|
REPAIR ROTATOR CUFF ACUTE(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 23410
|
| Hospital Charge Code |
761P0456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,459.47 |
| Rate for Payer: Aetna Commercial |
$1,239.99
|
| Rate for Payer: Ambetter Exchange |
$780.42
|
| Rate for Payer: Anthem Medicaid |
$685.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$780.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$936.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,459.47
|
| Rate for Payer: Healthspan PPO |
$1,123.17
|
| Rate for Payer: Humana Medicaid |
$685.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,023.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$780.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$698.84
|
| Rate for Payer: Molina Healthcare Passport |
$685.14
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,014.55
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$691.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$780.42
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,553.76 |
| Rate for Payer: Aetna Commercial |
$1,297.90
|
| Rate for Payer: Ambetter Exchange |
$811.37
|
| Rate for Payer: Anthem Medicaid |
$783.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$811.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$811.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$973.64
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: Healthspan PPO |
$1,175.62
|
| Rate for Payer: Humana Medicaid |
$783.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$811.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$799.13
|
| Rate for Payer: Molina Healthcare Passport |
$783.46
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,054.78
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$811.37
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR ROTATOR CUFF CHRONIC
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REPAIR ROTATOR CUFF CHRONIC(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 23412
|
| Hospital Charge Code |
761P0457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,553.76 |
| Rate for Payer: Aetna Commercial |
$1,297.90
|
| Rate for Payer: Ambetter Exchange |
$811.37
|
| Rate for Payer: Anthem Medicaid |
$783.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$811.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$811.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$973.64
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: Healthspan PPO |
$1,175.62
|
| Rate for Payer: Humana Medicaid |
$783.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$811.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$799.13
|
| Rate for Payer: Molina Healthcare Passport |
$783.46
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,054.78
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$811.37
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$569.15 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem Medicaid |
$569.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Humana KY Medicaid |
$569.15
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$574.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$580.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.95
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
REPAIR SALIVARY DUCT
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.93 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$493.29
|
| Rate for Payer: Ambetter Exchange |
$324.84
|
| Rate for Payer: Anthem Medicaid |
$254.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$389.81
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Healthspan PPO |
$508.07
|
| Rate for Payer: Humana Medicaid |
$254.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$324.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.03
|
| Rate for Payer: Molina Healthcare Passport |
$254.93
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.29
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.84
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
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 SALIVARY DUCT
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.48 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Aetna Commercial |
$661.60
|
| Rate for Payer: Ambetter Exchange |
$431.27
|
| Rate for Payer: Anthem Medicaid |
$391.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.52
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$660.93
|
| Rate for Payer: Healthspan PPO |
$661.76
|
| Rate for Payer: Humana Medicaid |
$391.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.31
|
| Rate for Payer: Molina Healthcare Passport |
$391.48
|
| Rate for Payer: Multiplan PHCS |
$993.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.65
|
| Rate for Payer: UHCCP Medicaid |
$579.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.27
|
|
|
REPAIR SALIVARY DUCT
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
76101692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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 SALIVARY DUCT
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
76101693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.50 |
| Max. Negotiated Rate |
$1,588.80 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.95
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
REPAIR SALIVARY DUCT(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 42500
|
| Hospital Charge Code |
761P1692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.93 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$493.29
|
| Rate for Payer: Ambetter Exchange |
$324.84
|
| Rate for Payer: Anthem Medicaid |
$254.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$389.81
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Healthspan PPO |
$508.07
|
| Rate for Payer: Humana Medicaid |
$254.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$324.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.03
|
| Rate for Payer: Molina Healthcare Passport |
$254.93
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.29
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.84
|
|
|
REPAIR SALIVARY DUCT(P
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 42505
|
| Hospital Charge Code |
761P1693
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.48 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Aetna Commercial |
$661.60
|
| Rate for Payer: Ambetter Exchange |
$431.27
|
| Rate for Payer: Anthem Medicaid |
$391.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.52
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$660.93
|
| Rate for Payer: Healthspan PPO |
$661.76
|
| Rate for Payer: Humana Medicaid |
$391.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.31
|
| Rate for Payer: Molina Healthcare Passport |
$391.48
|
| Rate for Payer: Multiplan PHCS |
$993.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.65
|
| Rate for Payer: UHCCP Medicaid |
$579.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.27
|
|
|
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27654
|
|
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, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27698
|
|
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 SHOULDER CAPSULE
|
Professional
|
Both
|
$2,715.00
|
|
|
Service Code
|
HCPCS 23465
|
| Hospital Charge Code |
76102729
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$878.95 |
| Max. Negotiated Rate |
$1,820.43 |
| Rate for Payer: Aetna Commercial |
$1,678.63
|
| Rate for Payer: Ambetter Exchange |
$1,062.81
|
| Rate for Payer: Anthem Medicaid |
$878.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,062.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,062.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,275.37
|
| Rate for Payer: Cash Price |
$1,357.50
|
| Rate for Payer: Cash Price |
$1,357.50
|
| Rate for Payer: Cigna Commercial |
$1,820.43
|
| Rate for Payer: Healthspan PPO |
$1,520.48
|
| Rate for Payer: Humana Medicaid |
$878.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,062.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$896.53
|
| Rate for Payer: Molina Healthcare Passport |
$878.95
|
| Rate for Payer: Multiplan PHCS |
$1,629.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,381.65
|
| Rate for Payer: UHCCP Medicaid |
$950.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$887.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,062.81
|
|
|
REPAIR SHOULDER CAPSULE
|
Professional
|
Both
|
$1,095.00
|
|
|
Service Code
|
HCPCS 23462
|
| Hospital Charge Code |
76102760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$1,748.14 |
| Rate for Payer: Aetna Commercial |
$1,607.46
|
| Rate for Payer: Ambetter Exchange |
$1,014.99
|
| Rate for Payer: Anthem Medicaid |
$895.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,014.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,014.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,217.99
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cigna Commercial |
$1,748.14
|
| Rate for Payer: Healthspan PPO |
$1,456.02
|
| Rate for Payer: Humana Medicaid |
$895.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,343.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,014.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$912.98
|
| Rate for Payer: Molina Healthcare Passport |
$895.08
|
| Rate for Payer: Multiplan PHCS |
$657.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,319.49
|
| Rate for Payer: UHCCP Medicaid |
$383.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$904.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,014.99
|
|
|
REPAIR SPICA BODY CAST/JACKE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761P1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Aetna Commercial |
$67.60
|
| Rate for Payer: Ambetter Exchange |
$41.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.80
|
| Rate for Payer: Anthem Medicaid |
$27.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$27.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.63
|
| Rate for Payer: Molina Healthcare Passport |
$27.09
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.26
|
| Rate for Payer: UHCCP Medicaid |
$22.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.74
|
|
|
REPAIR SPICA BODY CAST/JACKE(T
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761T1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPAIR SPICA BODY CAST/JACKE(T
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
761T1072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REPAIR SPICA BODY CAST/JACKET
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
76101072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$67.60
|
| Rate for Payer: Ambetter Exchange |
$41.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.80
|
| Rate for Payer: Anthem Medicaid |
$27.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.09
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$27.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.63
|
| Rate for Payer: Molina Healthcare Passport |
$27.09
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.26
|
| Rate for Payer: UHCCP Medicaid |
$22.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.74
|
|
|
REPAIR SUPERFICI 2.5CM OR LESS
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
761T0120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
REPAIR SUPERFICI 2.5CM OR LESS
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
761T0120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
