|
REPAIR NON/MALU HUM WO GRAFT
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
76100530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.82 |
| Max. Negotiated Rate |
$1,647.49 |
| Rate for Payer: Aetna Commercial |
$1,544.47
|
| Rate for Payer: Ambetter Exchange |
$1,004.80
|
| Rate for Payer: Anthem Medicaid |
$809.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,004.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,004.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,205.76
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,647.49
|
| Rate for Payer: Healthspan PPO |
$1,398.96
|
| Rate for Payer: Humana Medicaid |
$809.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,316.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,004.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.02
|
| Rate for Payer: Molina Healthcare Passport |
$809.82
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,306.24
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$817.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,004.80
|
|
|
REPAIR NON/MALU HUM WO GRAFT
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
76100530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.36 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
REPAIR NON/MALU HUM WO GRAFT(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
761P0530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.82 |
| Max. Negotiated Rate |
$1,647.49 |
| Rate for Payer: Aetna Commercial |
$1,544.47
|
| Rate for Payer: Ambetter Exchange |
$1,004.80
|
| Rate for Payer: Anthem Medicaid |
$809.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,004.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,004.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,205.76
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,647.49
|
| Rate for Payer: Healthspan PPO |
$1,398.96
|
| Rate for Payer: Humana Medicaid |
$809.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,316.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,004.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.02
|
| Rate for Payer: Molina Healthcare Passport |
$809.82
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,306.24
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$817.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,004.80
|
|
|
REPAIR NONUNION HAND
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
76100718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR NONUNION HAND
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
76100718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR NONUNION HAND
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
76100718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$486.30 |
| Max. Negotiated Rate |
$1,605.71 |
| Rate for Payer: Aetna Commercial |
$1,375.12
|
| Rate for Payer: Ambetter Exchange |
$974.24
|
| Rate for Payer: Anthem Medicaid |
$486.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$974.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$974.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.09
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,605.71
|
| Rate for Payer: Healthspan PPO |
$1,245.56
|
| Rate for Payer: Humana Medicaid |
$486.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,193.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$974.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.03
|
| Rate for Payer: Molina Healthcare Passport |
$486.30
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,266.51
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$491.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$974.24
|
|
|
REPAIR NONUNION HAND(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26546
|
| Hospital Charge Code |
761P0718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$486.30 |
| Max. Negotiated Rate |
$1,605.71 |
| Rate for Payer: Aetna Commercial |
$1,375.12
|
| Rate for Payer: Ambetter Exchange |
$974.24
|
| Rate for Payer: Anthem Medicaid |
$486.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$974.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$974.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.09
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,605.71
|
| Rate for Payer: Healthspan PPO |
$1,245.56
|
| Rate for Payer: Humana Medicaid |
$486.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,193.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$974.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.03
|
| Rate for Payer: Molina Healthcare Passport |
$486.30
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,266.51
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$491.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$974.24
|
|
|
REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 28322
|
|
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 nonun/malunion w/o graf
|
Professional
|
Both
|
$2,399.14
|
|
|
Service Code
|
HCPCS 27720
|
| Hospital Charge Code |
51000283
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$750.69 |
| Max. Negotiated Rate |
$1,439.48 |
| Rate for Payer: Aetna Commercial |
$1,307.36
|
| Rate for Payer: Ambetter Exchange |
$830.62
|
| Rate for Payer: Anthem Medicaid |
$750.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$830.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$996.74
|
| Rate for Payer: Cash Price |
$1,199.57
|
| Rate for Payer: Cash Price |
$1,199.57
|
| Rate for Payer: Cigna Commercial |
$1,428.95
|
| Rate for Payer: Healthspan PPO |
$1,184.19
|
| Rate for Payer: Humana Medicaid |
$750.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,093.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$765.70
|
| Rate for Payer: Molina Healthcare Passport |
$750.69
|
| Rate for Payer: Multiplan PHCS |
$1,439.48
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,079.81
|
| Rate for Payer: UHCCP Medicaid |
$839.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$758.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$830.62
|
|
|
REPAIR OF ACHILLES TENDON
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
76100908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.33 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Aetna Commercial |
$1,075.38
|
| Rate for Payer: Ambetter Exchange |
$682.70
|
| Rate for Payer: Anthem Medicaid |
$607.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.24
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,148.21
|
| Rate for Payer: Healthspan PPO |
$974.07
|
| Rate for Payer: Humana Medicaid |
$607.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$682.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.48
|
| Rate for Payer: Molina Healthcare Passport |
$607.33
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.51
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.70
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
76100908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.18 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem Medicaid |
$765.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| 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 |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Humana KY Medicaid |
$765.18
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$772.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$780.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.25
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
76100908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.25
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
REPAIR OF ACHILLES TENDON(P
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
761P0908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.33 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Aetna Commercial |
$1,075.38
|
| Rate for Payer: Ambetter Exchange |
$682.70
|
| Rate for Payer: Anthem Medicaid |
$607.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.24
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,148.21
|
| Rate for Payer: Healthspan PPO |
$974.07
|
| Rate for Payer: Humana Medicaid |
$607.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$682.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.48
|
| Rate for Payer: Molina Healthcare Passport |
$607.33
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.51
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.70
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27695
|
| Hospital Charge Code |
76100913
|
|
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 OF ANKLE LIGAMENT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27695
|
| Hospital Charge Code |
76100913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.72 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$729.69
|
| Rate for Payer: Ambetter Exchange |
$462.72
|
| Rate for Payer: Anthem Medicaid |
$419.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$462.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$462.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$555.26
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$815.21
|
| Rate for Payer: Healthspan PPO |
$660.94
|
| Rate for Payer: Humana Medicaid |
$419.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$600.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$462.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$428.11
|
| Rate for Payer: Molina Healthcare Passport |
$419.72
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$601.54
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$462.72
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27695
|
| Hospital Charge Code |
76100913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR OF ANKLE LIGAMENT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27695
|
| Hospital Charge Code |
761P0913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.72 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$729.69
|
| Rate for Payer: Ambetter Exchange |
$462.72
|
| Rate for Payer: Anthem Medicaid |
$419.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$462.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$462.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$555.26
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$815.21
|
| Rate for Payer: Healthspan PPO |
$660.94
|
| Rate for Payer: Humana Medicaid |
$419.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$600.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$462.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$428.11
|
| Rate for Payer: Molina Healthcare Passport |
$419.72
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$601.54
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$462.72
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$8,071.56
|
|
|
Service Code
|
CPT 49593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,765.40 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,071.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,783.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, REDUCIBLE
|
Facility
|
OP
|
$8,071.56
|
|
|
Service Code
|
CPT 49595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,765.40 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,071.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,783.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$4,565.09
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,260.78 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$8,071.56
|
|
|
Service Code
|
CPT 49615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,765.40 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,071.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,783.29
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$4,565.09
|
|
|
Service Code
|
CPT 49613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,260.78 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
|
