|
REPAIR OF BICEPS TENDON
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 24340
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REPAIR OF BICEPS TENDON
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 24340
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| 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 |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REPAIR OF BICEPS TENDON
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 24340
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.64 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$894.57
|
| Rate for Payer: Ambetter Exchange |
$579.28
|
| Rate for Payer: Anthem Medicaid |
$437.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$579.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$695.14
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$985.13
|
| Rate for Payer: Healthspan PPO |
$810.29
|
| Rate for Payer: Humana Medicaid |
$437.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$579.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.39
|
| Rate for Payer: Molina Healthcare Passport |
$437.64
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$753.06
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$579.28
|
|
|
REPAIR OF BICEPS TENDON(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 24340
|
| Hospital Charge Code |
761P0519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.64 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$894.57
|
| Rate for Payer: Ambetter Exchange |
$579.28
|
| Rate for Payer: Anthem Medicaid |
$437.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$579.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$695.14
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$985.13
|
| Rate for Payer: Healthspan PPO |
$810.29
|
| Rate for Payer: Humana Medicaid |
$437.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$756.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$579.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$446.39
|
| Rate for Payer: Molina Healthcare Passport |
$437.64
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$753.06
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$442.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$579.28
|
|
|
REPAIR OF BLADDER WOUND
|
Professional
|
Both
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
76102077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.34 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna Commercial |
$1,433.31
|
| Rate for Payer: Ambetter Exchange |
$845.10
|
| Rate for Payer: Anthem Medicaid |
$735.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$845.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$845.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,014.12
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$1,296.47
|
| Rate for Payer: Healthspan PPO |
$1,146.06
|
| Rate for Payer: Humana Medicaid |
$735.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$845.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.05
|
| Rate for Payer: Molina Healthcare Passport |
$735.34
|
| Rate for Payer: Multiplan PHCS |
$1,617.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,098.63
|
| Rate for Payer: UHCCP Medicaid |
$943.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$845.10
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
IP
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
76102077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$2,587.20 |
| Rate for Payer: Aetna Commercial |
$2,075.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.10
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$2,236.85
|
| Rate for Payer: First Health Commercial |
$2,560.25
|
| Rate for Payer: Humana Commercial |
$2,290.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,021.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.55
|
| Rate for Payer: PHCS Commercial |
$2,587.20
|
| Rate for Payer: United Healthcare All Payer |
$2,371.60
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
OP
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
76102077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$2,587.20 |
| Rate for Payer: Aetna Commercial |
$2,075.15
|
| Rate for Payer: Anthem Medicaid |
$926.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.10
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$2,236.85
|
| Rate for Payer: First Health Commercial |
$2,560.25
|
| Rate for Payer: Humana Commercial |
$2,290.75
|
| Rate for Payer: Humana KY Medicaid |
$926.81
|
| Rate for Payer: Kentucky WC Medicaid |
$936.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,021.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.55
|
| Rate for Payer: PHCS Commercial |
$2,587.20
|
| Rate for Payer: United Healthcare All Payer |
$2,371.60
|
|
|
REPAIR OF BLADDER WOUND
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 51860
|
| Hospital Charge Code |
76102076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.26 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$1,162.23
|
| Rate for Payer: Ambetter Exchange |
$703.59
|
| Rate for Payer: Anthem Medicaid |
$554.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$703.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$844.31
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,061.28
|
| Rate for Payer: Healthspan PPO |
$929.31
|
| Rate for Payer: Humana Medicaid |
$554.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$703.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$565.35
|
| Rate for Payer: Molina Healthcare Passport |
$554.26
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$914.67
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$703.59
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 51860
|
| Hospital Charge Code |
76102076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR OF BLADDER WOUND
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 51860
|
| Hospital Charge Code |
76102076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR OF BLADDER WOUND(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 51860
|
| Hospital Charge Code |
761P2076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.26 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$1,162.23
|
| Rate for Payer: Ambetter Exchange |
$703.59
|
| Rate for Payer: Anthem Medicaid |
$554.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$703.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$844.31
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,061.28
|
| Rate for Payer: Healthspan PPO |
$929.31
|
| Rate for Payer: Humana Medicaid |
$554.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$703.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$565.35
|
| Rate for Payer: Molina Healthcare Passport |
$554.26
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$914.67
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$703.59
|
|
|
REPAIR OF BLADDER WOUND(P
|
Professional
|
Both
|
$2,695.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
761P2077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.34 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna Commercial |
$1,433.31
|
| Rate for Payer: Ambetter Exchange |
$845.10
|
| Rate for Payer: Anthem Medicaid |
$735.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$845.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$845.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,014.12
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cash Price |
$1,347.50
|
| Rate for Payer: Cigna Commercial |
$1,296.47
|
| Rate for Payer: Healthspan PPO |
$1,146.06
|
| Rate for Payer: Humana Medicaid |
$735.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$845.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.05
|
| Rate for Payer: Molina Healthcare Passport |
$735.34
|
| Rate for Payer: Multiplan PHCS |
$1,617.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,098.63
|
| Rate for Payer: UHCCP Medicaid |
$943.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$845.10
|
|
|
REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH
|
Facility
|
OP
|
$3,017.85
|
|
|
Service Code
|
CPT 67904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,155.61 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
|
|
REPAIR OF BOWEL BULGE
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 57268
|
| Hospital Charge Code |
76102907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
REPAIR OF BOWEL BULGE
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 57268
|
| Hospital Charge Code |
76102907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
REPAIR OF BOWEL BULGE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 57268
|
| Hospital Charge Code |
76102907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.91 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$722.43
|
| Rate for Payer: Ambetter Exchange |
$477.42
|
| Rate for Payer: Anthem Medicaid |
$404.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.90
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$691.26
|
| Rate for Payer: Healthspan PPO |
$699.50
|
| Rate for Payer: Humana Medicaid |
$404.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$622.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.01
|
| Rate for Payer: Molina Healthcare Passport |
$404.91
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.65
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.42
|
|
|
REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
|
Facility
|
OP
|
$3,017.85
|
|
|
Service Code
|
CPT 67900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,155.61 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
|
|
REPAIR OF CHEST WALL HERNIA
|
Facility
|
OP
|
$7,091.00
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$6,807.36 |
| Rate for Payer: Aetna Commercial |
$5,460.07
|
| Rate for Payer: Anthem Medicaid |
$2,438.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cigna Commercial |
$5,885.53
|
| Rate for Payer: First Health Commercial |
$6,736.45
|
| Rate for Payer: Humana Commercial |
$6,027.35
|
| Rate for Payer: Humana KY Medicaid |
$2,438.59
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,892.79
|
| Rate for Payer: PHCS Commercial |
$6,807.36
|
| Rate for Payer: United Healthcare All Payer |
$6,240.08
|
|
|
REPAIR OF CHEST WALL HERNIA
|
Facility
|
IP
|
$7,091.00
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,127.30 |
| Max. Negotiated Rate |
$6,807.36 |
| Rate for Payer: Aetna Commercial |
$5,460.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.98
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cigna Commercial |
$5,885.53
|
| Rate for Payer: First Health Commercial |
$6,736.45
|
| Rate for Payer: Humana Commercial |
$6,027.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,892.79
|
| Rate for Payer: PHCS Commercial |
$6,807.36
|
| Rate for Payer: United Healthcare All Payer |
$6,240.08
|
|
|
REPAIR OF CHEST WALL HERNIA
|
Professional
|
Both
|
$7,091.00
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,963.70 |
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$4,254.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,963.70
|
| Rate for Payer: UHCCP Medicaid |
$2,481.85
|
|
|
REPAIR OF CHEST WALL HERNIA(T
|
Facility
|
IP
|
$7,091.00
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
761T0409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,127.30 |
| Max. Negotiated Rate |
$6,807.36 |
| Rate for Payer: Aetna Commercial |
$5,460.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.98
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cigna Commercial |
$5,885.53
|
| Rate for Payer: First Health Commercial |
$6,736.45
|
| Rate for Payer: Humana Commercial |
$6,027.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,892.79
|
| Rate for Payer: PHCS Commercial |
$6,807.36
|
| Rate for Payer: United Healthcare All Payer |
$6,240.08
|
|
|
REPAIR OF CHEST WALL HERNIA(T
|
Facility
|
OP
|
$7,091.00
|
|
|
Service Code
|
HCPCS 21899
|
| Hospital Charge Code |
761T0409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$6,807.36 |
| Rate for Payer: Aetna Commercial |
$5,460.07
|
| Rate for Payer: Anthem Medicaid |
$2,438.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cash Price |
$3,545.50
|
| Rate for Payer: Cigna Commercial |
$5,885.53
|
| Rate for Payer: First Health Commercial |
$6,736.45
|
| Rate for Payer: Humana Commercial |
$6,027.35
|
| Rate for Payer: Humana KY Medicaid |
$2,438.59
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,892.79
|
| Rate for Payer: PHCS Commercial |
$6,807.36
|
| Rate for Payer: United Healthcare All Payer |
$6,240.08
|
|
|
REPAIR OF CIRCUMCISION
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
76103031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$349.31 |
| Rate for Payer: Aetna Commercial |
$349.31
|
| Rate for Payer: Ambetter Exchange |
$207.39
|
| Rate for Payer: Anthem Medicaid |
$156.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$207.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$207.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.87
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$308.44
|
| Rate for Payer: Healthspan PPO |
$338.23
|
| Rate for Payer: Humana Medicaid |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$207.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.53
|
| Rate for Payer: Molina Healthcare Passport |
$156.40
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$269.61
|
| Rate for Payer: UHCCP Medicaid |
$180.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$207.39
|
|
|
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26540
|
|
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 OF DIGIT NERVE
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
76102372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.70
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
