|
REPAIR DEFECT OF ARTERY
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
76101356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.14 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| 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 |
$1,300.00
|
| 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: Humana Medicare Advantage |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 DEFECT OF ARTERY
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
76101356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.19 |
| Max. Negotiated Rate |
$1,754.84 |
| Rate for Payer: Aetna Commercial |
$1,754.84
|
| Rate for Payer: Ambetter Exchange |
$945.28
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$945.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,134.34
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,679.87
|
| Rate for Payer: Healthspan PPO |
$1,725.35
|
| Rate for Payer: Humana Medicaid |
$731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,359.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$945.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$745.81
|
| Rate for Payer: Molina Healthcare Passport |
$731.19
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,228.86
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$945.28
|
|
|
REPAIR DEFECT OF ARTERY(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35011
|
| Hospital Charge Code |
761P1356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.19 |
| Max. Negotiated Rate |
$1,754.84 |
| Rate for Payer: Aetna Commercial |
$1,754.84
|
| Rate for Payer: Ambetter Exchange |
$945.28
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$945.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,134.34
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,679.87
|
| Rate for Payer: Healthspan PPO |
$1,725.35
|
| Rate for Payer: Humana Medicaid |
$731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,359.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$945.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$745.81
|
| Rate for Payer: Molina Healthcare Passport |
$731.19
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,228.86
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$738.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$945.28
|
|
|
REPAIR DEFORMITY OF TOE
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
36001269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.07 |
| Max. Negotiated Rate |
$644.70 |
| Rate for Payer: Aetna Commercial |
$559.76
|
| Rate for Payer: Ambetter Exchange |
$346.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.07
|
| Rate for Payer: Anthem Medicaid |
$215.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.33
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$634.07
|
| Rate for Payer: Healthspan PPO |
$644.70
|
| Rate for Payer: Humana Medicaid |
$215.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$346.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.17
|
| Rate for Payer: Molina Healthcare Passport |
$215.85
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.94
|
| Rate for Payer: UHCCP Medicaid |
$192.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$218.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.11
|
|
|
REPAIR DEFORMITY OF TOE
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
360P1269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.07 |
| Max. Negotiated Rate |
$644.70 |
| Rate for Payer: Aetna Commercial |
$559.76
|
| Rate for Payer: Ambetter Exchange |
$346.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.07
|
| Rate for Payer: Anthem Medicaid |
$215.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.33
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$634.07
|
| Rate for Payer: Healthspan PPO |
$644.70
|
| Rate for Payer: Humana Medicaid |
$215.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$454.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$346.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.17
|
| Rate for Payer: Molina Healthcare Passport |
$215.85
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.94
|
| Rate for Payer: UHCCP Medicaid |
$192.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$218.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.11
|
|
|
REPAIR EARDRUM STRUCTURES
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,730.87 |
| Rate for Payer: Aetna Commercial |
$1,730.87
|
| Rate for Payer: Ambetter Exchange |
$1,181.65
|
| Rate for Payer: Anthem Medicaid |
$875.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,181.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,181.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,417.98
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,714.46
|
| Rate for Payer: Healthspan PPO |
$1,535.36
|
| Rate for Payer: Humana Medicaid |
$875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,556.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,181.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.55
|
| Rate for Payer: Molina Healthcare Passport |
$875.05
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,536.14
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,181.65
|
|
|
REPAIR EARDRUM STRUCTURES
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REPAIR EARDRUM STRUCTURES
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
76102431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REPAIR EARDRUM STRUCTURES(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 69635
|
| Hospital Charge Code |
761P2431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,730.87 |
| Rate for Payer: Aetna Commercial |
$1,730.87
|
| Rate for Payer: Ambetter Exchange |
$1,181.65
|
| Rate for Payer: Anthem Medicaid |
$875.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,181.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,181.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,417.98
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,714.46
|
| Rate for Payer: Healthspan PPO |
$1,535.36
|
| Rate for Payer: Humana Medicaid |
$875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,556.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,181.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.55
|
| Rate for Payer: Molina Healthcare Passport |
$875.05
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,536.14
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,181.65
|
|
|
REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 67917
|
| Hospital Charge Code |
76102754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$679.24 |
| Rate for Payer: Aetna Commercial |
$628.72
|
| Rate for Payer: Ambetter Exchange |
$419.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$263.62
|
| Rate for Payer: Anthem Medicaid |
$383.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$419.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$419.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$503.41
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$616.31
|
| Rate for Payer: Healthspan PPO |
$679.24
|
| Rate for Payer: Humana Medicaid |
$383.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$599.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$419.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$391.08
|
| Rate for Payer: Molina Healthcare Passport |
$383.41
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$545.36
|
| Rate for Payer: UHCCP Medicaid |
$276.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$387.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$419.51
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
76100524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$997.39 |
| Rate for Payer: Aetna Commercial |
$952.78
|
| Rate for Payer: Ambetter Exchange |
$634.11
|
| Rate for Payer: Anthem Medicaid |
$488.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$760.93
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$997.39
|
| Rate for Payer: Healthspan PPO |
$863.01
|
| Rate for Payer: Humana Medicaid |
$488.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$810.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$634.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.43
|
| Rate for Payer: Molina Healthcare Passport |
$488.66
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$824.34
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.11
|
|
|
REPAIR ELBOW DEB/ATTCH OPEN(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
761P0524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$997.39 |
| Rate for Payer: Aetna Commercial |
$952.78
|
| Rate for Payer: Ambetter Exchange |
$634.11
|
| Rate for Payer: Anthem Medicaid |
$488.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$760.93
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$997.39
|
| Rate for Payer: Healthspan PPO |
$863.01
|
| Rate for Payer: Humana Medicaid |
$488.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$810.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$634.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$498.43
|
| Rate for Payer: Molina Healthcare Passport |
$488.66
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$824.34
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.11
|
|
|
REPAIR ELBOW PERC
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$689.10 |
| Rate for Payer: Aetna Commercial |
$635.57
|
| Rate for Payer: Ambetter Exchange |
$393.72
|
| Rate for Payer: Anthem Medicaid |
$323.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.46
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$689.10
|
| Rate for Payer: Healthspan PPO |
$575.69
|
| Rate for Payer: Humana Medicaid |
$323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$330.17
|
| Rate for Payer: Molina Healthcare Passport |
$323.70
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.84
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.72
|
|
|
REPAIR ELBOW PERC
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REPAIR ELBOW PERC
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$211.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$213.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REPAIR ELBOW PERC(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 24357
|
| Hospital Charge Code |
761P0523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$689.10 |
| Rate for Payer: Aetna Commercial |
$635.57
|
| Rate for Payer: Ambetter Exchange |
$393.72
|
| Rate for Payer: Anthem Medicaid |
$323.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.46
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$689.10
|
| Rate for Payer: Healthspan PPO |
$575.69
|
| Rate for Payer: Humana Medicaid |
$323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$545.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$330.17
|
| Rate for Payer: Molina Healthcare Passport |
$323.70
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.84
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.72
|
|
|
REPAIR ELBOW W/DEB OPEN
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 24358
|
| Hospital Charge Code |
76102708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$810.15 |
| Rate for Payer: Aetna Commercial |
$752.88
|
| Rate for Payer: Ambetter Exchange |
$508.08
|
| Rate for Payer: Anthem Medicaid |
$382.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$508.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$508.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$609.70
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cash Price |
$365.00
|
| Rate for Payer: Cigna Commercial |
$810.15
|
| Rate for Payer: Healthspan PPO |
$681.95
|
| Rate for Payer: Humana Medicaid |
$382.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$508.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.10
|
| Rate for Payer: Molina Healthcare Passport |
$382.45
|
| Rate for Payer: Multiplan PHCS |
$438.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$660.50
|
| Rate for Payer: UHCCP Medicaid |
$255.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$508.08
|
|
|
REPAIR ENTROPION EXTENSIVE
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 67924
|
| Hospital Charge Code |
76102755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$675.52 |
| Rate for Payer: Aetna Commercial |
$591.87
|
| Rate for Payer: Ambetter Exchange |
$420.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$235.24
|
| Rate for Payer: Anthem Medicaid |
$369.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$420.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$504.12
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$578.96
|
| Rate for Payer: Healthspan PPO |
$675.52
|
| Rate for Payer: Humana Medicaid |
$369.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$420.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$376.99
|
| Rate for Payer: Molina Healthcare Passport |
$369.60
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.13
|
| Rate for Payer: UHCCP Medicaid |
$247.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$420.10
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR - EXTENSOR TENDON - HA
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
76100693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,004.08 |
| Rate for Payer: Aetna Commercial |
$788.31
|
| Rate for Payer: Ambetter Exchange |
$552.67
|
| Rate for Payer: Anthem Medicaid |
$228.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$663.20
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.08
|
| Rate for Payer: Healthspan PPO |
$714.04
|
| Rate for Payer: Humana Medicaid |
$228.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.45
|
| Rate for Payer: Molina Healthcare Passport |
$228.87
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$718.47
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.67
|
|
|
REPAIR - EXTENSOR TENDON - H(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
761P0693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,004.08 |
| Rate for Payer: Aetna Commercial |
$788.31
|
| Rate for Payer: Ambetter Exchange |
$552.67
|
| Rate for Payer: Anthem Medicaid |
$228.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$663.20
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.08
|
| Rate for Payer: Healthspan PPO |
$714.04
|
| Rate for Payer: Humana Medicaid |
$228.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.45
|
| Rate for Payer: Molina Healthcare Passport |
$228.87
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$718.47
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.67
|
|
|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.55
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
