|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$357.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$416.50
|
| Rate for Payer: UHCCP Medicaid |
$208.25
|
|
|
REPAIR EXT HALLUCIS LONGUSW/GR
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$297.50
|
| 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: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| 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 |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| 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
|
|
|
REPAIR EYELID DEFECT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.23 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
REPAIR EYELID DEFECT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
REPAIR EYELID DEFECT
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 67914
|
| Hospital Charge Code |
76102815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.21 |
| Max. Negotiated Rate |
$448.83 |
| Rate for Payer: Aetna Commercial |
$380.21
|
| Rate for Payer: Ambetter Exchange |
$302.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$164.21
|
| Rate for Payer: Anthem Medicaid |
$238.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.47
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$372.26
|
| Rate for Payer: Healthspan PPO |
$448.83
|
| Rate for Payer: Humana Medicaid |
$238.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$362.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$302.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.54
|
| Rate for Payer: Molina Healthcare Passport |
$238.76
|
| Rate for Payer: Multiplan PHCS |
$297.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.68
|
| Rate for Payer: UHCCP Medicaid |
$172.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.06
|
|
|
REPAIR FIBULA NONUNION
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$1,404.60 |
| Rate for Payer: Aetna Commercial |
$1,342.78
|
| Rate for Payer: Ambetter Exchange |
$911.67
|
| Rate for Payer: Anthem Medicaid |
$691.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$911.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$911.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,094.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,404.60
|
| Rate for Payer: Healthspan PPO |
$1,216.27
|
| Rate for Payer: Humana Medicaid |
$691.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,196.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$911.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.44
|
| Rate for Payer: Molina Healthcare Passport |
$691.61
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,185.17
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$911.67
|
|
|
REPAIR FIBULA NONUNION
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
REPAIR FIBULA NONUNION
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
76100921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.39 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| 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 |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
REPAIR FIBULA NONUNION(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27726
|
| Hospital Charge Code |
761P0921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$1,404.60 |
| Rate for Payer: Aetna Commercial |
$1,342.78
|
| Rate for Payer: Ambetter Exchange |
$911.67
|
| Rate for Payer: Anthem Medicaid |
$691.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$911.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$911.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,094.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,404.60
|
| Rate for Payer: Healthspan PPO |
$1,216.27
|
| Rate for Payer: Humana Medicaid |
$691.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,196.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$911.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$705.44
|
| Rate for Payer: Molina Healthcare Passport |
$691.61
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,185.17
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$698.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$911.67
|
|
|
REPAIR FINGER/HAND TENDON
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR FINGER/HAND TENDON
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$1,182.59 |
| Rate for Payer: Aetna Commercial |
$813.62
|
| Rate for Payer: Ambetter Exchange |
$482.84
|
| Rate for Payer: Anthem Medicaid |
$367.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.41
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$1,182.59
|
| Rate for Payer: Healthspan PPO |
$736.96
|
| Rate for Payer: Humana Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$658.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.54
|
| Rate for Payer: Molina Healthcare Passport |
$367.20
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.69
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.84
|
|
|
REPAIR FINGER/HAND TENDON
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
76102602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REPAIR FINGER/HAND TENDON
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26426
|
| Hospital Charge Code |
761P2602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$1,182.59 |
| Rate for Payer: Aetna Commercial |
$813.62
|
| Rate for Payer: Ambetter Exchange |
$482.84
|
| Rate for Payer: Anthem Medicaid |
$367.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.41
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$1,182.59
|
| Rate for Payer: Healthspan PPO |
$736.96
|
| Rate for Payer: Humana Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$658.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$374.54
|
| Rate for Payer: Molina Healthcare Passport |
$367.20
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.69
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$370.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.84
|
|
|
REPAIR FINGER TENDON
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.32 |
| Max. Negotiated Rate |
$1,004.44 |
| Rate for Payer: Aetna Commercial |
$787.91
|
| Rate for Payer: Ambetter Exchange |
$572.83
|
| Rate for Payer: Anthem Medicaid |
$228.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$572.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$572.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.40
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.44
|
| Rate for Payer: Healthspan PPO |
$713.68
|
| Rate for Payer: Humana Medicaid |
$228.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$572.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.89
|
| Rate for Payer: Molina Healthcare Passport |
$228.32
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$744.68
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$572.83
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
45000138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
45000138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| 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 |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REPAIR FINGER TENDON
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
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 FINGER TENDON
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76100694
|
|
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 FINGER TENDON(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
761P0694
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.32 |
| Max. Negotiated Rate |
$1,004.44 |
| Rate for Payer: Aetna Commercial |
$787.91
|
| Rate for Payer: Ambetter Exchange |
$572.83
|
| Rate for Payer: Anthem Medicaid |
$228.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$572.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$572.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.40
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,004.44
|
| Rate for Payer: Healthspan PPO |
$713.68
|
| Rate for Payer: Humana Medicaid |
$228.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$572.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.89
|
| Rate for Payer: Molina Healthcare Passport |
$228.32
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$744.68
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$230.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$572.83
|
|
|
REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
REPAIR FOOT DISLOCATION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.23 |
| Max. Negotiated Rate |
$1,132.05 |
| Rate for Payer: Aetna Commercial |
$1,132.05
|
| Rate for Payer: Ambetter Exchange |
$782.14
|
| Rate for Payer: Anthem Medicaid |
$302.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$782.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$782.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.57
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,106.81
|
| Rate for Payer: Healthspan PPO |
$1,025.40
|
| Rate for Payer: Humana Medicaid |
$302.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$782.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$782.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.27
|
| Rate for Payer: Molina Healthcare Passport |
$302.23
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,016.78
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$782.14
|
|
|
REPAIR FOOT DISLOCATION
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 28555
|
| Hospital Charge Code |
76103014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.07 |
| Max. Negotiated Rate |
$1,080.09 |
| Rate for Payer: Aetna Commercial |
$958.54
|
| Rate for Payer: Ambetter Exchange |
$618.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$337.07
|
| Rate for Payer: Anthem Medicaid |
$338.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$618.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$618.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$741.77
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$794.56
|
| Rate for Payer: Healthspan PPO |
$1,080.09
|
| Rate for Payer: Humana Medicaid |
$338.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$826.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$618.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.55
|
| Rate for Payer: Molina Healthcare Passport |
$338.77
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$803.58
|
| Rate for Payer: UHCCP Medicaid |
$353.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$618.14
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 FOOT DISLOCATION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
76101032
|
|
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 FOOT DISLOCATION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28615
|
| Hospital Charge Code |
761P1032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.23 |
| Max. Negotiated Rate |
$1,132.05 |
| Rate for Payer: Aetna Commercial |
$1,132.05
|
| Rate for Payer: Ambetter Exchange |
$782.14
|
| Rate for Payer: Anthem Medicaid |
$302.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$782.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$782.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.57
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,106.81
|
| Rate for Payer: Healthspan PPO |
$1,025.40
|
| Rate for Payer: Humana Medicaid |
$302.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$782.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$782.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.27
|
| Rate for Payer: Molina Healthcare Passport |
$302.23
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,016.78
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$782.14
|
|
