|
REPAIR OF HYDROCELE(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 55060
|
| Hospital Charge Code |
761P2144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna Commercial |
$608.95
|
| Rate for Payer: Ambetter Exchange |
$360.17
|
| Rate for Payer: Anthem Medicaid |
$275.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$360.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$432.20
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$536.40
|
| Rate for Payer: Healthspan PPO |
$589.62
|
| Rate for Payer: Humana Medicaid |
$275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$360.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$281.32
|
| Rate for Payer: Molina Healthcare Passport |
$275.80
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$468.22
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$360.17
|
|
|
REPAIR OF KNEECAP TENDON
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
76100829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.86 |
| Max. Negotiated Rate |
$955.03 |
| Rate for Payer: Aetna Commercial |
$857.73
|
| Rate for Payer: Ambetter Exchange |
$588.61
|
| Rate for Payer: Anthem Medicaid |
$438.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$588.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$588.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$706.33
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$955.03
|
| Rate for Payer: Healthspan PPO |
$776.92
|
| Rate for Payer: Humana Medicaid |
$438.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$728.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$588.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$447.64
|
| Rate for Payer: Molina Healthcare Passport |
$438.86
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$765.19
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$443.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$588.61
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
76100829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
76100829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REPAIR OF KNEECAP TENDON(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
761P0829
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.86 |
| Max. Negotiated Rate |
$955.03 |
| Rate for Payer: Aetna Commercial |
$857.73
|
| Rate for Payer: Ambetter Exchange |
$588.61
|
| Rate for Payer: Anthem Medicaid |
$438.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$588.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$588.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$706.33
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$955.03
|
| Rate for Payer: Healthspan PPO |
$776.92
|
| Rate for Payer: Humana Medicaid |
$438.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$728.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$588.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$447.64
|
| Rate for Payer: Molina Healthcare Passport |
$438.86
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$765.19
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$443.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$588.61
|
|
|
REPAIR OF KNEE CARTILAGE
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 27403
|
| Hospital Charge Code |
76100834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.88 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| 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 |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REPAIR OF KNEE CARTILAGE
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 27403
|
| Hospital Charge Code |
76100834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$940.58
|
| Rate for Payer: Ambetter Exchange |
$616.95
|
| Rate for Payer: Anthem Medicaid |
$499.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$740.34
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,033.56
|
| Rate for Payer: Healthspan PPO |
$851.96
|
| Rate for Payer: Humana Medicaid |
$499.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$791.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.62
|
| Rate for Payer: Molina Healthcare Passport |
$499.63
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$802.03
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.95
|
|
|
REPAIR OF KNEE CARTILAGE
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 27403
|
| Hospital Charge Code |
76100834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REPAIR OF KNEE CARTILAGE(P
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 27403
|
| Hospital Charge Code |
761P0834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$940.58
|
| Rate for Payer: Ambetter Exchange |
$616.95
|
| Rate for Payer: Anthem Medicaid |
$499.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$740.34
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,033.56
|
| Rate for Payer: Healthspan PPO |
$851.96
|
| Rate for Payer: Humana Medicaid |
$499.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$791.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.62
|
| Rate for Payer: Molina Healthcare Passport |
$499.63
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$802.03
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.95
|
|
|
REPAIR OF KNEE LIGAMENTS
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 27409
|
| Hospital Charge Code |
76102649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,555.57 |
| Rate for Payer: Aetna Commercial |
$1,430.03
|
| Rate for Payer: Ambetter Exchange |
$920.36
|
| Rate for Payer: Anthem Medicaid |
$811.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$920.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,104.43
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$1,555.57
|
| Rate for Payer: Healthspan PPO |
$1,295.30
|
| Rate for Payer: Humana Medicaid |
$811.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,202.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$827.76
|
| Rate for Payer: Molina Healthcare Passport |
$811.53
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,196.47
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$819.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$920.36
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 27664
|
| Hospital Charge Code |
76100909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$601.26 |
| Rate for Payer: Aetna Commercial |
$537.11
|
| Rate for Payer: Ambetter Exchange |
$339.38
|
| Rate for Payer: Anthem Medicaid |
$231.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.26
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$601.26
|
| Rate for Payer: Healthspan PPO |
$486.50
|
| Rate for Payer: Humana Medicaid |
$231.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.78
|
| Rate for Payer: Molina Healthcare Passport |
$231.16
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.19
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.38
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27665
|
| Hospital Charge Code |
76100910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
76102621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$829.97 |
| Rate for Payer: Aetna Commercial |
$744.43
|
| Rate for Payer: Ambetter Exchange |
$449.66
|
| Rate for Payer: Anthem Medicaid |
$362.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$449.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$449.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$539.59
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$829.97
|
| Rate for Payer: Healthspan PPO |
$674.29
|
| Rate for Payer: Humana Medicaid |
$362.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$449.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.87
|
| Rate for Payer: Molina Healthcare Passport |
$362.62
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$584.56
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$449.66
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 27664
|
| Hospital Charge Code |
76100909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27665
|
| Hospital Charge Code |
76100910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.18 |
| Max. Negotiated Rate |
$687.06 |
| Rate for Payer: Aetna Commercial |
$616.72
|
| Rate for Payer: Ambetter Exchange |
$395.99
|
| Rate for Payer: Anthem Medicaid |
$301.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$475.19
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$687.06
|
| Rate for Payer: Healthspan PPO |
$558.61
|
| Rate for Payer: Humana Medicaid |
$301.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$395.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.20
|
| Rate for Payer: Molina Healthcare Passport |
$301.18
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.79
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.99
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
76102621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
761P2621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$829.97 |
| Rate for Payer: Aetna Commercial |
$744.43
|
| Rate for Payer: Ambetter Exchange |
$449.66
|
| Rate for Payer: Anthem Medicaid |
$362.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$449.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$449.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$539.59
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$829.97
|
| Rate for Payer: Healthspan PPO |
$674.29
|
| Rate for Payer: Humana Medicaid |
$362.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$606.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$449.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.87
|
| Rate for Payer: Molina Healthcare Passport |
$362.62
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$584.56
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$449.66
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27659
|
| Hospital Charge Code |
76102621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REPAIR OF LEG TENDON EACH
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 27658
|
| Hospital Charge Code |
76102759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$626.55 |
| Rate for Payer: Aetna Commercial |
$563.90
|
| Rate for Payer: Ambetter Exchange |
$352.96
|
| Rate for Payer: Anthem Medicaid |
$257.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$352.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$352.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$423.55
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$626.55
|
| Rate for Payer: Healthspan PPO |
$510.78
|
| Rate for Payer: Humana Medicaid |
$257.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$352.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.83
|
| Rate for Payer: Molina Healthcare Passport |
$257.68
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.85
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$260.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$352.96
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27665
|
| Hospital Charge Code |
76100910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 27664
|
| Hospital Charge Code |
76100909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| 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 |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
REPAIR OF LEG TENDON EACH(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27665
|
| Hospital Charge Code |
761P0910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.18 |
| Max. Negotiated Rate |
$687.06 |
| Rate for Payer: Aetna Commercial |
$616.72
|
| Rate for Payer: Ambetter Exchange |
$395.99
|
| Rate for Payer: Anthem Medicaid |
$301.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$475.19
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$687.06
|
| Rate for Payer: Healthspan PPO |
$558.61
|
| Rate for Payer: Humana Medicaid |
$301.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$395.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.20
|
| Rate for Payer: Molina Healthcare Passport |
$301.18
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.79
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.99
|
|
|
REPAIR OF LEG TENDON EACH(P
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 27664
|
| Hospital Charge Code |
761P0909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$601.26 |
| Rate for Payer: Aetna Commercial |
$537.11
|
| Rate for Payer: Ambetter Exchange |
$339.38
|
| Rate for Payer: Anthem Medicaid |
$231.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.26
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$601.26
|
| Rate for Payer: Healthspan PPO |
$486.50
|
| Rate for Payer: Humana Medicaid |
$231.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.78
|
| Rate for Payer: Molina Healthcare Passport |
$231.16
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.19
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.38
|
|
|
REPAIR OF MESENTERY
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44850
|
| Hospital Charge Code |
76101867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna Commercial |
$1,064.26
|
| Rate for Payer: Ambetter Exchange |
$713.28
|
| Rate for Payer: Anthem Medicaid |
$432.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$713.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$713.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$855.94
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$993.85
|
| Rate for Payer: Healthspan PPO |
$897.51
|
| Rate for Payer: Humana Medicaid |
$432.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$713.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$713.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.05
|
| Rate for Payer: Molina Healthcare Passport |
$432.40
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.26
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$436.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$713.28
|
|
|
REPAIR OF MESENTERY
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44850
|
| Hospital Charge Code |
76101867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
