|
REVISE SPINE ELTRD PERQ ARAY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$786.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.44
|
| Rate for Payer: Anthem Medicaid |
$346.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$768.67
|
| Rate for Payer: Healthspan PPO |
$808.92
|
| Rate for Payer: Humana Medicaid |
$346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.59
|
| Rate for Payer: Molina Healthcare Passport |
$346.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$240.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.13
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$8,279.85 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,914.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,279.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,984.14
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$5,914.18
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,097.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem Medicaid |
$522.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Humana KY Medicaid |
$522.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$527.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$1,518.00 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Anthem Medicaid |
$368.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,518.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$801.99
|
| Rate for Payer: Healthspan PPO |
$687.93
|
| Rate for Payer: Humana Medicaid |
$368.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$737.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.87
|
| Rate for Payer: Molina Healthcare Passport |
$368.50
|
| Rate for Payer: Multiplan PHCS |
$910.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,062.60
|
| Rate for Payer: UHCCP Medicaid |
$531.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.18
|
|
|
REVISE ULNAR NERVE AT ELBOW(P
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
761P2362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$1,518.00 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Anthem Medicaid |
$368.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,518.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$801.99
|
| Rate for Payer: Healthspan PPO |
$687.93
|
| Rate for Payer: Humana Medicaid |
$368.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$737.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.87
|
| Rate for Payer: Molina Healthcare Passport |
$368.50
|
| Rate for Payer: Multiplan PHCS |
$910.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,062.60
|
| Rate for Payer: UHCCP Medicaid |
$531.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.18
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
IP
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.98 |
| Max. Negotiated Rate |
$1,100.16 |
| Rate for Payer: Aetna Commercial |
$882.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$893.88
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$951.18
|
| Rate for Payer: First Health Commercial |
$1,088.70
|
| Rate for Payer: Humana Commercial |
$974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$939.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$845.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,008.48
|
| Rate for Payer: Ohio Health Group HMO |
$859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.26
|
| Rate for Payer: PHCS Commercial |
$1,100.16
|
| Rate for Payer: United Healthcare All Payer |
$1,008.48
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.92 |
| Max. Negotiated Rate |
$1,146.00 |
| Rate for Payer: Aetna Commercial |
$612.69
|
| Rate for Payer: Anthem Medicaid |
$291.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,146.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$572.09
|
| Rate for Payer: Healthspan PPO |
$478.36
|
| Rate for Payer: Humana Medicaid |
$291.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.76
|
| Rate for Payer: Molina Healthcare Passport |
$291.92
|
| Rate for Payer: Multiplan PHCS |
$687.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$802.20
|
| Rate for Payer: UHCCP Medicaid |
$401.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.84
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.98 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$882.42
|
| Rate for Payer: Anthem Medicaid |
$394.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$893.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$951.18
|
| Rate for Payer: First Health Commercial |
$1,088.70
|
| Rate for Payer: Humana Commercial |
$974.10
|
| Rate for Payer: Humana KY Medicaid |
$394.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$398.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$939.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$845.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,008.48
|
| Rate for Payer: Ohio Health Group HMO |
$859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.26
|
| Rate for Payer: PHCS Commercial |
$1,100.16
|
| Rate for Payer: United Healthcare All Payer |
$1,008.48
|
|
|
REVISE ULNAR NERVE AT WRIST(P
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
761P2363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.92 |
| Max. Negotiated Rate |
$1,146.00 |
| Rate for Payer: Aetna Commercial |
$612.69
|
| Rate for Payer: Anthem Medicaid |
$291.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,146.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$572.09
|
| Rate for Payer: Healthspan PPO |
$478.36
|
| Rate for Payer: Humana Medicaid |
$291.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.76
|
| Rate for Payer: Molina Healthcare Passport |
$291.92
|
| Rate for Payer: Multiplan PHCS |
$687.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$802.20
|
| Rate for Payer: UHCCP Medicaid |
$401.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.84
|
|
|
REVISE URETHRA STAGE 1
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$1,302.35 |
| Rate for Payer: Aetna Commercial |
$1,302.35
|
| Rate for Payer: Anthem Medicaid |
$564.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$820.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$1,161.05
|
| Rate for Payer: Healthspan PPO |
$1,041.34
|
| Rate for Payer: Humana Medicaid |
$564.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.09
|
| Rate for Payer: Molina Healthcare Passport |
$564.79
|
| Rate for Payer: Multiplan PHCS |
$492.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$574.00
|
| Rate for Payer: UHCCP Medicaid |
$287.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.44
|
|
|
REVISE URETHRA STAGE 1
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.20
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
REVISE URETHRA STAGE 1
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem Medicaid |
$282.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Humana KY Medicaid |
$282.00
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$284.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.20
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.90 |
| Max. Negotiated Rate |
$1,238.00 |
| Rate for Payer: Aetna Commercial |
$746.03
|
| Rate for Payer: Anthem Medicaid |
$357.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,238.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$719.55
|
| Rate for Payer: Healthspan PPO |
$722.35
|
| Rate for Payer: Humana Medicaid |
$357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$625.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.06
|
| Rate for Payer: Molina Healthcare Passport |
$357.90
|
| Rate for Payer: Multiplan PHCS |
$742.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$866.60
|
| Rate for Payer: UHCCP Medicaid |
$433.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.48
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.94 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Humana KY Medicaid |
$425.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$430.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.78
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.94 |
| Max. Negotiated Rate |
$1,188.48 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.78
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
|
REVISE WRIST/FOREARM TENDON
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$895.34
|
| Rate for Payer: Anthem Medicaid |
$330.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,229.42
|
| Rate for Payer: Healthspan PPO |
$810.98
|
| Rate for Payer: Humana Medicaid |
$330.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$729.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$336.68
|
| Rate for Payer: Molina Healthcare Passport |
$330.08
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.38
|
|
|
REVISE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REVISE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REVISE WRIST/FOREARM TENDON(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
761P0602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$895.34
|
| Rate for Payer: Anthem Medicaid |
$330.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,229.42
|
| Rate for Payer: Healthspan PPO |
$810.98
|
| Rate for Payer: Humana Medicaid |
$330.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$729.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$336.68
|
| Rate for Payer: Molina Healthcare Passport |
$330.08
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.38
|
|
|
REVISE WRIST JOINT
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$2,105.00 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Anthem Medicaid |
$624.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,105.00
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,364.41
|
| Rate for Payer: Healthspan PPO |
$1,124.17
|
| Rate for Payer: Humana Medicaid |
$624.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,047.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.08
|
| Rate for Payer: Molina Healthcare Passport |
$624.59
|
| Rate for Payer: Multiplan PHCS |
$1,263.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,473.50
|
| Rate for Payer: UHCCP Medicaid |
$736.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.84
|
|
|
REVISE WRIST JOINT
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem Medicaid |
$723.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Humana KY Medicaid |
$723.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$731.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.55
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
REVISE WRIST JOINT
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$2,020.80 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.55
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
REVISE WRIST JOINT(P
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
761P0607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$2,105.00 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Anthem Medicaid |
$624.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,105.00
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,364.41
|
| Rate for Payer: Healthspan PPO |
$1,124.17
|
| Rate for Payer: Humana Medicaid |
$624.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,047.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.08
|
| Rate for Payer: Molina Healthcare Passport |
$624.59
|
| Rate for Payer: Multiplan PHCS |
$1,263.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,473.50
|
| Rate for Payer: UHCCP Medicaid |
$736.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.84
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
761P1842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,688.29 |
| Rate for Payer: Aetna Commercial |
$1,688.29
|
| Rate for Payer: Anthem Medicaid |
$538.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,582.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,564.20
|
| Rate for Payer: Healthspan PPO |
$1,423.76
|
| Rate for Payer: Humana Medicaid |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,502.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.26
|
| Rate for Payer: Molina Healthcare Passport |
$538.49
|
| Rate for Payer: Multiplan PHCS |
$949.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,107.40
|
| Rate for Payer: UHCCP Medicaid |
$553.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$543.87
|
|
