|
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 24343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
REPAIR LEAD PACE-DEFIB ONE
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 33218
|
| Hospital Charge Code |
76101252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.48 |
| Max. Negotiated Rate |
$670.11 |
| Rate for Payer: Aetna Commercial |
$670.11
|
| Rate for Payer: Ambetter Exchange |
$362.24
|
| Rate for Payer: Anthem Medicaid |
$285.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$362.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$362.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$434.69
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$633.52
|
| Rate for Payer: Healthspan PPO |
$658.85
|
| Rate for Payer: Humana Medicaid |
$285.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$553.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$362.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.19
|
| Rate for Payer: Molina Healthcare Passport |
$285.48
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$470.91
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$362.24
|
|
|
REPAIR LEAD PACE-DEFIB ONE
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 33218
|
| Hospital Charge Code |
76101252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.66 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,362.64
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,035.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
REPAIR LEAD PACE-DEFIB ONE
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 33218
|
| Hospital Charge Code |
76101252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
REPAIR LEAD PACE-DEFIB ONE(P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 33218
|
| Hospital Charge Code |
761P1252
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.48 |
| Max. Negotiated Rate |
$670.11 |
| Rate for Payer: Aetna Commercial |
$670.11
|
| Rate for Payer: Ambetter Exchange |
$362.24
|
| Rate for Payer: Anthem Medicaid |
$285.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$362.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$362.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$434.69
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$633.52
|
| Rate for Payer: Healthspan PPO |
$658.85
|
| Rate for Payer: Humana Medicaid |
$285.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$553.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$362.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.19
|
| Rate for Payer: Molina Healthcare Passport |
$285.48
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$470.91
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$362.24
|
|
|
REPAIR LIP - FULL THICKNESS
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
76101628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.05 |
| Max. Negotiated Rate |
$1,318.20 |
| Rate for Payer: Aetna Commercial |
$411.35
|
| Rate for Payer: Ambetter Exchange |
$300.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.05
|
| Rate for Payer: Anthem Medicaid |
$238.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.62
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$407.68
|
| Rate for Payer: Healthspan PPO |
$479.14
|
| Rate for Payer: Humana Medicaid |
$238.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.86
|
| Rate for Payer: Molina Healthcare Passport |
$238.10
|
| Rate for Payer: Multiplan PHCS |
$1,318.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.68
|
| Rate for Payer: UHCCP Medicaid |
$233.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.52
|
|
|
REPAIR LIP - FULL THICKNESS
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
76101628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$2,109.12 |
| Rate for Payer: Aetna Commercial |
$1,691.69
|
| Rate for Payer: Anthem Medicaid |
$755.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$1,823.51
|
| Rate for Payer: First Health Commercial |
$2,087.15
|
| Rate for Payer: Humana Commercial |
$1,867.45
|
| Rate for Payer: Humana KY Medicaid |
$755.55
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$763.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,911.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.93
|
| Rate for Payer: PHCS Commercial |
$2,109.12
|
| Rate for Payer: United Healthcare All Payer |
$1,933.36
|
|
|
REPAIR LIP - FULL THICKNESS
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
45000246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,533.12 |
| Rate for Payer: Aetna Commercial |
$1,229.69
|
| Rate for Payer: Anthem Medicaid |
$549.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cigna Commercial |
$1,325.51
|
| Rate for Payer: First Health Commercial |
$1,517.15
|
| Rate for Payer: Humana Commercial |
$1,357.45
|
| Rate for Payer: Humana KY Medicaid |
$549.21
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$554.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.93
|
| Rate for Payer: PHCS Commercial |
$1,533.12
|
| Rate for Payer: United Healthcare All Payer |
$1,405.36
|
|
|
REPAIR LIP - FULL THICKNESS
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
45000246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$479.10 |
| Max. Negotiated Rate |
$1,533.12 |
| Rate for Payer: Aetna Commercial |
$1,229.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.66
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cigna Commercial |
$1,325.51
|
| Rate for Payer: First Health Commercial |
$1,517.15
|
| Rate for Payer: Humana Commercial |
$1,357.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.93
|
| Rate for Payer: PHCS Commercial |
$1,533.12
|
| Rate for Payer: United Healthcare All Payer |
$1,405.36
|
|
|
REPAIR LIP - FULL THICKNESS
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
76101628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$659.10 |
| Max. Negotiated Rate |
$2,109.12 |
| Rate for Payer: Aetna Commercial |
$1,691.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,098.50
|
| Rate for Payer: Cigna Commercial |
$1,823.51
|
| Rate for Payer: First Health Commercial |
$2,087.15
|
| Rate for Payer: Humana Commercial |
$1,867.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,911.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.93
|
| Rate for Payer: PHCS Commercial |
$2,109.12
|
| Rate for Payer: United Healthcare All Payer |
$1,933.36
|
|
|
REPAIR LIP - FULL THICKNESS(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
761P1628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.05 |
| Max. Negotiated Rate |
$479.14 |
| Rate for Payer: Aetna Commercial |
$411.35
|
| Rate for Payer: Ambetter Exchange |
$300.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.05
|
| Rate for Payer: Anthem Medicaid |
$238.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.62
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$407.68
|
| Rate for Payer: Healthspan PPO |
$479.14
|
| Rate for Payer: Humana Medicaid |
$238.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$242.86
|
| Rate for Payer: Molina Healthcare Passport |
$238.10
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.68
|
| Rate for Payer: UHCCP Medicaid |
$233.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.52
|
|
|
REPAIR LIP - FULL THICKNESS(T
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
761T1628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,533.12 |
| Rate for Payer: Aetna Commercial |
$1,229.69
|
| Rate for Payer: Anthem Medicaid |
$549.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cigna Commercial |
$1,325.51
|
| Rate for Payer: First Health Commercial |
$1,517.15
|
| Rate for Payer: Humana Commercial |
$1,357.45
|
| Rate for Payer: Humana KY Medicaid |
$549.21
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$554.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.93
|
| Rate for Payer: PHCS Commercial |
$1,533.12
|
| Rate for Payer: United Healthcare All Payer |
$1,405.36
|
|
|
REPAIR LIP - FULL THICKNESS(T
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
761T1628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.10 |
| Max. Negotiated Rate |
$1,533.12 |
| Rate for Payer: Aetna Commercial |
$1,229.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.66
|
| Rate for Payer: Cash Price |
$798.50
|
| Rate for Payer: Cigna Commercial |
$1,325.51
|
| Rate for Payer: First Health Commercial |
$1,517.15
|
| Rate for Payer: Humana Commercial |
$1,357.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.93
|
| Rate for Payer: PHCS Commercial |
$1,533.12
|
| Rate for Payer: United Healthcare All Payer |
$1,405.36
|
|
|
REPAIR LIVER WOUND
|
Professional
|
Both
|
$6,175.00
|
|
|
Service Code
|
HCPCS 47361
|
| Hospital Charge Code |
76101952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,297.15 |
| Max. Negotiated Rate |
$4,406.06 |
| Rate for Payer: Aetna Commercial |
$4,406.06
|
| Rate for Payer: Ambetter Exchange |
$2,859.94
|
| Rate for Payer: Anthem Medicaid |
$1,297.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,859.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,859.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,431.93
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cigna Commercial |
$4,116.29
|
| Rate for Payer: Healthspan PPO |
$3,715.70
|
| Rate for Payer: Humana Medicaid |
$1,297.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,865.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,859.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,323.09
|
| Rate for Payer: Molina Healthcare Passport |
$1,297.15
|
| Rate for Payer: Multiplan PHCS |
$3,705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,717.92
|
| Rate for Payer: UHCCP Medicaid |
$2,161.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,310.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,859.94
|
|
|
REPAIR LIVER WOUND
|
Facility
|
OP
|
$6,175.00
|
|
|
Service Code
|
HCPCS 47361
|
| Hospital Charge Code |
76101952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$5,928.00 |
| Rate for Payer: Aetna Commercial |
$4,754.75
|
| Rate for Payer: Anthem Medicaid |
$2,123.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,816.50
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cigna Commercial |
$5,125.25
|
| Rate for Payer: First Health Commercial |
$5,866.25
|
| Rate for Payer: Humana Commercial |
$5,248.75
|
| Rate for Payer: Humana KY Medicaid |
$2,123.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,145.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,063.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,557.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,852.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,166.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,434.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,631.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,372.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,260.75
|
| Rate for Payer: PHCS Commercial |
$5,928.00
|
| Rate for Payer: United Healthcare All Payer |
$5,434.00
|
|
|
REPAIR LIVER WOUND
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 47350
|
| Hospital Charge Code |
76101951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.59 |
| Max. Negotiated Rate |
$1,964.93 |
| Rate for Payer: Aetna Commercial |
$1,964.93
|
| Rate for Payer: Ambetter Exchange |
$1,293.93
|
| Rate for Payer: Anthem Medicaid |
$567.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,293.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,293.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,552.72
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,823.19
|
| Rate for Payer: Healthspan PPO |
$1,657.06
|
| Rate for Payer: Humana Medicaid |
$567.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,293.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$578.94
|
| Rate for Payer: Molina Healthcare Passport |
$567.59
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,682.11
|
| Rate for Payer: UHCCP Medicaid |
$784.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$573.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,293.93
|
|
|
REPAIR LIVER WOUND
|
Facility
|
IP
|
$6,175.00
|
|
|
Service Code
|
HCPCS 47361
|
| Hospital Charge Code |
76101952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$5,928.00 |
| Rate for Payer: Aetna Commercial |
$4,754.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,816.50
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cigna Commercial |
$5,125.25
|
| Rate for Payer: First Health Commercial |
$5,866.25
|
| Rate for Payer: Humana Commercial |
$5,248.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,063.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,557.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,852.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,434.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,631.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,372.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,260.75
|
| Rate for Payer: PHCS Commercial |
$5,928.00
|
| Rate for Payer: United Healthcare All Payer |
$5,434.00
|
|
|
REPAIR LIVER WOUND
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 47350
|
| Hospital Charge Code |
76101951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem Medicaid |
$770.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Humana KY Medicaid |
$770.34
|
| Rate for Payer: Kentucky WC Medicaid |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$785.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
REPAIR LIVER WOUND
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 47350
|
| Hospital Charge Code |
76101951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
REPAIR LIVER WOUND(P
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 47350
|
| Hospital Charge Code |
761P1951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.59 |
| Max. Negotiated Rate |
$1,964.93 |
| Rate for Payer: Aetna Commercial |
$1,964.93
|
| Rate for Payer: Ambetter Exchange |
$1,293.93
|
| Rate for Payer: Anthem Medicaid |
$567.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,293.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,293.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,552.72
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,823.19
|
| Rate for Payer: Healthspan PPO |
$1,657.06
|
| Rate for Payer: Humana Medicaid |
$567.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,293.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$578.94
|
| Rate for Payer: Molina Healthcare Passport |
$567.59
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,682.11
|
| Rate for Payer: UHCCP Medicaid |
$784.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$573.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,293.93
|
|
|
REPAIR LIVER WOUND(P
|
Professional
|
Both
|
$6,175.00
|
|
|
Service Code
|
HCPCS 47361
|
| Hospital Charge Code |
761P1952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,297.15 |
| Max. Negotiated Rate |
$4,406.06 |
| Rate for Payer: Aetna Commercial |
$4,406.06
|
| Rate for Payer: Ambetter Exchange |
$2,859.94
|
| Rate for Payer: Anthem Medicaid |
$1,297.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,859.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,859.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,431.93
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cash Price |
$3,087.50
|
| Rate for Payer: Cigna Commercial |
$4,116.29
|
| Rate for Payer: Healthspan PPO |
$3,715.70
|
| Rate for Payer: Humana Medicaid |
$1,297.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,865.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,859.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,323.09
|
| Rate for Payer: Molina Healthcare Passport |
$1,297.15
|
| Rate for Payer: Multiplan PHCS |
$3,705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,717.92
|
| Rate for Payer: UHCCP Medicaid |
$2,161.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,310.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,859.94
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REPAIR LOWER LEG TENDONS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,010.14 |
| Rate for Payer: Aetna Commercial |
$921.58
|
| Rate for Payer: Ambetter Exchange |
$581.09
|
| Rate for Payer: Anthem Medicaid |
$461.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$581.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$581.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$697.31
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,010.14
|
| Rate for Payer: Healthspan PPO |
$834.75
|
| Rate for Payer: Humana Medicaid |
$461.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$581.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.64
|
| Rate for Payer: Molina Healthcare Passport |
$461.41
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$755.42
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$581.09
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
76100911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REPAIR LOWER LEG TENDONS(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27676
|
| Hospital Charge Code |
761P0911
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,010.14 |
| Rate for Payer: Aetna Commercial |
$921.58
|
| Rate for Payer: Ambetter Exchange |
$581.09
|
| Rate for Payer: Anthem Medicaid |
$461.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$581.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$581.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$697.31
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,010.14
|
| Rate for Payer: Healthspan PPO |
$834.75
|
| Rate for Payer: Humana Medicaid |
$461.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$581.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.64
|
| Rate for Payer: Molina Healthcare Passport |
$461.41
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$755.42
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$581.09
|
|
