|
REPAIR OF MESENTERY
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
REPAIR OF MESENTERY(P
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44850
|
| Hospital Charge Code |
761P1867
|
|
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 METATARSALS
|
Professional
|
Both
|
$1,980.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
76101009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.85 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Aetna Commercial |
$875.62
|
| Rate for Payer: Ambetter Exchange |
$548.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$294.85
|
| Rate for Payer: Anthem Medicaid |
$373.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$968.06
|
| Rate for Payer: Healthspan PPO |
$982.68
|
| Rate for Payer: Humana Medicaid |
$373.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$720.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$380.99
|
| Rate for Payer: Molina Healthcare Passport |
$373.52
|
| Rate for Payer: Multiplan PHCS |
$1,188.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$713.48
|
| Rate for Payer: UHCCP Medicaid |
$309.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.83
|
|
|
REPAIR OF METATARSALS
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
76101009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.92 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| 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 |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.20
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
REPAIR OF METATARSALS
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
76101009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.20
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
REPAIR OF METATARSALS(P
|
Professional
|
Both
|
$1,980.00
|
|
|
Service Code
|
HCPCS 28322
|
| Hospital Charge Code |
761P1009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.85 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Aetna Commercial |
$875.62
|
| Rate for Payer: Ambetter Exchange |
$548.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$294.85
|
| Rate for Payer: Anthem Medicaid |
$373.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$968.06
|
| Rate for Payer: Healthspan PPO |
$982.68
|
| Rate for Payer: Humana Medicaid |
$373.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$720.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$380.99
|
| Rate for Payer: Molina Healthcare Passport |
$373.52
|
| Rate for Payer: Multiplan PHCS |
$1,188.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$713.48
|
| Rate for Payer: UHCCP Medicaid |
$309.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.83
|
|
|
REPAIR OF MITRAL VALVE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33425
|
| Hospital Charge Code |
76101289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REPAIR OF MITRAL VALVE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33425
|
| Hospital Charge Code |
76101289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REPAIR OF MITRAL VALVE
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33425
|
| Hospital Charge Code |
76101289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,720.74 |
| Max. Negotiated Rate |
$4,427.18 |
| Rate for Payer: Aetna Commercial |
$4,427.18
|
| Rate for Payer: Ambetter Exchange |
$2,558.83
|
| Rate for Payer: Anthem Medicaid |
$1,720.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,558.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,558.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,070.60
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$3,981.69
|
| Rate for Payer: Healthspan PPO |
$4,352.78
|
| Rate for Payer: Humana Medicaid |
$1,720.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,830.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,558.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,558.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,755.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,720.74
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,326.48
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,737.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,558.83
|
|
|
REPAIR OF MITRAL VALVE(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33425
|
| Hospital Charge Code |
761P1289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,720.74 |
| Max. Negotiated Rate |
$4,427.18 |
| Rate for Payer: Aetna Commercial |
$4,427.18
|
| Rate for Payer: Ambetter Exchange |
$2,558.83
|
| Rate for Payer: Anthem Medicaid |
$1,720.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,558.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,558.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,070.60
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$3,981.69
|
| Rate for Payer: Healthspan PPO |
$4,352.78
|
| Rate for Payer: Humana Medicaid |
$1,720.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,830.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,558.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,558.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,755.15
|
| Rate for Payer: Molina Healthcare Passport |
$1,720.74
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,326.48
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,737.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,558.83
|
|
|
REPAIR OF NAIL BED
|
Facility
|
OP
|
$791.84
|
|
|
Service Code
|
CPT 11760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
|
|
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 24430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,888.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
|
|
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 25400
|
|
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 OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27720
|
|
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 OF RECTOCELE
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 45560
|
| Hospital Charge Code |
76103034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.78 |
| Max. Negotiated Rate |
$1,035.17 |
| Rate for Payer: Aetna Commercial |
$1,035.17
|
| Rate for Payer: Ambetter Exchange |
$654.77
|
| Rate for Payer: Anthem Medicaid |
$371.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$654.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$654.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$785.72
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$956.01
|
| Rate for Payer: Healthspan PPO |
$872.98
|
| Rate for Payer: Humana Medicaid |
$371.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$654.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.22
|
| Rate for Payer: Molina Healthcare Passport |
$371.78
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$851.20
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$654.77
|
|
|
REPAIR OF RECTUM
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 45505
|
| Hospital Charge Code |
76101905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR OF RECTUM
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 45505
|
| Hospital Charge Code |
76101905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$793.65 |
| Rate for Payer: Aetna Commercial |
$793.65
|
| Rate for Payer: Ambetter Exchange |
$568.04
|
| Rate for Payer: Anthem Medicaid |
$361.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.65
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Healthspan PPO |
$669.30
|
| Rate for Payer: Humana Medicaid |
$361.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$725.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.38
|
| Rate for Payer: Molina Healthcare Passport |
$361.16
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.45
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.04
|
|
|
REPAIR OF RECTUM
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 45505
|
| Hospital Charge Code |
76101905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR OF RECTUM(P
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 45505
|
| Hospital Charge Code |
761P1905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$793.65 |
| Rate for Payer: Aetna Commercial |
$793.65
|
| Rate for Payer: Ambetter Exchange |
$568.04
|
| Rate for Payer: Anthem Medicaid |
$361.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.65
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Healthspan PPO |
$669.30
|
| Rate for Payer: Humana Medicaid |
$361.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$725.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.38
|
| Rate for Payer: Molina Healthcare Passport |
$361.16
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.45
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.04
|
|
|
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 23410
|
|
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 OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 23412
|
|
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 OF RUPTURED SPLEEN (SPL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
761P1587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$1,813.54 |
| Rate for Payer: Aetna Commercial |
$1,813.54
|
| Rate for Payer: Ambetter Exchange |
$1,231.34
|
| Rate for Payer: Anthem Medicaid |
$610.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,231.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,231.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,477.61
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,655.03
|
| Rate for Payer: Healthspan PPO |
$1,450.09
|
| Rate for Payer: Humana Medicaid |
$610.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,617.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,231.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.77
|
| Rate for Payer: Molina Healthcare Passport |
$610.56
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,600.74
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,231.34
|
|
|
REPAIR OF RUPTURED SPLEEN (SPL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
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 OF RUPTURED SPLEEN (SPL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
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 Medicaid |
$687.80
|
| 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: Humana KY Medicaid |
$687.80
|
| 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 |
$600.00
|
| 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 OF RUPTURED SPLEEN (SPL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
76101587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$1,813.54 |
| Rate for Payer: Aetna Commercial |
$1,813.54
|
| Rate for Payer: Ambetter Exchange |
$1,231.34
|
| Rate for Payer: Anthem Medicaid |
$610.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,231.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,231.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,477.61
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,655.03
|
| Rate for Payer: Healthspan PPO |
$1,450.09
|
| Rate for Payer: Humana Medicaid |
$610.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,617.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,231.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.77
|
| Rate for Payer: Molina Healthcare Passport |
$610.56
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,600.74
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,231.34
|
|
