
| Rate for Payer: Humana Medicaid |
$936.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,700.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,115.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$954.95
|
| Rate for Payer: Molina Healthcare Passport |
$936.23
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,450.61
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$945.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,115.85
|
|
|
REPAIR ANEURYSM ARM INCISION(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35013
|
| Hospital Charge Code |
761P1357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,175.29 |
| Rate for Payer: Aetna Commercial |
$2,175.29
|
| Rate for Payer: Ambetter Exchange |
$1,115.85
|
| Rate for Payer: Anthem Medicaid |
$936.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,115.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,339.02
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,078.31
|
| Rate for Payer: Healthspan PPO |
$2,138.74
|
| Rate for Payer: Humana Medicaid |
$936.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,700.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,115.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$954.95
|
| Rate for Payer: Molina Healthcare Passport |
$936.23
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,450.61
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$945.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,115.85
|
|
|
REPAIR ARM TENDON/MUSCLE
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.10 |
| Max. Negotiated Rate |
$1,129.83 |
| Rate for Payer: Aetna Commercial |
$1,043.94
|
| Rate for Payer: Ambetter Exchange |
$714.22
|
| Rate for Payer: Anthem Medicaid |
$419.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$714.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$714.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$857.06
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,129.83
|
| Rate for Payer: Healthspan PPO |
$945.59
|
| Rate for Payer: Humana Medicaid |
$419.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$714.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$714.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.48
|
| Rate for Payer: Molina Healthcare Passport |
$419.10
|
| Rate for Payer: Multiplan PHCS |
$1,056.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$928.49
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$714.22
|
|
|
REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.26 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Humana KY Medicaid |
$605.26
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$611.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
REPAIR ARM TENDON/MUSCLE(P
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 24341
|
| Hospital Charge Code |
761P0520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.10 |
| Max. Negotiated Rate |
$1,129.83 |
| Rate for Payer: Aetna Commercial |
$1,043.94
|
| Rate for Payer: Ambetter Exchange |
$714.22
|
| Rate for Payer: Anthem Medicaid |
$419.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$714.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$714.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$857.06
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,129.83
|
| Rate for Payer: Healthspan PPO |
$945.59
|
| Rate for Payer: Humana Medicaid |
$419.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$714.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$714.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.48
|
| Rate for Payer: Molina Healthcare Passport |
$419.10
|
| Rate for Payer: Multiplan PHCS |
$1,056.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$928.49
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$714.22
|
|
|
REPAIR ARTERY RUPTURE - THIGH
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35142
|
| Hospital Charge Code |
76101366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
REPAIR ARTERY RUPTURE - THIGH
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35142
|
| Hospital Charge Code |
76101366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
REPAIR ARTERY RUPTURE - THIGH
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35142
|
| Hospital Charge Code |
76101366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.56 |
| Max. Negotiated Rate |
$2,348.58 |
| Rate for Payer: Aetna Commercial |
$2,348.58
|
| Rate for Payer: Ambetter Exchange |
$1,237.18
|
| Rate for Payer: Anthem Medicaid |
$939.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,237.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,237.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,484.62
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,243.11
|
| Rate for Payer: Healthspan PPO |
$2,309.11
|
| Rate for Payer: Humana Medicaid |
$939.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,820.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,237.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$958.35
|
| Rate for Payer: Molina Healthcare Passport |
$939.56
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,608.33
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,237.18
|
|
