|
REPAIR/GRAFT OF TIBIA
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
REPAIR/GRAFT OF TIBIA
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.25 |
| Max. Negotiated Rate |
$2,094.30 |
| Rate for Payer: Aetna Commercial |
$1,931.77
|
| Rate for Payer: Ambetter Exchange |
$1,190.71
|
| Rate for Payer: Anthem Medicaid |
$840.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,190.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,428.85
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$2,094.30
|
| Rate for Payer: Healthspan PPO |
$1,749.77
|
| Rate for Payer: Humana Medicaid |
$840.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,190.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.65
|
| Rate for Payer: Molina Healthcare Passport |
$840.83
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,547.92
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$849.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,190.71
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
76100920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
REPAIR/GRAFT OF TIBIA(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 27724
|
| Hospital Charge Code |
761P0920
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.25 |
| Max. Negotiated Rate |
$2,094.30 |
| Rate for Payer: Aetna Commercial |
$1,931.77
|
| Rate for Payer: Ambetter Exchange |
$1,190.71
|
| Rate for Payer: Anthem Medicaid |
$840.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,190.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,428.85
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$2,094.30
|
| Rate for Payer: Healthspan PPO |
$1,749.77
|
| Rate for Payer: Humana Medicaid |
$840.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,603.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,190.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$857.65
|
| Rate for Payer: Molina Healthcare Passport |
$840.83
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,547.92
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$849.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,190.71
|
|
|
REPAIR/GRAFT WRIST BONE
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.15 |
| Max. Negotiated Rate |
$1,295.75 |
| Rate for Payer: Aetna Commercial |
$1,141.50
|
| Rate for Payer: Ambetter Exchange |
$734.15
|
| Rate for Payer: Anthem Medicaid |
$571.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$734.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$734.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$880.98
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,295.75
|
| Rate for Payer: Healthspan PPO |
$1,033.95
|
| Rate for Payer: Humana Medicaid |
$571.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$954.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$734.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$734.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.57
|
| Rate for Payer: Molina Healthcare Passport |
$571.15
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$954.39
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$734.15
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
76100612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.62 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| 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 |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REPAIR/GRAFT WRIST BONE(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 25440
|
| Hospital Charge Code |
761P0612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.15 |
| Max. Negotiated Rate |
$1,295.75 |
| Rate for Payer: Aetna Commercial |
$1,141.50
|
| Rate for Payer: Ambetter Exchange |
$734.15
|
| Rate for Payer: Anthem Medicaid |
$571.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$734.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$734.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$880.98
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,295.75
|
| Rate for Payer: Healthspan PPO |
$1,033.95
|
| Rate for Payer: Humana Medicaid |
$571.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$954.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$734.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$734.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.57
|
| Rate for Payer: Molina Healthcare Passport |
$571.15
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$954.39
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$734.15
|
|
|
REPAIR HAND JOINT
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.40
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
REPAIR HAND JOINT
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.09 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem Medicaid |
$502.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| 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 |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Humana KY Medicaid |
$502.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$507.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.40
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
REPAIR HAND JOINT
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
76100715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.25 |
| Max. Negotiated Rate |
$1,133.28 |
| Rate for Payer: Aetna Commercial |
$928.43
|
| Rate for Payer: Ambetter Exchange |
$649.53
|
| Rate for Payer: Anthem Medicaid |
$382.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$649.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$779.44
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,133.28
|
| Rate for Payer: Healthspan PPO |
$840.96
|
| Rate for Payer: Humana Medicaid |
$382.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$795.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$649.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.89
|
| Rate for Payer: Molina Healthcare Passport |
$382.25
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$844.39
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.53
|
|
|
REPAIR HAND JOINT(P
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 26540
|
| Hospital Charge Code |
761P0715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.25 |
| Max. Negotiated Rate |
$1,133.28 |
| Rate for Payer: Aetna Commercial |
$928.43
|
| Rate for Payer: Ambetter Exchange |
$649.53
|
| Rate for Payer: Anthem Medicaid |
$382.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$649.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$779.44
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,133.28
|
| Rate for Payer: Healthspan PPO |
$840.96
|
| Rate for Payer: Humana Medicaid |
$382.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$795.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$649.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.89
|
| Rate for Payer: Molina Healthcare Passport |
$382.25
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$844.39
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.53
|
|
|
REPAIR HAND JOINT WITH GRAF(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
761P0716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.86 |
| Max. Negotiated Rate |
$1,165.23 |
| Rate for Payer: Aetna Commercial |
$960.40
|
| Rate for Payer: Ambetter Exchange |
$671.07
|
| Rate for Payer: Anthem Medicaid |
$362.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$671.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$671.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$805.28
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,165.23
|
| Rate for Payer: Healthspan PPO |
$869.91
|
| Rate for Payer: Humana Medicaid |
$362.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$823.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$671.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.12
|
| Rate for Payer: Molina Healthcare Passport |
$362.86
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$872.39
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$671.07
|
|
|
REPAIR HAND JOINT WITH GRAFT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 HAND JOINT WITH GRAFT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
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 HAND JOINT WITH GRAFT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26542
|
| Hospital Charge Code |
76100716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.86 |
| Max. Negotiated Rate |
$1,165.23 |
| Rate for Payer: Aetna Commercial |
$960.40
|
| Rate for Payer: Ambetter Exchange |
$671.07
|
| Rate for Payer: Anthem Medicaid |
$362.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$671.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$671.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$805.28
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,165.23
|
| Rate for Payer: Healthspan PPO |
$869.91
|
| Rate for Payer: Humana Medicaid |
$362.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$823.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$671.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.12
|
| Rate for Payer: Molina Healthcare Passport |
$362.86
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$872.39
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$671.07
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
76100159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Aetna Commercial |
$2,048.20
|
| Rate for Payer: Anthem Medicaid |
$914.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,074.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: First Health Commercial |
$2,527.00
|
| Rate for Payer: Humana Commercial |
$2,261.00
|
| Rate for Payer: Humana KY Medicaid |
$914.77
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$924.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,181.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,963.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$933.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,340.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,314.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,835.40
|
| Rate for Payer: PHCS Commercial |
$2,553.60
|
| Rate for Payer: United Healthcare All Payer |
$2,340.80
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
761P0159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$713.20 |
| Rate for Payer: Aetna Commercial |
$613.40
|
| Rate for Payer: Ambetter Exchange |
$313.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$338.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.15
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$713.20
|
| Rate for Payer: Healthspan PPO |
$624.42
|
| Rate for Payer: Humana Medicaid |
$338.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$534.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.17
|
| Rate for Payer: Molina Healthcare Passport |
$338.40
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.50
|
| Rate for Payer: UHCCP Medicaid |
$177.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.46
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem Medicaid |
$639.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Humana KY Medicaid |
$639.65
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
761T0159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
761T0159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,432.20
|
| Rate for Payer: Anthem Medicaid |
$639.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna Commercial |
$1,543.80
|
| Rate for Payer: First Health Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial |
$1,581.00
|
| Rate for Payer: Humana KY Medicaid |
$639.65
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,283.40
|
| Rate for Payer: PHCS Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Payer |
$1,636.80
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
76100159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$1,596.00 |
| Rate for Payer: Aetna Commercial |
$613.40
|
| Rate for Payer: Ambetter Exchange |
$313.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$338.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.15
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$713.20
|
| Rate for Payer: Healthspan PPO |
$624.42
|
| Rate for Payer: Humana Medicaid |
$338.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$534.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.17
|
| Rate for Payer: Molina Healthcare Passport |
$338.40
|
| Rate for Payer: Multiplan PHCS |
$1,596.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.50
|
| Rate for Payer: UHCCP Medicaid |
$177.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.46
|
|
|
REPAIR HEAD AREA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
76100159
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Aetna Commercial |
$2,048.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,074.80
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: First Health Commercial |
$2,527.00
|
| Rate for Payer: Humana Commercial |
$2,261.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,181.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,963.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$798.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,340.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,314.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,835.40
|
| Rate for Payer: PHCS Commercial |
$2,553.60
|
| Rate for Payer: United Healthcare All Payer |
$2,340.80
|
|
|
REPAIR HERNIA FEM INCAR
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
76102018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
